Accident and Emergency Units (Ayr and Monklands Hospitals)
The next item of business this afternoon is a 15-minute statement by Nicola Sturgeon, on accident and emergency reviews. The cabinet secretary will take questions at the end of her statement, so, as always, there should be no interventions.
In June last year, I reversed the previous Administration's decision to close the accident and emergency departments at Ayr and Monklands hospitals and charged NHS Lanarkshire and NHS Ayrshire and Arran with bringing forward new proposals to maintain high-quality, safe and sustainable A and E services at those hospitals. I also announced that their proposals would, for the first time in the National Health Service in Scotland, be subject to formal independent scrutiny. Immediately following my statement, the boards started work on their revised proposals.
The independent scrutiny panel chaired by Dr Andrew Walker was up and running by the beginning of September and, after a demanding and intensive period of work that included formal submissions, rigorous scrutiny, interim reports, option appraisal exercises and public engagement, it published its final reports in early January. The boards then agreed their preferred service proposals and submitted them for my consideration at the end of last month.
Later in my statement, I will reflect further on the detail of what the ISP and the boards had to say. However, at this point, I put on record my thanks to the ISP and the staff at NHS Lanarkshire and NHS Ayrshire and Arran for the considerable amount of work undertaken to deliver expert, informed commentary and comprehensive revised proposals within the very tight deadlines that were necessary to minimise delay and uncertainty while allowing rigorous scrutiny and public engagement.
With that said, after carefully considering both boards' revised proposals, the ISP reports and all other available evidence and representations, I have great pleasure in announcing that I am approving the proposals submitted by NHS Lanarkshire and NHS Ayrshire and Arran, which will ensure that the valued A and E services at Ayr and Monklands hospitals are not only maintained but enhanced. In my view, the proposals take full account of the ISP's reports.
Securing the future of A and E at Ayr and Monklands hospitals was a promise made by the Scottish National Party—and I am pleased to confirm that this SNP Government has kept it. In this statement, I will outline the context and background to this announcement, summarise how the ISP was set up, reflect on its findings and the boards' subsequent proposals, and confirm what will happen next.
First, I want to remind the chamber how we came to be in this position. This Government has been consistent in its belief that our predecessors' decisions to close these A and E departments were wrong. Indeed, the experts on the ISP subsequently and emphatically confirmed that view to be correct. The original service reviews failed to address the very real concern of a significant proportion of the local populations that the centralisation of A and E services would not deliver clear benefits for patients.
There is little doubt that the original consultations in Ayrshire and Lanarkshire and the boards' subsequent decisions compromised local people's trust, faith and confidence in their national health service. Moreover, it quite simply beggars belief that the previous Administration was prepared to sanction the closure of these A and E units, notwithstanding the lack of any clear and robust evidence base.
Those concerns, coupled with this Government's policy presumption against the centralisation of key health services, led to last June's decision to reverse the closures. In instructing the two health boards to come forward with revised proposals for maintaining these services, I felt that it was clear that local people and clinicians would expect the new plans to be robust, evidence-based, patient-centred and consistent with clinical best practice and national policy, that the plans would need to be critically assessed and that, in order to build confidence in the process, the work should be carried out by a panel of independent experts.
In setting up the independent scrutiny panel, I was clear that the post of chair should be filled by a respected and capable individual with extensive experience of health service planning and redesign work in Scotland. As a respected health economist, as a previous adviser to the Parliament's Health Committee and as a contributor to the Kerr report, Dr Andrew Walker was, in my view, an excellent choice. The other members of the panel were an A and E clinical expert, a financial expert, and an individual with expertise in the field of public engagement and consumer interests. None of the panel members was selected by me; they were all nominated by independent bodies.
All parties agreed formally the process of scrutiny at an early stage, to ensure clarity around remit, terms of reference and engagement. The boards received advice and assurance from external auditors on the compliance of their option appraisal work with national guidance. The ISP consulted the Scottish health council on appropriate methods of engaging with local people.
Time does not allow me to go through the ISP reports in detail, but members should be aware that they are published in full on the ISP's website, as are the interim reports and all notes of the public meetings. However, the fundamental finding of the ISP was clear. It found that neither board had
"made a convincing case for significant changes to emergency services."
In other words, the reports confirmed that the Government's decision to reverse the closures of both A and E departments was absolutely right. The ISP recognised the high quality of A and E provision at Monklands and Ayr and said that there was scope to develop those services in the best interests of local people.
It is to the credit of both NHS boards that they took time to consider fully the ISP reports. Let me outline what the boards' proposals mean for local services. The proposals of both boards recognise the potential to build on the strengths of the current services. That means that there will be no cutbacks in either A and E unit or in their support services. The units will retain all the back-up services that they have at present and, in both cases, service enhancements are planned. For example, on-site consultant cover at Ayr's accident and emergency unit will be extended from eight hours a day to 12 hours a day, seven days a week. Ayrshire and Arran NHS Board also plans to build a combined medical and surgical assessment unit on site to enhance the service further. NHS Lanarkshire is also planning service enhancements such as the establishment of an emergency response centre.
NHS Ayrshire and Arran estimates that the additional recurring cost of developing the A and E services at Ayr will be £5.7 million. That accounts for revenue costs such as the cost of employing additional clinical and nursing staff. The board estimates that the additional capital cost of developing and extending the A and E facilities at Ayr will be £18.6 million. NHS Lanarkshire estimates that its additional recurring cost will be £5.3 million. The board is now moving forward with plans to develop appropriate business cases to maintain and improve the Monklands site. The emergency service will be a key part of those plans. Both boards have agreed that the additional costs that will be incurred in maintaining and developing A and E services will be accommodated over a number of years within their overall budgets, which are, of course, rising. Next year alone, the budget of NHS Ayrshire and Arran will increase by £17 million to £547 million. NHS Lanarkshire's budget will increase by an above-average £26 million to £760 million.
Members will recall that when I made my statement last June I was keen to emphasise that there was much to be commended in the original service plans; I refer to the proposals for community-based health services. I was also clear that I wanted the boards, in bringing forward revised proposals to maintain A and E services in their areas, to deliver as many of the planned community services as possible. The boards of both NHS Ayrshire and Arran and NHS Lanarkshire will meet soon to review their planning priorities in light of their funding allocations.
As always, I expect the boards to take account of national priorities and guidelines—and, of course, the needs of their local communities—when coming to decisions. However, I have consistently made it clear that I expect both boards to deliver as many of their planned service developments as possible. I am pleased to confirm that both boards have confirmed to me their intention to do so. Indeed, NHS Ayrshire and Arran has already confirmed that its plans for mental health services, which are additional to its original proposals, will proceed in full, as will the plans for a cancer centre at Ayr hospital and the plans for new community hospitals in Irvine and on Arran. NHS Lanarkshire has likewise confirmed that its plan for the new cancer centre at Monklands will go ahead, with haematology inpatient services for the area provided on site. The resource centre in Bellshill is under construction and plans for other resource centres in Airdrie, Carluke and Coatbridge are key candidates for prioritisation.
As part of its service proposals submitted for my consideration, NHS Lanarkshire indicated that it intends to develop a specialist unit at Hairmyres hospital for those heart attack patients who will benefit from primary angioplasty. I am happy for that work to proceed. Although the Government operates a policy of presumption against the centralisation of core health services, we have always been clear that there are a small number of services where a concentration of skills on a specialist site really benefits patients. Indeed, the particular service we are referring to—angioplasty—was singled out by the ISP as being a service for which the case for concentration had been made.
I turn to what happens next. I confirm that I have written to both boards today to approve their service proposals. I will now look to the boards to implement effectively those proposals and to sustain and develop the services at Ayr and Monklands hospitals.
In a dynamic planning environment such as the NHS, it is inevitable that health boards will plan and review, prioritise and reprioritise, to meet the needs of local people within the resources available. However, I make one thing clear: local people can be assured that any further proposals to change significantly local services in Lanarkshire, Ayrshire and Arran, or any other part of Scotland, will be subject to full public consultation, independent scrutiny where appropriate and, ultimately, ministerial approval.
Members will be aware that the Government recently concluded its consultation on proposals to embed independent scrutiny in the major service change process in the NHS. I confirm my intention to seek a debate in Parliament on the issue in the next few weeks. I intend to use that opportunity to cover our plans for independent scrutiny and to outline more fully our view of the national policy implications of some of the decisions that we have already taken in the interests of patients and in the spirit of a mutual NHS.
The decision taken today to save the accident and emergency departments from the closure sanctioned by the previous Labour-Liberal Administration—and not only to maintain but to develop those valued local services—is evidence that this Government is committed to high-quality local services. We are committed to working with everyone in this chamber, with all in the NHS and with communities throughout Scotland to deliver a mutual health service that is efficient and effective, that delivers a consistent, high-quality service to the Scottish people and that is committed to stronger public involvement, better patient experience and enhanced local decision making.
I firmly believe that if we can continue to build on the successes of the past 10 months of effective Government, and continue to work in partnership with all stakeholders, we have the rare opportunity to secure for another 60 years and beyond a truly mutual Scottish health service of which the Scottish people can be truly proud. I commend my statement to Parliament.
The cabinet secretary will now take questions on the issues raised in her statement. We have a tight 30 minutes for questions, after which we will move on to the next item of business. It would be extremely helpful if members who wish to ask questions would press their request-to-speak buttons now. I assure the chamber that it will probably prove impossible to fit everybody in, therefore brevity in both questions and answers would be greatly appreciated.
I will try to be as co-operative as possible, Presiding Officer. I thank the cabinet secretary for advance notice of her statement. Inevitably, there is much to pursue in the range of issues that has been raised this afternoon. I have no doubt that the issues will continue to be pursued in the forthcoming parliamentary debate.
I want to press the cabinet secretary on primary health care investment and particularly on whether she can guarantee delivery in relation to Kilsyth health centre, Cumbernauld minor injuries unit and Lanark minor injuries unit. Those are important primary health care investments, which we must insist are maintained.
Given the shortage of time and the Presiding Officer's pleadings, I ask a specific question. I understand that the Government's approach is based on the full retention of Monklands hospital's accident and emergency service. Is that exactly what will be delivered? Following this afternoon's statement, can the cabinet secretary tell the Parliament whether full cardiology services will be maintained in Monklands A and E? Let me put that another way: under the cabinet secretary's plans, if the chief reporter from the Airdrie & Coatbridge Advertiser has a heart attack while working in their office, will they be taken to Monklands A and E?
I will answer all Margaret Curran's questions in full, but what was missing from her questions were the words, "Labour got it wrong in trying to close the accident and emergency units and we apologise for getting it so wrong." I am sure that Margaret Curran forgot to make her apology to the people of Ayrshire and Lanarkshire.
First, on primary care investment, I have made it clear all along that I expect both boards to deliver as many as possible of the primary and community care investments that they planned. For example, NHS Ayrshire and Arran plans more than it originally planned, in relation to its development of mental health services. I gave examples of projects that will definitely go ahead. Both boards will meet shortly to discuss the prioritisation of their future plans, but they will do so in a situation that is different in one regard from the situation when the Labour Government was in office. Primary and community care developments will proceed hand in hand with a functioning A and E service, whereas under the Labour Government they would have been without such a service.
Secondly, on heart attacks, I will be upfront and straight. The majority of people who suffer a heart attack in Lanarkshire will go to Monklands hospital. All the evidence—this Government will always follow the expert evidence—suggests that patients who require primary angioplasty need to be seen as quickly as possible in a specialist centre. In the context of regional planning, it is envisaged that Hairmyres hospital will provide that service for patients from Lanarkshire and Ayrshire, and that for all other west of Scotland health boards the service will be provided by the Golden Jubilee national hospital. Heart attack patients in Glasgow who need primary angioplasty will not go to the Southern general hospital or to Glasgow royal infirmary; they will go to the Golden Jubilee, but nobody is seriously suggesting that the GRI or the Southern general will not continue to have full A and E departments.
The reality is that the A and E departments in Ayr and Monklands hospitals are not only being saved and maintained but have been enhanced by this Government. The people of Scotland will draw their own conclusions from that.
We welcome the announcement that the planned closure of A and E departments at Ayr and Monklands hospitals has been reversed. Given that you said that decisions about the services were based on consultations that
"compromised local people's trust, faith and confidence in their national health service",
and given that you said that neither board made a convincing case for significant changes, can I ask whether you will now reconsider—
No, you cannot, I am afraid. It is the cabinet secretary who is dealing with the matter, not me.
I apologise.
Will the cabinet secretary reconsider the downgrading and loss of services at the Vale of Leven hospital, or is she convinced that a significant case has been made for the reduction in services?
The Walker report questioned or contradicted recommendations that were made in the Kerr report. Will the cabinet secretary consider commissioning another independent review?
In my statement to the Parliament on 6 June I made it clear that it would not be possible to unpick all the decisions that the previous Administration had made, some of which had been taken several years previously. I stand by that view. Unpicking such decisions would be wrong for patients, wrong for the NHS and wrong for Scotland as a whole.
Mary Scanlon mentioned the Vale of Leven hospital. She will know that no decisions have been taken on it. The independent scrutiny panel that was set up to consider the proposals of Greater Glasgow and Clyde NHS Board published its report at the end of last year. After the board's decision not to go to consultation, I asked the independent scrutiny panel to reconsider the decision, to see whether the board had produced any new or compelling evidence for its actions. I expect that supplementary report of the independent scrutiny panel within the next few days. When it comes out, I expect Greater Glasgow and Clyde NHS Board to take full account of it and to act accordingly.
Mary Scanlon's question about the Kerr report is pertinent. All members were very involved in the debate on the report, and all members welcomed it. The Kerr report was a framework report—it did not look in detail at accident and emergency services at Ayr or Monklands or, indeed, at any particular service in detail. The Kerr report said clearly that any specific service changes would have to be underpinned by robust evidence. The independent scrutiny panel clearly found that the proposed service changes at Ayr and Monklands were not underpinned by robust evidence. I therefore contend that this Government was absolutely right to reverse the closures.
We operate on a presumption against centralisation of services. I have said it before and I will say it again: that does not mean that there are no cases in which specialisation or a concentration of services will not be in the interests of patients. However, it does mean that there will have to be evidence before I, as Cabinet Secretary for Health and Wellbeing, will approve any such changes.
I, too, thank the cabinet secretary for the advance copy of her statement.
I do not disagree that the Kerr report was a general framework report. However, much of the thinking of health boards and of the previous Government was predicated on some of the general views in the Kerr report. Kerr concluded that eight to 10 high-intensity specialists might be required to provide a 24/7 service, that junior doctors would work 40 per cent less time as a consequence of European directives, and that there would be pressure on consultants. Those pressures were wholly refuted by Walker. Kerr highlighted the benefits of centralising a large number of services, but Walker questioned that and gave a much more restricted list of services, as the cabinet secretary pointed out. Kerr said that 70 per cent of patients who presented at accident and emergency units did not require to see consultants, and Walker made the case for not reducing any service.
What about a question?
I am coming to the question. It is important to give the background.
Walker criticised the peer-group reviews that had been cited, and he criticised Kerr's conclusion on unscheduled care.
Notwithstanding what the cabinet secretary has just said, if she is in effect endorsing Walker, and if Kerr was so spectacularly wrong about the accident and emergency units, can we continue to use the Kerr report as a template for the NHS?
Walker also questions the credibility of the evidence supporting the ability of paramedics to stabilise conditions. He also questions the credibility of longer ambulance journeys. Does the cabinet secretary not therefore have to review not the decisions that were previously made, but some of the ambulance journeys that do not meet the criteria that Walker has set out in two reports?
I have made my views clear about going back and unpicking decisions that were made several years ago. Whatever arguments Ross Finnie might make, my doing so would not be in the interests of the NHS.
People have to remember that, as well as being a framework, the Kerr report was a general and wide-ranging report. It had much to say about the shift in the balance of care—a shift away from acute services units and into the community. I think that everybody in the chamber agrees with that shift.
However, notwithstanding Ross Finnie's citations, it was at the heart of the Kerr report that any proposals for specific changes to services had to be based on evidence. Where I agree with Ross Finnie is that, when we put some of the proposed changes under the microscope, we found that the evidence for change was not as strong as had previously been contended: for example, some of the evidence around volumes and outcomes turned out to be not as strong and clear cut as some people had thought.
We are debating A and E services today, but only this week the Government made an announcement of a similar nature. Following the Kerr report, the previous Minister for Health and Community Care asked a group of experts to consider neurosurgery with the clear intention to centralise provision on a single site. The experts who looked into the matter reported to me a couple of weeks ago that there was no evidence to support the change.
The general thrust of the Kerr report is valid and relevant, but we must subject to rigorous scrutiny any change that is proposed in the name of Kerr. Where the proposed change withstands such scrutiny—for example, in the case of primary angioplasty, about which I have spoken today—the change is fine and well. Where a proposal does not withstand rigorous scrutiny, I say categorically to Parliament that I will not, as Cabinet Secretary for Health and Wellbeing—unlike my predecessor—sanction any unnecessary centralisation of hospital services that has no foundation in evidence.
We come to questions from back benchers. I have 18 members with a question to put and 17 minutes in which to do that. It is pretty obvious that I do not want a lot of preamble; I want brief questions and—preferably—brief answers. We will get the doctors up front. I call Dr Ian McKee who will be followed by Dr Richard Simpson.
The announcement is very welcome. Clearly, the Scottish National Party Government is delivering on our party's manifesto commitments. Following today's announcement and Monday's announcement that neurosurgery will continue to be provided at four centres around the country—contrary to the plans of the previous Executive—will the cabinet secretary confirm that our party's view that health services should be provided locally has been completely vindicated?
In answering the question, I can comply with the Presiding Officer's request for brevity. The answer is yes. The experience at the two hospitals in terms of accident and emergency provision shows that this party and this Government's commitment to providing health care services as locally as possible are thoroughly vindicated.
Different groups of experts will provide different results—that statement is important in going forward. I have a couple of questions. First, will the cabinet secretary publish the Scottish health council's reports on the original Lanarkshire NHS Board and Ayrshire and Arran NHS Board consultations, and its views on the independent scrutiny panel's recent consultation? Secondly, will she invite the independent scrutiny panel to publish any evidence that it researched in coming to the view that it reached? In the statement in which it criticised the previous evidence, the panel made not a single reference. My third—
And final question, please.
Given the 43 consultant vacancies in the NHS Lanarkshire area and the serious pressures on the NHS in Ayrshire and Arran, does the cabinet secretary feel that the latter board in particular can sustain spending £5.7 million of its £17 million increase on one service alone, given the many pressures that a health board faces, particularly at present as a result of this year's fairly low settlement?
From the questions, it is clear that the Labour Opposition is still in denial on accident and emergency provision. It would benefit the Labour Opposition, and all of Scotland, if its members were to have the good grace to say that the previous Executive got it badly wrong on closure of the A and E units, and to admit that we are right to overturn the closures.
I will answer all the questions. First, all Scottish health council reports are published. If Richard Simpson wants to check, I am sure that he will find any SHC report that he wants to look at. Secondly, as I said in my statement, the ISP report, notes of its public meetings, and other evidence that it used are available on the panel's website. I am sure that Richard Simpson can manage to source anything that he wants to look at. If there is a particular document that he wants to access, and if he asks me for it specifically, I will ensure that he gets it.
I turn to the pressures on NHS boards. All boards face such pressures. I was in the NHS Lanarkshire area this morning, visiting the accident and emergency department at Monklands hospital. Consultants at the hospital told me that, although the recruitment and retention pressures that the board faces have not gone completely—as they have not for any board—they have eased significantly from the position of a few years ago.
To respond to Richard Simpson's question about funding, it is not only me who thinks that the NHS boards have what it takes financially to maintain the accident and emergency departments—the boards think that they can sustain the costs and have accident and emergency departments that are not just as good as, but better than the ones that have been there to date.
Will the health secretary confirm that her decision is based on recent research, unlike that of her predecessor, which was based on 20-year-old United States research that was totally out of date and irrelevant to the needs of Lanarkshire? Does the health secretary agree that the difference between the decision that she has confirmed today and the decision of her predecessor is that somebody who has a heart attack in Monklands will be able to go to Monklands accident and emergency unit, unless there is a specialist requirement—[Interruption.]
Order.
That is unlike the decision of the cabinet secretary's predecessor, under which people may have had to go to Glasgow or, in some cases, Dundee for treatment.
It is clear to me from the heckling and catcalls from Labour members that, if they had their way, the accident and emergency units at Ayr and Monklands would still be closing. The people of Scotland will draw strong conclusions from that.
Alex Neil asked me about evidence. As I said in my statement, the report of the independent scrutiny panel said that, based on the rigorous assessment of evidence that the panel undertook, neither board had
"made a convincing case for … changes to emergency services."
Given Labour's obsession with centralisation of hospital services, a Labour health minister may have opted to ignore that advice and press ahead with the closure of valued accident and emergency departments anyway. The SNP Government will not.
Alex Neil is absolutely right. Let us for a minute put to one side the inaccuracy of Margaret Curran's earlier questions about the situation surrounding heart attack patients, and focus on their sheer and utter hypocrisy. If Margaret Curran and her colleagues had had their way, nobody would go to Monklands accident and emergency unit, because it would not exist—it would be closed.
As the minister knows, I campaigned with my constituents for the retention of all accident and emergency services at Monklands hospital. Can the minister explain to my constituents why she is accepting NHS Lanarkshire's recommendation that cardiac services be centralised in East Kilbride? Is the cabinet secretary content to ignore the people of Monklands and her colleague Alex Neil—I would listen to this, Mr Neil—who said in Parliament:
"if someone in Airdrie had a heart attack … by the time that they got to Hairmyres … at best, their position would be severely worse and, at worst, their life could be in danger"?—[Official Report, 14 September 2006; c 27502.]
He did not at that time talk about a specialist heart attack. Is not the failure to retain full emergency cardiac services at Monklands hospital a promise broken rather than a promise kept?
For the benefit of Karen Whitefield—who I know has for many reasons struggled with the issue all along—I confirm that the vast majority of people who have heart attacks in Airdrie will go to Monklands accident and emergency unit. They would not have been able to do that if Karen Whitefield's party had been elected to Government in the recent election.
To answer Karen Whitefield's specific question, I have given the go-ahead for NHS Lanarkshire's further work on specialising primary angioplasty at Hairmyres for the same reason that patients who require such treatment in Glasgow will go not to the A and E units at the Southern general hospital or the GRI, but to the Golden Jubilee hospital. All the evidence shows that, for a small number of heart attack patients, that is the best result for them and will deliver the best outcome. I will always do what is in the interests of patients. We have done what is in the interests of patients and the public by saving A and E services at Monklands and Ayr. We will continue to act in patients' interests.
Nicola Sturgeon's statement will be warmly welcomed among my constituents in Ayrshire. As the cabinet secretary will know, staff at Ayr hospital are concerned that, notwithstanding the agreement to keep A and E services located at the hospital, those services could be jeopardised in the longer term by an inadequate level of consultant-led staffing. What discussions has the cabinet secretary had with NHS Ayrshire and Arran concerning staff numbers at Ayr hospital A and E department? Will she assure me that she is satisfied that the health board is committed to providing a long-term staffing level that will safeguard the service?
I pay tribute to John Scott, who—like Alex Neil in Lanarkshire—campaigned for retention of Ayr accident and emergency unit. I give him an absolute assurance that I have made it clear to Ayrshire and Arran NHS Board that it is now expected to sustain accident and emergency services at Ayr hospital. Indeed, I hope that he is reassured that I said today that I am approving proposals that will enhance A and E services at Ayr. For example, on-site consultant cover at Ayr's A and E unit will be extended from the current eight hours a day to 12 hours a day, seven days a week. It is incumbent on the board to ensure that it has the consultant staff to deliver that commitment and that Ayrshire has the accident and emergency unit at Ayr hospital that it wants and deserves.
The cabinet secretary mentioned a rise of £17 million for NHS Ayrshire and Arran and £26 million next year for NHS Lanarkshire. Those increases are welcome but are a little more than 3 per cent and, therefore, really just above inflation.
She also mentioned embedding scrutiny in the change process in the national health service. Surely more open consultation would be more appropriate than embedding scrutiny in another layer, with decisions having to be ratified by the cabinet secretary, further bureaucracy, slowing up of processes and a temptation for centralised decision making by Government, thereby compromising local decision making by health boards.
I will be gentle, because I appreciate that Jim Hume was not in the Parliament in the previous session. If only his party had done some of what he has just asked me to do, Ayr and Monklands might never have been under threat in the first place. That aside, I agree with him. There should be more open consultation, and I have made it clear to boards that I expect full consultation to take place whenever they make proposals for significant service change.
We had a debate last week in Parliament about the principle of elected health boards, and I can think of no better way of bringing real accountability and transparency to health boards than by their having elected members. I do not think that Jim Hume's party supports that proposal, although I am hopeful of persuading it during the course of our deliberations.
Independent scrutiny has already shown its worth in the cases of Ayr and Monklands, and in Greater Glasgow and Clyde NHS Board's proposals for services in the Clyde area. It gives the public the confidence that the evidence and reasons for change that boards advance are factually based, accurate and robust. The public have not always had that assurance in the past, so I look forward to ensuring that that part of the process is embedded for the future in the NHS because it will help to restore public confidence in how our NHS is run.
I ask that there be no more multiple questions. One question per member, please.
Will the cabinet secretary inform members how health board consultations on proposed changes to A and E and other services that boards provide will be improved in the future, and how the improvements will avoid any sham consultations, such as the one in Lanarkshire that led to the initial proposal to close Monklands A and E?
My answer will be simlar to the one that I have just given to Jim Hume. I cannot overstate the point that the independent scrutiny process greatly enhances decision making. I repeat my thanks to Andrew Walker and his team, who have done an absolutely outstanding job in the cases of Ayr and Monklands.
Independent scrutiny builds confidence in the decision-making process. It is not for an independent scrutiny panel to take the decisions; rather, its job is to help to build confidence in the evidence base that underpins them. That, coupled with the other reforms that we detail in "Better Health, Better Care: Action Plan" to strengthen existing public consultation mechanisms, plus the possibility of elected health board members, will radically reform and improve the process of consultation and public engagement. The NHS will be stronger and better for it.
The cabinet secretary has set much store by the independent scrutiny panel's report. As far as Ayr is concerned, she will know that the report supports the extension of minor injury provision into communities, notably communities in outlying areas. Is she therefore concerned that Ayrshire and Arran NHS Board's proposals have effectively scrapped the work that was under way to extend community casualty unit provision at East Ayrshire community hospital in Cumnock, and at the planned community casualty unit, which would have gone ahead at the new Girvan community hospital? That work is no longer in the pipeline. Does it give the cabinet secretary cause for concern that people in those outlying areas will now have to travel a considerable distance for the treatment of minor injuries?
Those plans have not been scrapped. It is sad that Labour, having had its plans to centralise hospitals completely stymied, is now reduced to scaremongering among the populations of Ayrshire and Lanarkshire. I have made it clear—I will do so again for the benefit of Cathy Jamieson, who was a minister in the Government that wanted to close the Ayr accident and emergency unit—that I expect the boards in Ayrshire and Lanarkshire to proceed with as many of their community developments as possible. I have every confidence that the boards will do so, because both of them are committed to the development of primary and community services, as is the Government. Getting the balance right between acute, primary and community care is one of our key objectives. The approach of the previous Government was to shut hospitals in order to do the other thing. We want to do it all, and we want to do it properly.
First, I extend my support and thanks to the firefighters who fought the recent fire in Whiteinch. I am sure that Parliament will join me in that. That resulted in some of the firefighters—
Could we just have a question, please?
Some of the firefighters were taken to the Western infirmary. Given the changes that are taking place with A and E services in Glasgow, will particular attention be paid to emergency services, such as I have just mentioned, and to restricted use of the Clyde tunnel, which is a main artery between the north and south of Glasgow?
I thank Sandra White for her questions and echo her comments about the work of the fire service. I assure her that the issues around the emergency services in Glasgow are very important, as they are in any other part of Scotland, and that the Government will always pay close attention to them.
Sandra White and other members know my views on not going back to unpick decisions that were taken many years ago. However, I am determined to ensure that we have the right and the best configuration of A and E services in Ayrshire, Lanarkshire, Glasgow and throughout Scotland. I am happy to give Sandra White that commitment on behalf of the Government.
Does the cabinet secretary agree that the Government's decision was based on a manifesto commitment, and not on any decision to save lives—that it was to gain votes? As she basks in the short-term glory of the decision, will she admit that it will leave the health service in Lanarkshire substantially weaker in the longer term? What faith can we have in the cabinet secretary's conclusion if she appoints the panel, restricts its remit, does not allow it to examine the board's original proposals and provides such a paltry, ill-thought-through report?
Much more important, does the cabinet secretary now trust the voice of her appointed academic over and above the views not just of communities in Lanarkshire that supported the proposal—including my own—but of the management of NHS Lanarkshire, its clinical and staff community, its independent, publicly appointed board, the Scottish Executive health department and its chief executive and staff—
I must ask you to be brief.
I also mention the Scottish health council and Professor David Kerr, who specifically condemns the minister for the decision. Is that now how Scottish health policy is made? Is it you we have to believe, cabinet secretary, while all those others are wrong?
I must ask you to be as brief as possible, minister.
If Andy Kerr cannot manage a period of silence following the decision, which most people in Scotland would think appropriate from the Minister for Health and Community Care who wanted to close the accident and emergency departments, I respectfully suggest that the only appropriate intervention from him today would have been to say, "I am sorry" to Ayrshire and Lanarkshire for trying to close their hospitals.
Saving accident and emergency at Ayr and Monklands was indeed a manifesto commitment of the SNP. It is a commitment that has been kept by this Government. That commitment was endorsed and vindicated by a panel of independent experts. Andy Kerr should reflect on that. It is interesting that Andy Kerr is unable to stand up here and admit that he was wrong. He has resorted, as usual, to attacking experts: a respected independent expert who chaired the panel; other members of the panel; a respected A and E consultant in Glasgow, who was appointed not by me but by his academic body; a member of the Scottish Consumer Council; and a financial expert. They all said that Andy Kerr was wrong. Lanarkshire said that Andy Kerr was wrong, Ayrshire said that Andy Kerr was wrong and Scotland said that Andy Kerr was wrong. Why? Because Andy Kerr was wrong.
That brings us to the end of the statement on accident and emergency reviews. We must move on swiftly. I apologise to the eight members whom I was unable to call.