Plenary, 28 Nov 2002

Meeting date: Thursday, November 28, 2002

Official Report 794KB pdf

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Acute Health Services Review (Glasgow)

The final item of business is a members' business debate on motion S1M-3580, in the name of Bill Aitken, on Glasgow's acute health services review. The debate will be concluded without any question being put. I invite those members who wish to speak in the debate to press their request-to-speak buttons now.

Motion debated,

That the Parliament notes the continued and growing concern of Glasgow residents regarding the Scottish Executive's proposals following the recent Acute Health Services Review in Glasgow.

Even at the end of a particularly busy and trying day, I make absolutely no apology for raising once again this highly charged and evocative issue. I do so because the problem will not go away. Even at this late stage I appeal to the Executive to recognise that what it is placing on the table and, indeed, now intends to implement will not work in Glasgow.

Since we previously debated the matter, further information has come to light. In particular, we now know that highly relevant in the decision-making considerations of the Greater Glasgow NHS Board was a report on travelling times that it received in January this year. The information in that report was released in a more general, condensed form towards the end of last month.

The report came up with the extraordinary finding that travelling times would be reduced for about 60 per cent of those using Glasgow's emergency hospitals. Bearing it in mind that in the south side of the city all patients requiring to use those services will have to go to the Southern general hospital as opposed to the Victoria infirmary and that the Southern general is on the periphery of the city, the report's findings seem to defy logic. If the report was material in the decision-making process, I find that little short of terrifying.

I turn to the question of the overall provision. It is nonsense to suggest that two units will provide an adequate service. That decision has impacted dramatically on morale within the health services. Nobody denies that additional money has come and, indeed, is coming, but the fact is that the Executive's priorities are completely concerned with waiting list initiatives. It is probably appropriate on this day of all days to point out that the amount of money that the Executive has undeniably put into the health service does not appear to be getting much of a result.

Will Mr Butler take an intervention?

No. Mr Butler is over on the Labour side of the chamber. Mr Fitzpatrick may have an opportunity with him later, but I will take an intervention from Mr Fitzpatrick now.

On the important issue of funding and going forward in relation to a long-term plan, does Mr Aitken propose assisting Greater Glasgow NHS Board and other parts of the country by matching our funding commitment and indicating that he will lend his support to increased funding for the national health service commensurate with our plans for the NHS?

Mr Fitzpatrick, of course, aspires to be a member of the Executive, which has figures that we do not have. However, as I have stated previously, it is clear that the existing provision for emergency provision in Glasgow is totally inadequate. We would provide a greater degree of service than the Executive is currently prepared to. We have costed that particular aspect and the issue is clear.

Will the member give way?

Let me go on a little bit, first.

It is clear that the Scottish Executive seeks to ensure a dramatic fall in waiting lists prior to next May's election and to put upon those figures the most beneficial spin. However, the Executive has failed dramatically to achieve that. Equally, I must honestly admit that there will be benefits in cutting waiting lists, but it is a question of priorities. Many people may wait in constant pain and distress for a hip replacement, for example, but if there is an insufficient accident and emergency service, deaths are inevitable.

Since our previous discussion of the matter, there has also been new evidence about the effectiveness of ambulatory care and diagnostic units—ACADs. As I have said previously, there is nothing wrong with the ACAD principle if an acute services provision is also on site. However, that will not be the case. The most recent soundings in that respect do not make happy reading. It is significant that the stand-alone ACAD concept is not being followed elsewhere.

The Executive's position contrasts sharply with what is happening down south. Sir George Alberti has been appointed as the tsar in charge of emergency services and will carry out a review of their operation. It seems that the health ministers south of the border place acute services much higher on the health agenda than is the case north of the border. There is considerable fear in Glasgow, which has not been allayed, that nothing has happened since the matter was last debated.

Does the member accept that the increasing fear is perhaps a result of irresponsible scaremongering, which is illustrated by the headline in the Evening Times, which quotes Mr Aitken as saying that the "review threatens lives"? Mr Aitken just said that deaths are inevitable. Given that that is not the way in which we should debate this serious issue, will he recant?

I was absolutely right in that article and I am absolutely right now. The fact is that ACADs will cost lives. What will happen if something goes wrong when someone is having exploratory surgery? The person might begin to haemorrhage dramatically, but the hospital will not be able to take the appropriate remedial action. The bottom line, which cannot be refuted, is that that person will die.

Does the member agree that the words "life" and "risk" came from the accident and emergency consultants who were asked about the plan to cut the accident and emergency facilities in Glasgow from five to two? In other words, the people who deal with the problems at the coalface have told us that life is at risk.

I agree absolutely with Mr Sheridan. The fact is that those who have said that lives will be at risk know better than Mr Sheridan or me and a lot better than Mr Butler. We must face the fact that lives will be put at risk. There is no question of scaremongering.

It is noticeable that the Labour members are more active tonight than they were in the run-up to the debate. For example, few of them were present at the demonstration at Queen's park recreation ground, shortly after the previous debate on the issue. The extent of public feeling was manifest then and, since that time, the unease has increased. Matters are made worse by rumours of impending transfers of services from Stobhill hospital and Victoria infirmary, which would be contrary to the undertakings that were given a few weeks ago. If those services are to be transferred, it is inevitable that public anxiety will increase. The minister should clarify the position on that matter.

Will the member give way on a point of information?

I will take one more intervention.

No Mr Aitken, you do not have time.

Sorry.

Even at this late stage, I ask the Executive to think again and to recognise the real problems that the move will cause and the dangers that are obvious to everyone apart from the Executive.

I am acutely aware that the issue was debated in September, when a number of members tried to speak in the debate but were not called. I intend to call those members and one or two others. Too many members wish to speak and it is not possible to extend the debate.

It is around 10 years since I became involved in the acute services review, although I hasten to add that I was on the other side of the table as a trade union officer. At that time, we realised that there would be a reorganisation of Glasgow's health services. I am pleased to say that, in anticipation of full-scale reorganisation, we reached an important agreement for unionised staff members that protected their salaries for life under the new section 47 rules, and that will ensure that staff feel that their jobs are safe during the reorganisation. I feel strongly about that issue.

I want to use the little time that I have to mention the submission that I made to Greater Glasgow NHS Board and the concerns that I expressed on behalf of my constituents in Glasgow Kelvin. I welcome the Executive's investment of £700 million. There will be five new ACADs by the end of the process, two of which will be bigger than Hairmyres hospital. That investment should be recognised. My submission to Greater Glasgow NHS Board opposes the reduction in accident and emergency services from five to two. I welcome the announcement of a review of the matter and I intend to use my time during that review to press my view on ministers.

Does Pauline McNeill agree that the conclusion of the transport study, which suggested that the reduction in the number of accident and emergency departments from five to two would reduce travel times for 60 per cent of patients, beggars belief?

I was going to go on to talk about my own reasons for opposing the reduction in the number of those departments from five to two.

I believe that Glasgow royal infirmary, which is also in my constituency, will be too large. I accept the clinical argument that bringing services together can produce a better quality of service; however, there is a point at which the service gets too large. My constituents in Partick will no longer have an accident and emergency department in the west, but will have to use the services in the Southern general hospital. Although I acknowledge that some of my constituents will have only a short distance to travel, no account has been taken of the fact that the Clyde tunnel is sometimes closed. Alastair Watson of Glasgow City Council also recently warned us that the Clyde tunnel has a short life.

During my visits to Gartnavel general hospital, which is in the constituency of my colleague, Bill Butler, he and I spent some time considering the Gartnavel plans. What is happening is impressive, but a proper accident and emergency department is missing from those plans.

One of the good things that will come out of the review is the streamlining of accidents and injuries in the system. At the moment, someone who is ill might lie on a trolley for hours on end because there is always a greater priority. The streamlining of cases into minor injuries units is extremely important, as that will mean that people will be attended to right away, and will leave the accident and emergency departments for those who need the most urgent help.

I believe strongly that the clinicians are right, although I recognise that there are differences of opinion among them about the reorganisation. The central point is that our health services in Glasgow need to improve, and clinical excellence is the way forward.

I hope that the minister is listening carefully to what members who represent greater Glasgow have to say about the reorganisation. It would be all too easy for members to speak only about their own constituents—although I am happy to do that—when we should recognise that there is a bigger picture of a greater Glasgow service that serves the wider community. The minister has debated with me on many occasions the need for a recognition of regional funding for the services that the health service in Glasgow delivers outside its boundaries.

I congratulate Bill Aitken on securing the debate. Sometimes it takes a really experienced politician to do so, and Bill is certainly that.

A Glasgow consultant to whom I spoke the other night suggested an interesting fact-finding trip that I am sure Mr McAveety would be pleased to undertake—someone has to do it, and Frank must go to Vienna. Vienna tried the same sort of plan as Glasgow is considering. In fact, at one stage, it reduced its service to only one major hospital—one of those new monster hospitals—with only one major accident and emergency department, but that did not work. I invite members to check the death rate from major incidents in Vienna.

Can Dorothy-Grace Elder tell us how the size of the population of Vienna compares with the size of the population of Glasgow?

Everything is relative. The traffic problem is the curse that every major city in Europe is faced with, as Robert Brown knows.

Around 43,000 people signed petitions against the plan for Glasgow, but they have been ignored. The situation goes beyond a local fight or a major fight for hospitals: it verges on the denial of democracy, and we know what happened when democracy was denied in England. We all remember Kidderminster hospital and the election of Dr Richard Taylor as an independent MP with a stunning majority. Dr Jean Turner is planning to stand in Strathkelvin and Bearsden. Good luck to her. Immense local campaigns are extremely important, and people are not prepared to be swept aside time and again. When 43,000 people sign a petition, warning bells should start to ring.

The health boards are uncontrolled and have become Pygmalions who are much mightier than their creator. They might have been created by the Executive, but they are running wild far beyond the Executive's control and have not been pulled into line to take account of the feelings of local people.

To reduce accident and emergency departments in a city such as Glasgow to only two endangers life. To put a huge hospital south of the river in Govan and to suck traffic into Govan through the tunnel is loopy. Nobody else would do it. Three years ago, those who did the planning admitted to us that they had not considered the traffic situation before they went into top gear on their plans, although that should have been the first of their considerations.

You have one minute left.

We hear of a £50,000 subsidy for public transport services that need to be upgraded, but that is absolute peanuts: the problem of ambulances having to go through the Clyde tunnel will still exist. The Minister for Health and Community Care promised to re-examine the issue of accident and emergency services in two years' time but I think that that was a mere sop to Cerberus during our debate in September. Why does the minister have to re-examine the issue in two years' time? Why can he not think again right now, as Bill Aitken sensibly suggested?

Perhaps members from other parts of the country need to be reminded on the record that there is a 10-year difference in life expectancy between Glaswegians at the well-paid end of the social spectrum and those who are at the bottom of the financial heap, of whom there are far too many. Glasgow is the sickest city in Britain and contains the six most deprived and sickest constituencies in Britain. That is not a proud record for our trophy room.

You are being unfair to other members. Please wind up now.

We have a chance to save and protect lives, but that chance is being blown.

I congratulate Bill Aitken on securing the debate but point out that, in his long and distinguished career, he must recall the years when Michael Forsyth, Ian Lang, Lord James Douglas-Hamilton and George Kynoch were in charge of the Scottish Office. I do not recall Ian Lang giving any consideration to local feelings when the maternity unit at Stobhill hospital was closed. The coming of the Scottish Parliament has ensured that the people who make such decisions are more accountable and we are now able to scrutinise those decisions. Bill Aitken should cast his mind back to his good old days and reflect on the situation that pertained back then. Although Lord James Douglas-Hamilton gave us a fair hearing, little could be said of his colleagues in that regard.

Does the minister agree that, according to the legislation that was passed in 1973, a transport study should be completed in full prior to any decision being taken on hospital closures and resiting? I would like confirmation that he received a full transport study during the relevant period and ask him to delve further into that issue to ensure that the process met with the requirements of legislation dealing with the reconfiguration of services and the consideration of business cases.

I would like to deal with the accountability of the boards. It appears that local people are good enough to serve on housing associations, tenants associations and community councils, but are not good enough to be part of the quango health boards. It is about time that we considered the democratisation of our health boards to ensure that those people reflect community views. If people can be involved in organisations such as the Glasgow Housing Association, which is dealing with a £1 billion investment, surely they can be involved in parochial decisions relating to the health boards. The challenge that faces this Parliament is to make the boards accountable and ensure that people on them have an electoral mandate instead of being made up of the so-called great and the good. I ask the minister to tell us what plans there are to modernise the health boards in that respect.

Secondly, I will deal with the process that the Parliament has set in place to ensure that it monitors the decision and I will deal with the Auditor General's involvement. Will the minister assure me that if, during the five-year period for which we have committed ourselves to preserving the services, the Auditor General or the monitoring boards discover that it will not be possible to remove and reconfigure services in other hospital facilities, the Executive of the day will reconsider the decision that the Parliament took on 12 September?

That is a very serious issue because in the past—let us face the facts—authorities have taken a number of decisions that have later been found to be flawed. The involvement of the Auditor General and the monitoring process that has been set in place will ensure that we have the opportunity to discover whether the decision is flawed.

I am proud of the fact that I am a local resident—I stay in my constituency—and of the fact that I was born in Stobhill hospital. Over the five-year period, it will be possible to interrogate the decision that was taken on 12 September and to reconsider a number of issues, perhaps at a later date.

Bill Aitken's motion mentions the continuing concerns over the decisions on the acute services review that Greater Glasgow NHS Board has taken. I point out that those concerns were demonstrated by many hundreds of members of the public who marched through the streets of Kirkintilloch only two weeks ago to express their continuing concern about Stobhill hospital's future under the acute services review.

As part of my continuing concern with the acute services review, on 5 November I attended the Greater Glasgow NHS Board annual general meeting. I appeared to be the only politician who attended that evening, but it was instructive to be there. Perhaps a few quotations—

Perhaps we could consider attendance at several other meetings since May 1999. Perhaps we could exchange information on what meetings Fiona McLeod has attended that I have not attended, and what meetings I have attended that she has not. It is not fair to refer to one particular meeting and not the other meetings that have taken place in that period.

I am sorry if Paul Martin is feeling sensitive. Perhaps, as part of that exchange of information, I can give some quotations from the AGM. Professor Dickson, the interim chair of Greater Glasgow NHS Board, lauded Professor Hamblen, who was chair at the time of the acute services review and who made the decisions, for his "courageous decisions" on the acute services review. When we look at the courageous decisions that led us to having only two accident and emergency departments for the whole of greater Glasgow, we must wonder whether they should have been termed foolhardy decisions.

As we have heard, those two accident and emergency departments have been criticised by the very consultants who will have to provide the services. Those two accident and emergency departments were decided upon on the basis of a flawed—I think that we all agree with that—transport study, which says that it is quicker for my constituents in Bearsden and Milngavie to travel through the Clyde tunnel than to go to the accident and emergency department at the Western infirmary. I remind members that the Clyde tunnel is shut to trucks because of the firefighters' strike, as it is such a hazardous route to travel. To ask accident and emergency patients to travel that route seems nonsensical.

To decide that two standalone ACAD units should take the place of two general hospitals in greater Glasgow also seems a foolhardy decision. Pauline McNeill mentioned that those ACAD units will be very big. They will be very big, but they are untried. Without the support of a general hospital, they will be, in the words of the consultant who runs the ACAD unit at Central Middlesex hospital, glorified outpatient departments, no matter how big they are.

It was also worrying to be at that AGM and hear the interim chair of Greater Glasgow NHS Board say that the acute services review decisions had been "vindicated" by a vote in the Parliament in September. The fact that the acute services review is a continuing concern that MSPs continually have to raise in the chamber to debate its shortcomings with the Executive tells us that the decision was not vindicated by the Parliament.

The vote that will vindicate the acute services review of Greater Glasgow NHS Board is the vote that will be held on 1 May next year, when I presume the people will return an SNP Government, which will be able to implement policies. Unlike the current one, which seems to do less for patients, we will actually provide services for patients.

I ask for speeches to be kept to three minutes from now on.

This debate provides an opportunity to discuss some of the concerns about the acute services review that have been expressed by constituents throughout Glasgow.

There are no members present who will not have been made aware of the genuine concern that constituents feel about the changes that are to happen in the provision of health care in their areas over the next few years. Change is never easy. Long-held customs, often spanning generations, are very dear to people's hearts, and if a local hospital is held in high esteem, the change can be very difficult to accept. I am sure that all of us have heard stories from constituents about individual hospitals. In my area, those are usually about the Victoria infirmary. Patients have had very good treatment there, and would like the hospital to continue to function.

Developments in medicine and in health care provision move at a very fast pace. Despite the fact that I trained and worked as a nurse for a number of years, that was some time ago now and I would not consider myself clinically fit to practise now, because great changes have taken place in how we provide health care.

The difficulty is that we can accept change only if we are provided with all the facts and if we are given the chance to have meaningful discussion and consultation. That is the crux of the matter. Looking back is not going to help, however. I do not think that anyone is in any doubt about the need to improve the provision of health care in our communities. In south Glasgow, our health needs are met by crumbling Victorian institutions, which were built more than 100 years ago and are most certainly not fit for medicine in the 21st century. Hospitals suffered 18 years of neglect when Mr Aitken's party was in power, and it is disingenuous of members of that party to criticise a modernisation programme when its health service reforms set the NHS back, rather than moving it forward.

We now need to move forward. The decision that was taken by Greater Glasgow NHS Board was not my preference, particularly in the context of south Glasgow. I would like to hear the minister say that mechanisms have been, and will be, put in place to alleviate the concerns that my constituents have put to me.

The first of those concerns is about transport links. How will people from Rutherglen and Cambuslang get to the Southern general hospital? It is not very easy even to reach the Victoria infirmary. If we accept that about 85 per cent of people will be treated at the ACAD unit, then I am concerned about visitors as well as patients. We all know that visitors play a vital part in the recovery process.

The second concern is about monitoring. Because my constituents have a complete lack of faith in Greater Glasgow NHS Board, it is vital that the proposed changes are closely and independently monitored. I would like to hear how the minister intends to provide for that.

The third concern relates to the Victoria infirmary. Those of us who use the Vicky as our local hospital are concerned about the lack of investment over the past few years. The movement of specialties also causes concern. I would like the minister to give an assurance of short-term investment in the Victoria and of the retention of its current services.

Accident and emergency provision is the most contentious issue of all. The decision to reduce the number of accident and emergency departments from five to two has led to concerns from various quarters, including the medical fraternity. There are calls to rethink the decision. I would like the minister to confirm more details about the Executive's commitment to reviewing the situation in two years' time—before accident and emergency departments in Glasgow close—and to involving local people in the process. We need to ensure that the views of constituents are taken into consideration in a meaningful way on any further moves in the context of the acute services review.

It is a bare few weeks since we last debated this issue, during a debate that was subject to a vote. Although this has been a useful debate, I confess to some uncertainty about the precise purpose of Bill Aitken's motion.

The £700 million of investment in the acute hospital estate throughout greater Glasgow has been the subject of considerable controversy throughout the parliamentary session. Unlike some members, I and other members of the all-party group that was set up to monitor and campaign on the issue have been involved in discussions from the beginning of the session.

Many of us disagreed with the process. We did not think that there had been genuine consultation, and we had doubts about the bona fides of it. As Janis Hughes has illuminated, many of us disagree with a number of aspects of the outcome. However, we are now moving into phase 2, which must be approached differently. Rightly or wrongly, the minister has decided to confirm the Greater Glasgow NHS Board proposals. We do not all like them, but we must build on that structure.

I make no apology for saying that there can be no more urgent need for modernisation than in Glasgow's hospitals, many of which date back to the century before last. In Glasgow of all areas, with its appalling health statistics, further delay is not acceptable.

Considerable expertise has been built up by health groups across the city—in particular, by the south-east health forum and the Friends of the Victoria Infirmary. Their efforts have been highly impressive. However, it is important that we do not lose the focus on what is happening as opposed to what we would like to happen in an ideal world. Neither I, nor other members, nor the campaign groups outside the Parliament are the Minister for Health and Community Care. A proposal is going ahead, which will lead in a reasonably short time to the development of ACAD units.

Unlike some members, I believe that ACAD units are largely a positive development that hold out the hope of providing good local services to people throughout the city. However, there are still serious issues relating to the implementation process. One such issue is bed numbers. In recent weeks, winter vomiting sickness has led to the closure of a number of wards at the Victoria and other hospitals. Flexibility must be built into the system to ensure that hospitals have the capacity to deal with such eventualities—or major catastrophes.

Another issue is funding. I make no apology for returning to that matter, about which I have had exchanges with the Minister for Health and Community Care and with Frank McAveety. There is considerable doubt about whether the £700 million funding plan for the current proposals adds up. More money will need to be invested in the Glasgow review. That is true for the current structure, never mind for the alternative, more ambitious project that some members support. The Executive will need to find additional funds to make the reorganisation proposals and the long-needed modernisation happen much sooner than is planned at the moment.

Finally, I want to return to the point that Janis Hughes rightly made. Before we reach a decision about the bricks and mortar of new hospital provision, emphasis must be placed on the quality of current provision at the Victoria infirmary.

I congratulate Bill Aitken on securing the debate and welcome the chance to speak on the subject. I was not granted such an opportunity when the matter was last debated.

The papers suggest that members of the Parliament are not always held in high regard, but I regard it as an honour and a privilege to represent my constituents and the people of Scotland in this chamber. I am proud of our achievements—new schools, record numbers of police, and investment in and expansion of further and higher education. I am particularly proud of our investment in the health service. For that reason, I was—and am—particularly disappointed with the decision about the location of Glasgow's hospitals.

I am especially proud of our investment in and commitment to the health service because there is no doubt that we are at a turning point. We can stand aside and pretend to support the NHS—as the Tories did during the 1980s and 1990s—while letting the service wither on the vine, as it fails to keep up with our demands and expectations. Alternatively, we can try to save the NHS. We can invest in staff, equipment and services so that all of us—rich or poor, healthy or infirm, young or old—feel that the NHS really belongs to us and will be there when we need it most.

The Government has taken and continues to take the second route. Billions of pounds are being invested in improving the service. There are still serious problems to overcome, but there have been success stories, too. In south Glasgow, the frightening delays and bottlenecks that patients with suspected colorectal cancer experienced have been tackled, thanks to improved endoscopy services and the recruitment of further specialist surgical teams. Such stories tend not to grab the headlines, but they are happening nonetheless.

The achievements that I have described make the decision on acute services stand out. It is doubly galling that, despite our combined efforts over the past three years, MSPs who represent the people of greater Glasgow have had little or no control over the decision-making process. Local health boards are supposed to have regard to the views of patients and local residents. Greater Glasgow NHS Board is supposed to have consulted the people of the south side and to have taken their opinions into account.

We were consulted, but most of us were left wishing that we had not been. I would have more respect for a decision based on the fact that the Southern general is the cheapest option. I would not have liked it, but I would not have wasted my time taking part in a process that has left most residents feeling ignored.

As the minister knows, I believe that the decision that has been taken is the wrong one, but I acknowledge and welcome the investment that is now on its way. I ask the minister what measures can be put in place to ensure that local people are involved in all decisions affecting that investment.

The minister will be aware of strong concerns over the safety of a so-called standalone ACAD unit. However, the Victoria hospital will continue to provide for the acute hospital needs of residents in the south side for at least the next five years. Will the minister confirm that services at the Victoria—accident and emergency services in particular—will be maintained at that site and that an assessment will be made of the relationship between the ACAD unit and the acute hospital with regard to patient safety?

Many issues are still to be addressed, including the need to guarantee a paramedic service in every ambulance. We should start by re-engaging with local people and establishing trust in the decision-making process. We could start with a further reform of the boards and the trusts.

I call Bill Butler and then I shall see where we can go from there.

I congratulate Bill Aitken on securing the debate, but I am genuinely a bit upset at the tone of some of the things that he said. I recognise and take seriously the concerns that Glaswegians express about the review process and I am sure that I am not alone in that. On that basis, I intend to introduce a member's bill to make it mandatory for at least 50 per cent of the membership of health boards to be directly elected. That is not a panacea, but it is a good idea to give citizens confidence in and direct ownership of the consultative process.

In the debate on 12 September, I took the opportunity to ask the minister about the reduction in accident and emergency services. I asked him to consider that reduction, because I was concerned and disagreed with it. Part of the minister's amendment to the SNP motion said that there would be a two-year review. I asked him whether, if the review said that there should be three accident and emergency departments, he would accept that. He said that he was open-minded about that and that he would listen carefully to what was said. On the basis of that serious point, I voted for the Executive's amendment.

In meetings with Pauline McNeill, my colleague from Glasgow Kelvin, I asked Mr Gemmell of the trust concerned whether, if the review said that there should be three departments rather than two, that would be possible, practically, after two years. He said that it would be possible. I hope that the review comes out with that decision.

Having said that, I believe that few, if any, truly believe that the status quo is an option. The huge pressures in Glasgow's hospitals, the outdated buildings, which are unfit for modern services, and the fragmented care system, which is dotted around different buildings, are totally unacceptable.

In my constituency of Glasgow Anniesland, the £700 million investment that is planned for the 10-year process will mean that Gartnavel general hospital will become the main in-patient hospital serving west Glasgow. It will be redeveloped to deliver a full range of specialty services, accompanied by a redesign of out-patient care, day-case care and day surgery on ambulatory care principles. In addition, there will be a minor injuries unit and an emergency receiving service. That will mean—and I emphasise this point—that serious emergency cases will be treated at Gartnavel. That includes people who are having a heart attack. All the talk of their being trapped in the tunnel is fallacious. There will be adequate resources to treat them at Gartnavel.

I welcome the planned developments and I hope that all members will support the need for modernised NHS facilities in Glasgow and will welcome the £700 million investment, which will bring desperately needed improvements—I have said it before and I shall keep on saying it. As serious politicians, we should all seek to allay the concerns of our constituents and avoid any hint of petty party-politicking or ill-informed scaremongering. I hope that the debate continues in that way, because the health of the people is too serious for party posturing.

We are right down to the wire. I propose to give John Young and Brian Fitzpatrick one minute each to make a basic point and that is it.

Paul Martin and Bill Butler talked about more public representation on health boards. In the debate a few weeks ago, I suggested that 51 per cent of the membership of health boards should be elected.

In the brief time that I have, I want to say that the one thing that puzzles me is how consensus was reached on the time limits for journeys, because they simply do not match any of the times for the journeys that I tried out as experiments.

As Tommy Sheridan said in his speech in the previous debate, a big match at Ibrox or Hampden could cause real problems. I notice that the minister has been passed so many notes that he has as many pages as are in "The Decline and Fall of the Roman Empire". His face has been getting gloomier and gloomier.

A degree of hypocrisy is coming from certain quarters of the Labour party. Why did those members not vote in accordance with how they seem to feel? It is no good coming along with whitewash now.

Will the member give way?

I am sorry—I have no time. Bill Butler will need to sit down. The constituents will not wear such hypocrisy. It is right that Labour members should pay for it at the polling booths.

Glasgow City Council has good population projections for the whole of the city. Considerable increases have been predicted in the south-east of Glasgow, particularly in the elderly population. Elderly people are the ones who will suffer. People will have heart attacks and will die as a result of the acute health services review in Glasgow. Ian Anderson, who is head of accident and emergency services at the Victoria infirmary, has said so and he is one of the best experts out.

No one can pretend that this issue will not be political. Some of tonight's speeches have not graced members. It was asked why Bill Aitken was anxious to have the debate. We all know that there will be an important debate on the acute services review during the coming weeks. Those of us who read this morning's edition of the Evening Times had the opportunity to read what Bill Aitken was going to say. It is unfortunate that other members will be curtailed in what they say, given what appeared in the morning edition of the Evening Times.

The issue goes wider than the boundaries of the city of Glasgow—East Dunbartonshire and other parts of the country will be affected. Labour members welcome substantial investment in the NHS and it is unfortunate that the Tories are unable to join us in that welcome. We know their views on the NHS. Their position is that it must be shown that the NHS cannot work and will not ever work.

We want a return on the investment. The best return on that investment will be for people across the city to be satisfied that they and their families will benefit from the acute provision proposals. The intervention of Audit Scotland, together with robust local monitoring, would be one of the best ways of achieving that.

There is a tremendous paucity of information for local communities about what the proposals mean for them. It is not right or responsible to suggest, for example, that the ACAD unit that will come to Stobhill hospital in Paul Martin's constituency is some sort of glorified out-patient clinic. Tell that to the people who will use the much-needed renal dialysis unit that is coming to Stobhill. We must not pretend that something is going on that is not going on, simply for party-political purposes. I want the minister to ensure that people have robust measures that allow them to assess, and to continue to assess, the recommendations and the underlying assumptions.

For the record, Sandra White and Nicola Sturgeon both pressed their request-to-speak buttons, but gave way to allow others to make use of the available time.

I thank Bill Aitken for providing the opportunity for the debate. That is perhaps the only thanks that he will receive over the next six or seven minutes. Mr Aitken's argument assumed that there has been a gathering storm of reduction in the quality of provision and commitment to the NHS in Glasgow, which stands in direct contrast to the situation during the alleged golden years of the Tory Government between 1979 and 1997.

I have lived in Glasgow all my life. I must have been going about the city with my eyes closed, as I seem to have missed the generous benefaction of Tory Governments. Those Governments were interested not in a national health service, but in a model of health provision that was much more attuned to private provision.

It has been claimed that the acute services review will produce a diminution in the quality of acute care in hospitals that serve the greater Glasgow conurbation. The Government has presided over a substantial increase in accident and emergency provision in south Glasgow. There has been an enormous improvement in south Glasgow in the past two years of the Administration. That has been largely because we have committed to putting in resources and have recognised the role of staff.

I refer Mr Aitken—and others who have made similar claims this evening and on a previous occasion—to the words of Diana Beard, director of the Scottish trauma audit group. She indicated that patients are not dying unnecessarily because of delays in pre-hospital care. The Scottish trauma audit group, which has more specialist knowledge than Mr Aitken or Mr Young, went on to add that pre-hospital care is the first link in the chain of survival after injury.

Most interestingly, the group says that under the current Administration, accident and emergency consultant presence for seriously injured patients increased from 29 per cent in 1992 to 47 per cent in 2001. Consultant surgeon presence increased from 19 per cent in 1992 to 55 per cent in 2001 and the number for consultant anaesthetists—despite the shortage of them—is twice as much as we inherited from the previous Administration.

Those issues are important. None of us who represent the citizens of greater Glasgow entered into the debate lightly, because the subject is important. Another important comment by the trauma audit group is that there is no difference in outcome between urban and rural trauma patients. The group has made a fairly interesting contribution.

Many claims were made about specialists. Tim Park, who is the clinical director of accident and emergency in south Glasgow, says that simply rushing the patient to hospital—some people argued for that—no longer guarantees the best outcome. The debate is at both ends. It concerns the role of paramedics and their intervention when they reach the patient, but more important, it concerns the quality and consistency of the accident and emergency trauma team. Those are the two critical elements. I understand people's concern, but we are talking about seven and 10-year programmes before we enter that most critical arena.

I will deal with the points that members made. In the previous, passionate debate on the subject, we said that we wanted to find ways to get the system right. I hear the voices across the Parliament. It is unfortunate that some who are fond of having their voices heard and their pictures in the paper have not stayed for today's debate. Their previous comments suggested that the debate was important to them, so I am disappointed that Mr Sheridan and Ms Sturgeon could not sustain themselves for at least 45 minutes.

The central issue is to acknowledge what we have done since September and to move on from that. We were asked to develop implementation arrangements for measures that we want to progress. Along with Audit Scotland, Greater Glasgow NHS Board has appointed PricewaterhouseCoopers to monitor the systems and processes that underpin the acute services strategy. The Auditor General for Scotland has said that he will take on board the contributions that that assessment makes and that he will authorise any viewpoints from it.

I am glad that the minister raised that subject. It became apparent during the debate in September that Audit Scotland, not PricewaterhouseCoopers, would undertake the greater Glasgow review, but the minister has confirmed that PricewaterhouseCoopers will undertake the review. Will the minister confirm that PricewaterhouseCoopers already audits greater Glasgow's NHS services, which means that it is not the most appropriate body to use?

I think the reverse of that. That fact means that the company is aware of some of the key issues in NHS greater Glasgow. The important element is the independence and autonomy of Audit Scotland's processes. The SNP's spokesperson was careless in the previous acute services review debate and in debates about waiting lists and other matters to suggest that Audit Scotland's role makes it an emissary of the Executive. Audit Scotland has an important independent role.

The monitoring group that people have asked about will consider a range of issues and will include elected representatives from throughout greater Glasgow—including local authority representatives and members of the Scottish Parliament—community representatives from throughout the area, clinicians, local health council nominees and nominees from each acute hospital-patient liaison group. We are keen to ensure that trade union and staff involvement is central, so staff partnership forums will contribute. That will address many concerns.

Contrary to the claims that some have made, the review is not about cuts, but about investment to deliver a step change in the quality of provision throughout Glasgow.

Will the minister assure us that the monitoring committee will operate independently of, and will not necessarily report to, the health board? Will he confirm my understanding that Audit Scotland will continue to perform the audit but will subcontract work to PricewaterhouseCoopers?

I confirm that. Audit Scotland will have autonomy and ensure the integrity of the process. It will assess the quality of PricewaterhouseCoopers's work.

I stress that the health board intends to advertise openly for an independent chairperson of the monitoring group. That is a strong issue that people raised. I give the chamber a categoric assurance that that is an important element in the process.

The health board project directors will progress a series of related issues to try to address many of the issues that members have raised.

A number of members raised the legitimate issue of the transport accessibility study. I recognise their concerns. A number of processes will be employed to interrogate the role of that study. If members are concerned about the accuracy of whether there would be a 60 per cent reduction in some travel times, that question is worthy of interrogation. I was interested to note that members did not give genuine evidence to the contrary about travel times—all that I heard was anecdotes. It is important to get substantive evidence from reputable studies on that subject.

What time of day or night were the surveys carried out? If someone is on a late night bus at 2 o'clock in the morning, they move through the city quite quickly, but that is not the case at other times.

John Young's intervention proves that what people are saying is anecdotal, rather than based on scientific analysis. Much of the other comment that was made about major football matches in Glasgow was exaggerated. I recognise the impact that major matches on the south side of the city can have on the Clyde tunnel in particular. However, many of the acute admissions that were made from the Gorbals in my constituency to the Victoria can now find their way to the Royal without any great difficulty. We need to take those factors into account.

Dorothy-Grace Elder kindly suggested that I take the opportunity to visit other parts of Europe. We cannot compare Vienna and Glasgow, not only not in social terms but because of the impact of our hospital provision. I am conscious that members raised an incredible number of other issues and I will endeavour to respond to them in writing. I am happy to do that.

As part of the reconfiguration of services, members have asked about guarantees. On 19 November, Malcolm Chisholm approved the NHS board proposals for early changes to ear, nose and throat, gynaecology and ophthalmology services in north and east Glasgow and dermatology services across the city. He did so to target specialties in ways that we think are appropriate.

The role of the monitoring group will be important with respect to future provision. Those who are involved in that process will be able to monitor the situation much more effectively than has been the case. That will help us to try to address the issues, and it will mean that any decisions are arrived at by rigorous assessment rather than in the way that people claim has happened in the past.

We must ensure that we take the people of Glasgow with us. The health board has a major responsibility now. There is a political scenario around the issue that will undoubtedly colour much of the debate between now and May. We are talking, however, about a seven to 10-year vision to put in place something that should last for 40 or 50 years. I am delighted that the Executive is prepared to face up to the challenges. In the words of Tim Park:

"Glasgow should not be condemned to another 20 years of second rate ‘make-do' emergency care by the narrow interests of pressure groups and ill-informed MSPs."

We need to move beyond that and be more effective on the issue.

I hope that members take on board the references that I made to the Scottish trauma audit group and I also hope that we can move forward. I give the guarantee and assurance that we want to take the people of Glasgow and greater Glasgow with us on this new journey of change for clinical care in Glasgow.

On a point of order, Presiding Officer, about the length of the debate, which has of necessity been curtailed. Will you give consideration to the circumstances of members' debates? I refer you to an article in today's Evening Times as it relates to an issue of courtesy to other members in the chamber.

I accept that members might want to bring attention to and seek to promote debates, particularly members' debates. However, where the publicity for the debate is essentially the speech that the member is to give, consideration should be given to the contributions of those members whose speeches have been curtailed.

The reason that the debate is time constrained is neither my fault, nor Bill Aitken's. I am afraid that the minister's diary did not permit an extension, although, as it turned out, once the minister started to wax eloquent, he was more flexible. The fact that the debate was constrained was simply unavoidable, because of diary considerations. It is up to members to say what they want in promoting their motions.

On a point of order, Presiding Officer. This is a pleasant one. I think that you followed a fair system and took the trouble to take a note of the names of those Glasgow members who had not managed to speak in the previous debate. I am sorry that I exceeded my time and did not hear the dreaded tap of the biro against the microphone clearly enough. Thank you for that courtesy.

I am sure that that is fair, and I should say in the interests of fairness that I told the SNP that I would probably call only one speaker, which is why Nicola Sturgeon was not called.

That concludes this evening's business, and I close this meeting of the Parliament.

Meeting closed at 18:05.