Meeting of the Parliament (Hybrid)

Meeting date: Tuesday, November 16, 2021

Official Report 986KB pdf

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Urgent Question

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NHS Lanarkshire (Support)

To ask the Scottish Government what support is being provided to NHS Lanarkshire in light of reports that Wishaw hospital accident and emergency department was at full capacity at the weekend with patients being transferred to Monklands hospital.

First, it has always been part of boards’ operational practice to work as a clinical network to manage demand by diverting patients between their hospitals when it is clinically safe to do so, minimising delays for patients.

As Meghan Gallacher—and every member—knows, the health and care system is under extreme pressure due to the pandemic. NHS Lanarkshire, like all health boards, is experiencing significant issues, including workforce challenges and high levels of delayed discharge. We recognise that some people are not getting the service or care that they—or, indeed, we—would expect. I regret that and I apologise to anybody who has suffered as a result of it.

As members will know, we have invested in an additional £300 million winter package of measures to support health and care services. Over and above that, in order to maximise capacity, we have also invested £10 million in specialist programmes that aim to provide alternatives to admission and ensure that our processes are right, to ensure timely discharge.

On top of that, the member is probably aware that NHS Lanarkshire has been assigned 64 military medics to support the three acute sites; the period of their task has recently been extended from 11 November until 17 December—something that I and the board welcomed.

My senior officials and I have been meeting the executive team at NHS Lanarkshire regularly to agree immediate actions that will support improvements and minimise delays for patients. I spoke to the chief executive of NHS Lanarkshire yesterday.

Some patients who presented at Wishaw general hospital at the weekend were diverted to Monklands hospital’s A and E department to receive treatment, as there was a shortage of beds and there was high demand. The journey time between the two hospitals is 24 minutes.

The cabinet secretary was aware of concerns about Wishaw general hospital and other NHS Lanarkshire hospitals, given that code black was recently announced. Why was no immediate intervention made to prevent patients from having to be diverted to another hospital nearly 10 miles away?

I disagree with the characterisation that no action was taken. I will come to that in a second but, first, I should say that when any patient is diverted to another hospital that happens on the basis of a clinician deciding that it is safe to do that.

The idea that we have not taken action is incorrect. I can write to the member with a lot of detail about the action that we have taken. On code black status, of course we do not want to see NHS Lanarkshire at the highest level of escalation. That is why we have invested £300 million in a winter funding package.

I have met NHS Lanarkshire regularly. The key is to ensure that we can discharge, where it is clinically safe to do so, as many people as possible out of the acute sites—the three hospitals that the member knows—and into care, as best and as quickly as we can do. I am more than happy to write to Meghan Gallacher with a great amount of detail about the additional investment that has gone into NHS Lanarkshire, and I express my thanks to all the national health service and social care staff who are working so hard under extreme pressure.

The Scottish Government set a target of 95 per cent of patients being seen within four hours in A and E departments in all NHS localities, but recent figures from NHS Lanarkshire show that only 61.8 per cent of patients are being seen within that timeframe. The Scottish Government has failed to get a grip on the crisis and NHS Lanarkshire patients are paying the price.

Will the cabinet secretary apologise to staff and patients across NHS Lanarkshire and will he commit to getting a grip on the crisis?

What I will do is thank our NHS staff—something that Meghan Gallacher has not been able to do thus far—for their incredible work in the midst of this global pandemic.

Meghan Gallacher talks about the 95 per cent target. Of course I acknowledge that we have not met that target—[Interruption.] If Megan Gallacher stops shouting from a sedentary position and listens, she might get the answer as to why that is the case. We are in the midst of a global pandemic. Of course we are not where we want to be—[Interruption.] I can hear someone else shouting from a sedentary position. Mr Kerr and other Conservatives would do well to listen to my answer, because this is incredibly important.

We have had two weeks of improvement. [Interruption.] Of course NHS performance is not where I would want it to be, but I say to Ms Gallacher and the Conservatives who are still shouting that we have the best-performing A and E departments in the entire UK—[Interruption.] Again, the Conservatives would do well to listen. I do not say that because we are abdicating our responsibility for the Scottish NHS but because it surely demonstrates to members that this is a problem that health services right across the UK are facing.

My job is to ensure that NHS boards, including NHS Lanarkshire, and our staff get the funding that is necessary to make improvements. We have seen improvements over the past two weeks, which Ms Gallacher did not acknowledge.

We must also take care of staff wellbeing, which is why I reiterate my thanks to NHS and social care staff, who are working incredibly hard in the midst of the pandemic.

Does the cabinet secretary agree that the unprecedented pressure on our NHS is attributable to the Covid-19 pandemic, and that that emphasises the importance of using every tool at our disposal to increase vaccination uptake and reduce case numbers? Does he therefore agree that the Conservatives’ opposition to on-going public health measures, and Ms Gallacher’s previous calls for us to align with England in that regard, sit at odds with their concern for the health service?

Yes, I agree. [Interruption.] I can still hear Conservative members shouting from sedentary positions.

Clare Adamson is entirely correct that Covid is one of the pressures that we face. Not all of the pressures can be attributed to Covid, but anyone who lives in the real world will understand that the pandemic has caused the biggest shock to our NHS in its 73-year existence. The fact that we have well over 750 patients with Covid in our hospitals, taking up beds, adds to that pressure. Controlling transmission of Covid infection will clearly help to alleviate some of that pressure as we go into the depths of winter.

Following the First Minister’s statement this afternoon, we heard that the Conservatives’ only contribution to the debate is to oppose every sensible measure that the Government looks to introduce to control Covid, which will help to alleviate the pressure on NHS boards, including NHS Lanarkshire.

This is an extremely serious situation, and I, too, thank our NHS staff.

NHS Lanarkshire moved to code black on 22 October, which resulted in some cancer operations being cancelled for patients who were already experiencing unacceptably long delays. Some three weeks on since that code black was declared, the reports from the A and E department of University hospital Wishaw clearly demonstrate that the Scottish Government has not dealt with the situation. When does the cabinet secretary expect all elective surgeries, especially cancer procedures, to recommence?

I remind Paul O’Kane that we are still in the midst of a global pandemic. [Interruption.] I can hear him shouting from a sedentary position, but we are still in the midst of a global pandemic. I suspect that it is impossible for any Government across the United Kingdom to set a target date for when all elective surgeries will be back on track. We published the NHS recovery plan to increase capacity by 10 per cent, and that plan is backed by £1 billion of investment over this parliamentary session.

It is, of course, not my decision to pause elective care. Such decisions are, quite rightly, taken by clinicians in the local NHS health board. I know from speaking to NHS Lanarkshire—as I do every week and as my officials do on, in effect, a daily basis—that such decisions are not taken lightly.

Once NHS Lanarkshire went to the highest level of escalation—code black—I announced a number of additional measures and proposals, with increased funding. I am happy to write to Paul O’Kane with details of the funding that went directly to NHS Lanarkshire.

I have been contacted by a constituent whose twin babies were born prematurely on 21 October at University hospital Wishaw. I send them our congratulations. They were then transferred to the Victoria hospital in Kirkcaldy, as the special care baby unit at Wishaw was closed due to staff shortages and a lack of available cots. It has now been three weeks, and my constituent and his partner are both living out of suitcases and sleeping in the neonatal unit on a fold-down bed. Will the cabinet secretary look into the matter and ascertain whether alternative arrangements can be made to get them closer to home, if not back in Wishaw?

Yes. If Gillian Mackay can furnish me with the details, I will, of course, look into the matter. The constituent’s story that she has rightly articulated is symptomatic of the pressures that we are facing. The pressures that NHS Lanarkshire is facing are even more acute than those faced by other health boards across the country. We will continue to invest, and I will leave no stone unturned. That is why we were happy to facilitate the MACA—military aid to the civilian authorities—request for further assistance for NHS Lanarkshire.

If Ms Mackay furnishes me with the details, I will raise the case with the board and see what more can be done for the family involved.

The cabinet secretary has been incredibly patronising towards my colleague Meghan Gallacher. She asked very reasonable questions, and she got back snippets from a ministerial briefing and soundbites about investment. She asked what he and his Government had done to pre-empt the crisis that was declared in NHS Lanarkshire. What he has given us back is politics. Can he give us a sample of the extensive and exhaustive list of things that he has done, given that he could not tell us one thing a few minutes ago?

That was barely worth listening to, I have to say. This is a serious issue that deserves far more than Stephen Kerr’s bluff and bluster. [Interruption.]

I remind all members—who are well versed in the code of conduct—that we have a duty to treat one another with courtesy and respect at all times.

On the action that we have taken, we have invested £20 million additional funding in the Scottish Ambulance Service—that is £20 million before the announcement that I made in September—taking the additional resource for the Scottish Ambulance Service to £40 million. I am happy to give Mr Kerr details about the £300 million winter funding package. Recently, the First Minister announced £482 million to help with Covid pressures. In July, I announced an additional £12 million, last week I announced an additional £10 million, and the week before that I announced an additional £10 million. If the member wants me to keep going, I can list a number of actions.

What about practical things?

The member does not think that money or investment is practical. However, that investment is helping our NHS boards, including NHS Lanarkshire.

Constituents in Lanarkshire have told me that they are willing to travel to other health boards. When I asked NHS Lanarkshire about that on Friday, I was told that there is no capacity in other health boards, apart from at the Golden Jubilee national hospital for a small number of cases. Since then I have been told that other health boards have approached NHS Lanarkshire, which is in code black, asking for help.

Are any other health boards close to being in code black and when can we expect mutual aid to become available? Is there any spare capacity at all in our health system?

At the moment, no other health board intends to raise its escalation level to the highest level, which is black—the level that NHS Lanarkshire is in. However, that situation is reviewed daily; given the extreme pressures that health boards are under, I suspect that it is reviewed hourly.

It is not uncommon for health boards to reach out to other health boards for mutual aid. I know that several health boards have done that for different services. I was talking to NHS Tayside yesterday and I understand that it is speaking to other health boards about potential mutual aid for some of its breast cancer services.

For elective surgery, if there is any theatre capacity at all, and teams can be brought together from different health boards, we are looking closely to see how we can maximise that opportunity. The Golden Jubilee national hospital is helping health boards across the country, including NHS Lanarkshire, with some elective surgeries.