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Chamber and committees

Meeting date: Wednesday, January 18, 2017

Meeting of the Parliament 18 January 2017

Agenda: Portfolio Question Time, Trauma Network, Highlands and Islands Enterprise, Health, Business Motion, Parliamentary Bureau Motion, Decision Time, Point of Order, Caterpillar Plant Occupation (30th Anniversary)


Trauma Network

The next item of business is a statement by Shona Robison on delivering an enhanced trauma network for Scotland. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.


I am pleased to be able to set out the next steps in the creation of an enhanced trauma network for Scotland. This builds on the excellent services that are already provided by national health service staff across the country and will lead to full implementation of four major trauma centres in Aberdeen, Dundee, Edinburgh and Glasgow.

The dedication of our NHS staff in delivering trauma care is beyond question. These plans will help to support them to achieve even more. Through the new, enhanced network, our trauma teams up and down the country will work together and with the Scottish Ambulance Service to make sure that patients who are facing life-threatening injuries receive the best care possible as quickly as possible.

A trauma network provides clinical leadership throughout the entire patient journey, not just in a trauma centre, from trauma prevention right through to rehabilitation in the community. Trauma centres sit at the heart of a trauma network, providing multi-specialty care for severely injured patients. They provide consultant level care and are fully equipped to provide definitive care for the most severely injured—people with multiple, serious and complex injuries to the head, chest and other parts of the body.

Uniquely, trauma centres provide a dedicated trauma service through a highly specialist team that is expert in major trauma care. The team also has a dedicated trauma ward that is led by specialist trauma consultants and supported by doctors, nurses, physiotherapists, occupational therapists and other health professionals on a 24/7 basis. The last vital component of any trauma network is existing hospitals that are called trauma units, which deal with the vast majority of trauma involving those who are not as seriously injured as major trauma patients.

A trauma network cannot succeed without all those vital components being in place. It should therefore come as no surprise that trauma networks require significant planning and investment if they are to be appropriately resourced and to give seriously injured patients the best care possible. There has been a rigorous debate in the clinical community as to what the optimum model for Scotland would be. I am grateful to the community and to the chief medical officer for shaping the plans that we are now taking forward.

In September 2013, the national planning forum major trauma sub-group produced a report that contained a number of recommendations for the development of a major trauma network. The group recommended that a trauma network be developed and that, as a first step, there should be a four-centre model. However, the group recognised that there was no clear consensus among clinicians on the optimum number of centres.

In April 2014, my predecessor Alex Neil asked for the suggested four-centre model to be taken forward, as a practical first step. However, in line with the 2013 national planning forum report, we knew that

“the findings of the GEOS study”—

the geospatial evaluation of systems of trauma care study—

“should be taken into account when considering future configurations of a trauma network in Scotland, including whether the number of major trauma centres can and should be reduced further from 4 MTCs and where the optimal location(s) might be.”

The fieldwork of the GEOS study was conducted in 2014 and the report was compiled thereafter. The study was noted on a number of occasions by the NPF major trauma oversight group as it took forward its work.

In 2015, the GEOS study cast doubt on the four-centre model and instead suggested that two trauma centres would be the optimal configuration for Scotland. I had to choose whether to ignore the GEOS report, accept it or ask that further work be done to assess the relative benefits and risks of the alternative model. I judged that the report had to be fully considered, to ensure that the right model for Scotland was being developed and to try to address clinical concerns.

Clinicians and other NHS staff then worked tirelessly with the GEOS study group, to assess the risks of having just two centres. In spring last year, it became clear from that further work that the risks outweighed the notional benefits. The views and concerns of clinicians and the Scottish Ambulance Service about a two-centre model were critical at that stage.

As a result, I asked the chief medical officer to lead an implementation group, to look at how a new trauma network, based on the original model of four major trauma centres, in Aberdeen, Dundee, Edinburgh and Glasgow, could be made to work in practice, taking cognisance of the lessons learned from the GEOS report, the concerns of the Scottish Ambulance Service and Scotland’s unique geography.

In June last year, the Scottish Government announced that the necessary preparatory work for an enhanced four-centre trauma network would be completed by December 2016. That commitment was repeated in our programme for government, and we have delivered on it.

As part of building a consensus around the model, the chief medical officer has visited clinicians across the country to get views on what the model should look like and how it can be made to work in practice. All that has been done with expert advice, collaboration and support from our NHS throughout, which meets the commitment in our programme for government. I thank the chief medical officer for her hard work and perseverance in taking forward this complex project.

The chief medical officer’s report, “Saving Lives. Giving Life Back”, sets out how we will deliver an agreed and unique network model of trauma care in Scotland, which will enhance trauma services across Scotland and deliver improved outcomes for our most severely injured patients.

A great deal of good work has been done in parallel with work to develop the network model—complementary initiatives that can and will help to make the trauma network sustainable and, simultaneously, start us on the road to delivering enhanced trauma care. Early progress will include the expansion of the Scottish Ambulance Service trauma desk to operate 24/7, so that patients can be triaged appropriately and access definitive trauma care as quickly as possible, with the desk up and running by October; the testing, in summer, of a triage tool that helps paramedics to identify major trauma patients quickly and tells them where patients should be taken; and the recruitment by the Scottish Ambulance Service of additional staff, with the aim of having staff in place by July. Vital trauma equipment for all Scottish Ambulance Service vehicles has already been procured and will be in universal use by the end of February.

We anticipate that Aberdeen and Dundee will take a shorter time to establish trauma centres—that will happen over the next 12 to 18 months. Work will be guided by the Scottish trauma network steering group and set out in a national phased implementation plan later this year.

It is extremely important to note that the steering group’s plans will not be developed in isolation. Clinicians from all regions, including Aberdeen and Dundee, have been fully involved in the development of the network model, and will continue to be fully involved as the network develops.

The new trauma network model and the way forward is now fully supported by healthcare professionals across Scotland and by the Scottish Ambulance Service. They will continue to work with the new network steering group and the trauma centres and hospitals in their areas in order to deliver the changes that are needed. We are investing an extra £5 million in 2017-18 to accelerate those improvements. Over the lifetime of implementation, the anticipated cost of the new enhanced network and four-centre model is approximately £30 million; the final costs will be informed by the development of the network steering group’s plans.

The new network will not only benefit people with major trauma. Six thousand of Scotland’s seriously injured patients each year, of whom around 1,100 will have major trauma injuries, will benefit and, once the network is fully operational, we expect that an additional 40 lives can be saved. However, many more people will go on to have an improved quality of life due to improved rehabilitation pathways.

If members still have any doubt about the scale and complexity of what we are trying to achieve, I urge them to speak to the doctors and NHS staff who have been involved in developing the network model.

The eleventh of January marked an important day in changing trauma care in Scotland for the better. Through this network, we will provide world-class trauma care that will save more lives and help thousands more people to make a better recovery and get on with their everyday lives.

I am confident that the right model has come out of all this work, and that it will enhance our trauma services and save more lives every year. I am proud of the efforts of our NHS staff who have helped steer us through this complex and difficult process and I am happy to take questions on the statement.

The cabinet secretary will take questions on issues that were raised in her statement. I will allow around 20 minutes for questions. A lot of members want to ask questions, so I ask all participants to bear that in mind.

I thank the cabinet secretary for prior sight of her statement, but I find it strange that it took calls from Ruth Davidson at last week’s First Minister’s question time to get her to come to the chamber to address the issue. The fact that the First Minister went to the media instead of telling the Parliament what was happening is unacceptable. Will it always be the case that we have to apply pressure to the Government in these circumstances?

I am afraid that there has been a complete failure of forward planning, given that these vital trauma centres were supposed to have been in place last year and are now subject to a three-year delay. That delay is intolerable, because these are quite literally lifesaving centres whose very existence will often make all the difference between life and death for those with severe injuries, as the cabinet secretary recognised in her statement.

Given that the week ending 8 January 2017 revealed the worst accident and emergency figures since March 2015, and that the Scottish Ambulance Service tells us that ambulances are struggling to attend life-threatening call-outs quickly enough, there is clearly serious pressure on the whole A and E and trauma system. Further delay to the trauma centres is just about the last thing that the system needs.

There is a distinct lack of clarity on another issue. The Scottish Government said that it did not know how much the new network will cost—that is the analysis of the Scottish Government, which told the Scottish Parliament information centre last week that the costs of the Scottish trauma network have yet to be determined. We have now learned that the network could cost up to £30 million to establish, but we do not know what the running costs will be.

Could we come to the question please, Mr Cameron?

With that in mind, and on the basis that the cabinet secretary states that the necessary preparatory work is complete, I assume that she is in a position to confirm what the expected yearly operating costs are for the service.

I was happy to come here and make a statement to Parliament and I am happy to set out the detail of the complexity of the issue and to share with Parliament some of the detail of why it was important to reach a consensus among clinicians, which previously was not there. I hope that members across the chamber will agree that it was right to take the time to build that consensus rather than to push ahead with a model that did not have that clinical buy-in. I hope that, in the light of the detailed information that has been provided today, members will accept that.

I do not accept Donald Cameron’s criticism about a failure of forward planning. The issue was not a lack of forward planning but a lack of clinical consensus. That consensus had to be built, and the chief medical officer has done sterling work in that regard the length and breadth of Scotland.

Donald Cameron referred to pressures in our A and E departments and the Scottish Ambulance Service. Winter always brings pressures; what is important is the additional layer of support that the major trauma network will provide for those patients who are most injured and who have major trauma injuries. We are talking about approximately 0.2 per cent of the 6,000 people who are injured; a very small number of people with major trauma ever go anywhere near our A and E departments. Most A and E departments see very few major trauma patients, and the new layer of provision will help to support those patients who are the most injured and have major trauma injuries.

With regard to the cost, the £30 million has been on the public record for quite some time. I have said that the £30 million should be taken as a guide for the network to work on, but the steering group will be doing further detailed work around the phasing of it. We have already announced £5 million for 2017-18, and I outlined in my statement the early priorities for that spend. I hope that that gives Donald Cameron some clarity.

I thank the cabinet secretary for prior sight of the statement.

This is the second time that the cabinet secretary has attempted to hide behind the First Minister and has then been forced to come to Parliament to explain her failures. The cabinet secretary promised that the trauma network would be delivered by 2016, but it is now delayed until at least 2020. According to the Government’s own figures, 6,000 patients each year are expected to benefit from the network, which means that up to 18,000 patients will be failed by the cabinet secretary.

I listened with interest to the cabinet secretary when she said, with a straight face:

“We are investing an extra £5 million in 2017-18 to accelerate those improvements”.

Only in Shona Robison’s world is a delay of three years an acceleration. One of the excuses that she gave for the delay was that there was a debate on whether to provide two or four trauma centres. We always knew that two of the trauma centres would be in Glasgow and Edinburgh. Can she tell us why they are not up and running already?

The cabinet secretary likes to talk about England. The fact is that, under this cabinet secretary, the major trauma centres in Scotland will be delivered 10 years behind those in the NHS in England. Will she take this opportunity to apologise?

We give Opposition members copies of a statement an hour in advance so that they can read it and frame their questions based on its contents. It is quite clear that Anas Sarwar has done neither of those things. If he had read the statement beforehand and then listened when it was delivered, he would be quite clear about why it has taken time to reach a consensus among the clinical community on the right model for Scotland. I reiterate that it was very important that consensus was built in the clinical community in order to provide a sustainable major trauma network to benefit the people of Scotland.

Anas Sarwar shows how ill informed he is by saying—to paraphrase his words—that 18,000 people will somehow miss out on good trauma care. If he had listened to the detail of the statement, he would have heard that 6,000 people a year who experience trauma in Scotland already get first-rate treatment and care for their injuries through our existing network of A and E departments. We are talking today about the 1,100 people within that group of 6,000 who have major trauma injuries. If he had listened to the detail and read the statement, he would be aware of that. We are talking about 1,100 people with major trauma injuries who will be treated in the new major trauma network. They already get excellent care; the new network is about providing optimal care and—importantly—rehabilitation. If Anas Sarwar listened to anyone other than himself, he might learn something for once.

I remind members that I am the parliamentary liaison officer for the cabinet secretary.

When will the detailed implementation plans be in place for the four trauma regions? [Interruption.]

I do not know what Labour members find so amusing about the development of a major trauma network that could save 40 lives a year—perhaps they need to take the subject a little more seriously.

We expect the four regional trauma networks and the Scottish Ambulance Service to have their regional implementation plans completed by October this year. Those plans will inform the completion of a phased national implementation plan for the entire trauma network, which plan will be ready by the end of the year.

As I said in my statement, Aberdeen and Dundee will be the trailblazers for the network; they are ahead of Glasgow and Edinburgh at this stage. It is quite right that we support Aberdeen and Dundee to get on with the establishment of the major trauma centres, which will be followed by Edinburgh and Glasgow in due course.

Will the cabinet secretary commit to publishing all materials and documents, including details of ministerial discussions, that relate to the decisions to support four trauma sites? How will the trauma site network form part of the workforce planning strategy, and when will Parliament receive information about that?

Quite a lot of that information is already in the public domain, for example the GEOS study. If there are other materials that would be helpful to Miles Briggs and others, I will certainly look at his request.

Regarding the workforce plan, the trauma site network will form part of that, although it should be remembered—as I said in my statement—that adding the major trauma network layer on top of our trauma services is about enhancing the existing capability. Part of the workforce planning will be to ensure that staffing resources are adequate, because we require not just those who work on the front line, but the staff who work behind the scenes. I confirm that that will be part of the workforce plan, which we will bring forward in the spring.

The cabinet secretary will no doubt have spoken, as I have, to those who are involved in developing plans for the major trauma centre in Aberdeen, so I hope that she will understand their frustration that, even at this stage, the Government is not yet ready to go. However, I have read Catherine Calderwood’s report that was published last week and I listened closely to what she had to say. If Aberdeen royal infirmary will be ready to provide a dedicated new trauma ward this year—if, indeed, a full-blown major trauma centre can be established at Foresterhill within the next 12 to 18 months—what is holding up those deployments? Is the issue that, as Catherine Calderwood seems to say, staffing is a constraint? Why will the cabinet secretary not put in place the regional trauma network for the north of Scotland that she has talked about—what is preventing that from happening now?

There would have been a great deal more frustration in Aberdeen and the north-east if we had gone ahead with the two-centre model that came to my desk and to which we had to give consideration. The member asks why, but when a group of clinicians cast doubt on the sustainability of a clinical model that is being pursued, it would be reckless not to listen to their clinical advice. We had to rebuild a consensus around the four-centre model, which is what the chief medical officer has done with the clinical community. We now have that consensus, which is very important if we are to have a sustainable model. The model is unique and bespoke to Scotland; it is not based on centres and networks in places with major populations elsewhere. It takes into account Scotland’s unique geography.

Regarding the trauma centres in Aberdeen and Dundee, the 12 to 18 month timeframe is realistic for those two centres. They are out of the stalls most quickly and they are very keen to get up and running. The steering group will set out the work that needs to be done over the next few months. As I laid out in my statement, before anything else happens, an important component is the Scottish Ambulance Service implementing its 24/7 trauma desk and ensuring that it has its enhanced triage services in place.

I will then want to see very quickly the detail of how Aberdeen and Dundee will get the trauma wards up and running and the staffing in place. I am happy to keep Lewis Macdonald informed of the detail of that as we take it forward and I am sure that the CMO will do likewise.

With increasing pressure on every aspect of primary and acute care, getting triage right will be essential. I welcome the improvements to that end that were outlined in the statement.

When the last trauma survey was conducted, in the 1990s, the injury severity scale was calibrated so that scores of 16 or more were classified as serious trauma. Despite advances in triage of head trauma, a head injury of any magnitude is still always given an automatic score of 16. To prevent inundation of our new trauma centres from the automatic referral of head injury when the patient could receive exemplary and appropriate care in local hospitals, will the cabinet secretary commit to reviewing the injury severity scale in respect of head injury to take account of advances in triage in that area, while not, of course, compromising on patient safety?

I am happy to write to Alex Cole-Hamilton on the detail of his question, but we have to be clear that the definition of major trauma is very specific. Within the 6,000 serious injuries each year, 1,100 cases involve major trauma, including major head injuries and major trauma to the head. A very specific group of patients require the services of major trauma teams. I am happy to write to Alex Cole-Hamilton, but I hope that he appreciates that we are talking about a small number of people out of those who have serious injuries.

How will effective communications on the development of the new network be delivered to clinicians and the public?

The new Scottish trauma network steering group will work closely with clinicians and NHS staff from the four trauma regions to maintain effective communications in order to ensure that the national trauma network is implemented. The new Scottish trauma network website will also serve as an effective communications tool that will help to keep clinicians and the public—and, indeed, members of the Parliament—informed as the network develops. The new trauma website is available at and I hope that members will avail themselves of the information on it.

In her statement, the cabinet secretary said:

“We are investing an extra £5 million in 2017-18 to accelerate ... improvements.”

Will she clarify how much of that £5 million fund to militate against delay will be allocated to the Aberdeen trauma centre? How much does she expect will be required to deliver the Aberdeen trauma centre on time?

I laid out in my statement the initial priorities for the £5 million spend, which include the development and enhancement of services in the Scottish Ambulance Service. I am sure that Ross Thomson will appreciate that, if the SAS could not do triage through its 24/7 trauma desk, there would not be the glue for the rest of the network.

We have asked the steering group to develop some of the more detailed costings, which will include the development of Aberdeen and Dundee over the 12 to 18-month period. That goes beyond the £5 million and that work will be on-going. The 12 to 18-month period straddles two financial years and, in planning for 2018-19, I will want to make sure that any additional costs of developing Aberdeen and Dundee are included. I am happy to keep Ross Thomson informed as the detail of that work is developed.

It is clear from some of the questions that have been asked that some members have not read the CMO’s report and do not understand the concept of a trauma network. Will the cabinet secretary provide details of the additional services that will be provided by the major trauma centres over and above those that are already provided in local emergency hospitals? How will all those services combine with the Ambulance Service in the Scottish trauma network to improve patient outcomes through the trauma pathway?

As I said in my statement, severely injured patients already receive excellent trauma care in Scotland. We should remember that. This is not about people not getting trauma care at the moment, because people already get trauma care. This is about optimising trauma care for the most severely injured—for those who suffer major trauma.

As I outlined in my statement, major trauma centres uniquely provide a specialist, dedicated trauma service that involves a highly specialist team that is expert in major trauma care, with a dedicated trauma ward that is led by specialist trauma consultants who are supported by doctors, nurses, physiotherapists, occupational therapists and other health professionals on a 24/7 basis. Trauma units in other hospitals will support the major trauma centres. Those units deal with the vast majority of traumas and will continue to deal with those who are not as seriously injured as major trauma patients are.

The trauma network will provide clinical leadership through the entire patient journey, not just in the trauma centre but from trauma prevention through to rehabilitation in the community. It is important that clinicians in the trauma centres will be able to support colleagues in the trauma units and beyond when they deal with trauma cases and will help to develop and enhance the skills of all those staff. Staff will work together to ensure that the patient gets to the right place quickly and has the best possible outcomes.

The chief medical officer has said that she expects Dundee to have its trauma ward operational in this calendar year. The cabinet secretary keeps talking about 12 to 18 months for Dundee and Aberdeen. Does she agree with Catherine Calderwood’s expected timescale for opening? Other than the funding and workforce factors that Catherine Calderwood has outlined, will any factors affect the timeline for opening those centres?

As I said in my statement, the first thing that has to happen is the enhancement of the Scottish Ambulance Service, because it is the triage organisation that will get the major trauma patient to the right place. That must be up and running first on a 24/7 basis through the trauma desk. I set out in my statement the timeline for doing that over the next few months.

I have met those who are leading on the major trauma centre in Dundee; they are trailblazers. They want to get on with delivering the centre in Dundee. They are keen and are getting on with the job. Some things have already changed, and things are already in place that were not in place previously to enhance the experience of patients in Ninewells hospital who have suffered major trauma. I confirm that improvements have already been made.

As for funding and the workforce, this is in the main about ensuring that people have the equipment and skills available to them. Most of the skill sets already exist, but they will have to be enhanced, and the new staffing that will be required to deliver the Dundee centre is being looked at. However, I am optimistic that that centre can be delivered within the CMO’s timescale.

I am afraid that we have come to the last question. Stuart McMillan should be very quick.

The cabinet secretary indicated that the lifetime implementation costs will be approximately £30 million. How will investment in the trauma network in future years be determined?

As I have said, the steering group will develop the detail of the costings. The figure of £30 million has been on the record for some time and I am happy to confirm it as a guideline budget. The phasing of the spend over the next three years will be important. As the network will be quite different from the model that was originally envisaged, the detail will have to be considered. That detailed work will be taken forward by the steering group. I am happy to keep Parliament updated on that.

That concludes questions on the cabinet secretary’s statement. I apologise to members whose questions were not taken, but we ran out of time and lots of members were left over.