Meeting of the Parliament

Meeting date: Tuesday, May 30, 2017

Official Report 818KB pdf

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Vale of Leven Hospital (GP Out-of-hours Service)

The next item of business is a members’ business debate on motion S5M-05016, in the name of Jackie Baillie, on Vale of Leven hospital general practitioner out-of-hours services. The debate will be concluded without any question being put.

Motion debated,

That the Parliament expresses its concerns about the future provision of GP out-of-hours services at the Vale of Leven Hospital; notes that a report produced by NHS Greater Glasgow and Clyde recommends the withdrawal of the service between Mondays and Fridays due to financial and staffing pressures; understands that the publication of the report follows months of temporary closures at the hospital during weekends as the NHS board is unable to recruit enough medical staff to cover the service; considers that it is unacceptable to force people in Dumbarton, Vale of Leven, Helensburgh and Lomond to travel to the Royal Alexandra Hospital in Paisley to access emergency primary care services; believes that the report identifies a reduction in services at the Vale of Leven Hospital as the preferred option, despite the NHS board’s own figures revealing higher attendances at GP out-of-hours services among Dumbarton and Alexandria residents than residents in Paisley; considers that such services are a vital component of any local hospital, and notes calls on the Cabinet Secretary for Health and Sport to intervene to ensure that the commitment in the Vision for the Vale agreement to maintaining these services is respected.

17:17  

I welcome the opportunity to discuss the future of GP out-of-hours services in NHS Greater Glasgow and Clyde. I will focus my attention on the cuts that are proposed at the Vale of Leven hospital, but I am sure that other members will speak about the out-of-hours services in their areas because—we should make no mistake—there is an NHS Greater Glasgow and Clyde-wide plan to cut back access to GP out-of-hours services.

According to the recommendations in a paper that was sent to all health and social care partnerships in the NHS Greater Glasgow and Clyde area, the services at the Vale of Leven hospital, Greenock health centre and the Inverclyde royal hospital will be closed between Mondays and Fridays in the evenings and overnight. That will leave just five GP out-of-hours centres covering the whole of NHS Greater Glasgow and Clyde during the week, will put even more pressure on national health service staff and will cause concern for patients. The health board argues that the cuts are necessary due to staff shortages and financial pressure on NHS budgets. Those staff shortages have arisen in part due to the reduction in medical training places that has been made by the current Government.

Since the beginning of the year, services at the Vale of Leven hospital have been withdrawn for hours at a time on at least eight occasions with no notice having been given. Patients who have been sitting in the waiting room have been handed letters telling them that no doctor is available to see them and that they need to go to Paisley. The irony is that the vast majority of temporary closures at the Vale of Leven’s out-of-hours service have happened during the weekend, but the health board wants to axe the service during the week, when it appears to have less difficulty filling staff rotas.

What happens if the cuts go ahead but the health board still does not have enough staff to run the out-of-hours service on a Saturday or Sunday? If it is so concerned about staffing, why did the health board stop trainees doing shifts—a practice that has been allowed to continue in Glasgow but not at the Vale of Leven? Local GPs believe that it is only a matter of time before the service is removed completely.

There has been no consultation on the proposed changes, and the health board has issued empty reassurances via the local media while, behind the scenes, its officials send out papers to the health and social care partnership recommending cuts to the service. Just ask the local GPs in Dumbarton, Vale of Leven and Helensburgh who met me and hospital campaigners last Friday. They are furious about the lack of engagement. Not only have they not been invited to share their unique insight into the needs of local patients, they were not even informed of the proposals. One of the GPs in my area found out about the proposed cuts not from the health board, but on Facebook. Family doctors should be at the forefront of shaping local primary care services, but NHS Greater Glasgow and Clyde treats them merely as an afterthought.

Local GPs, who are responsible for the care of about 75,000 patients across the entire catchment area of the Vale of Leven hospital, have issued a unanimous statement condemning the proposals, in which they say:

“Closure of the Vale service constitutes an unacceptable clinical risk which will be felt most by disadvantaged patients, thereby widening health inequality.”

They claim that the proposals go against Government and NHS Scotland advice, and made the point very clearly that the GP out-of-hours service is a core service that should be local and accessible. It is not a specialised service. There is no clinical argument in favour of centralisation; indeed, the GPs have said that patient safety is at risk if the proposals go ahead. Emergency primary care is one of the most basic components of any local healthcare provision and should be protected.

Let me tell Parliament about the practical implications for patients of the Vale of Leven if the service is centralised in Paisley. This is just one example. I was told about a woman with a heart condition who turned up recently at the Vale on one of the evenings when the out-of-hours service was closed due to staff shortages. When she was told that she would have to make the 34-mile round trip to Paisley to see a doctor, she decided to go home and wait until her local surgery reopened in the morning. Fortunately, in this case the patient’s condition improved, but things could have been very different. That example highlights how vital it is to protect access to local out-of-hours care. If the service is withdrawn permanently, many people from Dumbarton, Vale of Leven and Helensburgh, especially people who do not have a car, will simply not be able to see a GP in an emergency. They might not see a GP at all, because they do not want to bother anybody. My local GPs firmly believe that patients’ lives will be put at risk.

The health board’s own analysis of the footfall at out-of-hours centres shows that the service at the Vale of Leven hospital is well used. Dumbarton and Alexandria have the highest share of out-of-hours attendances of any postcode area in the whole of the NHS Greater Glasgow and Clyde area, but, predictably, the health board once again singles out the Vale of Leven hospital for cuts. On average, more than 120 patients in my constituency use the service on Mondays to Fridays; they would be forced to travel to Paisley. Patients in Helensburgh and the remote communities on the Rosneath peninsula and in Arrochar would face even longer journeys if the service were to be centralised. Local GPs estimate that it would lead to in excess of 500,000 miles of travel annually for Helensburgh patients alone.

In West Dunbartonshire, we have some of the most deprived communities in Scotland and the lowest rates of car ownership. The last bus from the Vale of Leven to the Royal Alexandra hospital leaves at 10 past 6, and the patient transport service does not have the capacity to offer transport within one or even two hours. The poorest patients would be hardest hit and would, in effect, lose access to emergency primary care. Whatever happened to the mantra about prevention and early treatment? If the proposals go ahead, patients will self-refer and end up in the wrong place—at the front door of an accident and emergency department, thereby further increasing waiting times.

The provision of GP out-of-hours services was a key commitment in the vision for the Vale agreement that was signed by Nicola Sturgeon when she was Cabinet Secretary for Health and Wellbeing. I welcomed the Vale vision back in 2009 because it offered stability and promised to retain a range of services at my local hospital. However, in recent years the health board has started ripping up those promises. Maternity services are under review, wards have been closed, and haematology and a host of other clinics have been cut. There are 113 fewer nurses and midwives, and bed numbers have been slashed by a third. Now, even the most basic local service is under threat.

Every time I raise the Vale of Leven hospital in the chamber, the minister, the cabinet secretary or the First Minister tells me that they are committed to the vision for the Vale. However, if that is the case, why has not one Scottish National Party member of the Scottish Parliament signed my motion—not even Stuart McMillan, whose constituents in Greenock and Inverclyde will be directly affected?

The message is not understood by the health board. If the health secretary and her minister are serious about the vision for the Vale—I believe that they are—will they tell the health board to take the cuts off the table? I hope to hear about that from the minister when she sums up this evening.

The out-of-hours service is a basic service. It is not a specialist service and it will not benefit from centralisation. If we remove it, we will be “putting patients at risk”. Those are not my words, but the words of local GPs. On Thursday afternoon after First Minister’s question time, I will have the pleasure of welcoming to Parliament a delegation of local activists from the hospitalwatch campaign. Their recent demonstration at the Vale of Leven hospital was a huge success, with more than 5,000 people attending. I hope that on Thursday they will get the opportunity to meet the cabinet secretary and ministers, and I encourage colleagues from all parties to join us at 1 pm in committee room 4.

The message that we want to convey is clear: stop the cuts and protect local services.

17:26  

Jackie Baillie raised many issues in her speech, and I can find common ground with her on many of them. The issue that is before us is the GP out-of-hours service.

When I was a regional MSP, occasionally on behalf of constituents I raised issues regarding service delivery, the future of the Vale of Leven hospital and services in the Dumbarton constituency. The “Vision for the Vale” document, which Jackie Baillie mentioned, was published in 2009-10, and inpatient and day-case activity has increased by a third since then.

We should remember that the current SNP Government ended a decade of damaging uncertainty by delivering the vision for the Vale. Under the previous Labour-Liberal Democrat Administration, in which Jackie Baillie served as a minister, the Vale’s accident and emergency department was closed in 2002. In addition, the number of acute beds reduced in every year of the Labour-led Scottish Executive.

I highlight those points for a reason: health service delivery is changing. The report, “Pulling together: transforming urgent care for the people of Scotland”, which was published in November 2015, highlights the need to think anew about what is best for urgent care for the people of Scotland and it highlights that that will require transformational change across many sectors. Doing that is not easy, and I have raised concerns about proposals that have been made regarding the Inverclyde royal hospital, both publicly and in correspondence with the cabinet secretary and the health board, and will continue to do so. However, I do not deploy the tactic of running to the press with a story before I have all the information—although I am not accusing Ms Baillie of doing that.

I am aware that the review clearly affects the Inverclyde area, which is why I wrote to the chief executive of the health board on 10 May. I asked questions regarding access to public transport because public transport is not always available, and the cost of a taxi from Inverclyde to Paisley will be prohibitive for many of my constituents. Jackie Baillie used the phrase,

“The poorest patients would be hardest hit”,

and I absolutely agree with her on that.

I have also asked questions about unsociable hours and accompanied travel for people who need to use the service, and I have asked about patient safety and care and the long-term future of the service.

I know that the review is taking place. The health board’s reply in last week’s Greenock Telegraph to someone else who raised the issue was extremely informative. It said:

“This review, being led by health and social care partnerships, is considering how we can continue to provide an efficient, responsive GP service out of hours that is sustainable in the long term ... The recommendations from this review will be reported back to the six integrated joint boards and NHS Greater Glasgow and Clyde in due course.

A spokesman for Inverclyde Council said: ‘The service is wholly reliant on having enough GPs available to cover out-of-hours, and this is proving difficult across the whole of the NHS Greater Glasgow and Clyde area.

A number of proposals will be put to joint boards, including Inverclyde’s, next month for consideration and a preferred option identified.’”

The out-of-hours service is important to Jackie Baillie’s constituents and to mine, and the review that is under way is one of the recommendations from Professor Sir Lewis Ritchie’s review.

As ever, the Scottish Government will expect meaningful engagement with the public to take place. There have been occasions on which that has happened, but there have been other occasions on which the engagement activities of NHS Greater Glasgow and Clyde have fallen short, as I am sure Ms Baillie would agree.

I will look at all the recommendations that are made, and I will encourage all my constituents in Greenock and Inverclyde to do likewise and to make loud and clear representations to the integration joint board and the health board, because the service in question is crucial to Jackie Baillie’s constituents and to mine.

17:30  

I thank Jackie Baillie for securing this important debate. The future of the Vale of Leven hospital—which I will concentrate on, because it is in my area—is vital to the constituents we both represent in the Dumbarton constituency and to people across the wider West Scotland region. Therefore, it is right that we have the chance to debate our concerns about the future of the hospital here in Parliament today.

The Vale of Leven hospital is a central part of life in our area of Scotland. For many of us—myself included—it is where we remember our children being born and family members receiving life-saving treatment; for some, it is also the place where we have said our last goodbyes to loved ones. That is why every threat of a reduction in services at the Vale is followed by such a passionate outcry from the local community and furious debate. Only local people can truly understand how important the Vale is to our community.

The moving of the GP out-of-hours service from the Vale to Paisley is another example of a threat against the hospital, and it would be detrimental to our area. Asking people in places such as Dumbarton, Vale of Leven, Helensburgh, Lomond and the Rosneath peninsula, which Jackie Baillie mentioned, to travel for more than an hour to the Royal Alexandra hospital in Paisley to access emergency primary care services is unfair, and I certainly do not believe that it will improve patient care or people’s ability to access that care.

As Jackie Baillie correctly points out in her motion, demand for out-of-hours GP services has not fallen in the areas that I mentioned; it is actually higher in those areas than it is in others. We are not talking about an underused service that wastes manpower and resources that could be better used elsewhere; rather, it is a service that meets a vital need of residents north of the Clyde in my West Scotland region.

Alongside the suggested cuts, the removal of other services has been mooted in recent months and years. Cuts in pharmacy services would, I believe, have a detrimental effect on patient care, as would the suggested closure of the community maternity unit and the reduction in haematology services at the hospital. Local people have been left questioning whether the Scottish Government and NHS Greater Glasgow and Clyde truly have the dedication and commitment that are required to deliver on the promises that they made in the “Vision for the Vale” document.

The service that we are debating and the others that I have mentioned are vital parts of our local hospital. Those services are essential to a hospital’s ability to successfully serve its local community, as the Vale of Leven hospital has done for many decades.

With the proposed expansion of the Faslane naval base over the coming years, the population in the area will only increase. Service personnel and their families will move to the local area, and many will be reliant on the services that are provided by the Vale of Leven hospital. By getting rid of those services, we are discouraging people from living in our area; importantly, we are also discouraging those who want to settle there.

I welcome the calls that have been made for Cabinet Secretary for Health and Sport to intervene in the matter, and I, too, call on her to do so.

The out-of-hours service is not a centralised service; it is a basic service for our communities. The issue can only be understood by local people who rely on the service and see the benefit of its being provided in the Vale of Leven hospital. Moving the service to Paisley would mean that patients would have travel times of more than an hour and would incur personal costs in making those journeys. Young married couples come up to the area to serve in the Navy. The wives might not drive, and in the middle of the night one of them might face a panic situation with one of the children. If there was no cash on the table for a taxi, there would be a problem.

Demand for the out-of-hours service has not fallen; it is actually higher among Dumbarton and Alexandria residents. The Scottish Government should deliver on the promises that were made in the “Vision for the Vale” document. The service is needed because of the plans to increase the size of Her Majesty’s Naval Base Clyde, from which there are about 10 referrals per day to the Vale of Leven hospital. It is vital that the Government steps forward, protects the out-of-hours service and keeps the promises that it made to local residents, patients and NHS staff in the “Vision for the Vale” document.

17:34  

I hope that the Presiding Officer will permit me to start by thanking all staff at Wishaw general hospital, who have responded very quickly to what is believed to be a bomb threat today. Staff have had to evacuate patients, but they have been getting the situation back under control and getting back to work. I put on record my thanks to all our wonderful NHS staff, and to those working at Wishaw general in particular.

I also thank Jackie Baillie for bringing to the chamber this important debate. It is no secret that she is a strong defender of the Vale of Leven hospital and a strong advocate for local services in her constituency. She has worked closely with local people, including those who run the hospitalwatch campaign. I look forward to accepting her invitation to meet campaigners from hospitalwatch on Thursday, and I put on record my thanks to them for their on-going commitment to protecting services and staff at the hospital.

It is important to place the debate in the context of the on-going concern about the Vale of Leven hospital’s maternity services unit, which is currently under review and has been recommended for closure by NHS Greater Glasgow and Clyde. I hope that the Scottish Government takes the earliest opportunity to end the uncertainty by clarifying for service users that the maternity unit will be protected.

The pressure on the out-of-hours service is a result of two key factors. First, resource is not currently meeting demand in the NHS. Secondly—and perhaps of more concern—there is an on-going workforce crisis in the NHS. We should not forget that health boards are being asked to make £1 billion of cuts over the next four years, which will impact directly on services and patient care and on all NHS staff. The situation at the Vale of Leven is perhaps an early indication of what the results of those cuts will be.

The NHS workforce has been mismanaged over the past 10 years, and our NHS staff have been left overworked, undervalued, underresourced and underpaid. The situation needs to be addressed urgently.

There is also an on-going GP crisis. The Royal College of General Practitioners tells us that the NHS is projected to be 830 GPs short by 2021, which is a concern for out-of-hours services in particular.

I hope that the minister, in responding to the debate, will highlight the opportunities that will arise during the GP contract process to provide more support for general practice. First, there is an opportunity to provide more auxiliary support for GPs in the form of specialist and advanced nurses, physiotherapists, mental health nurses and so on. Secondly, there is an opportunity to look at what further support pharmacies can offer to take the pressure away from GP practices and out-of-hours services.

In addition, there is an opportunity to look at the role of out-of-hours services and their relationship with primary care, given that any closures to those services will only pile more pressure on GPs and on our already overstretched accident and emergency departments.

I thank all the GPs in the area around the Vale of Leven hospital who have drawn up a joint statement to highlight the unacceptable clinical risks that they believe will be posed to patients if the out-of-hours service proposal goes ahead. The minister must listen very carefully to the concerns of general practitioners in the region.

In closing, I highlight the direct impacts that will occur as the result of the loss of a lifeline service. There will be more pressure on GP practices and additional pressures on already overstretched GP practices and surrounding A and E departments. The continued centralisation of services will mean longer travel times for people in the Vale of Leven area, and it will impact in particular on those people from the most deprived communities. There are poor transport links to other hospitals in the area, which will have an impact on wider health inequalities. There will also be further pressure on staff in other areas. The fact that the withdrawal of services from the hospital may be the beginning of a downward slope will be of huge concern to people in the area.

It is important to recognise that it is not only the Vale of Leven that is impacted by such changes, because people in Greenock and Inverclyde are affected by pressures around Greenock health centre and Inverclyde royal hospital. I hope that the minister will take the opportunity to provide clarity to local people by saying that local services will be protected, which was a manifesto commitment, and that the Government will invest in our NHS and take the pressure off our hard-working NHS staff.

Thank you, Mr Sarwar. You localised it eventually. You were a bit general to start with, but you are an astute speaker and realised that you had to bring your contribution round to the motion at hand. I compliment you for that.

17:39  

I apologise, because I have to leave early. I notified your office, Presiding Officer, and Jackie Baillie last week that arrangements for an event that I am hosting were changed because of the security issues.

I, too, thank Jackie Baillie for bringing the motion to the chamber; I know that she, quite rightly, cares deeply about the issue. Indeed, we should all—certainly every West Scotland representative—feel strongly about the issue. Access to healthcare in the local area is of vital importance to everyone. The importance of the local connection and accessibility should not be underestimated.

Primary care services should be available in the local community and from a GP who people know and trust. That is exactly what is under threat at the Vale of Leven. Year on year, services such as haematology and pharmacy have been chipped away, and now out-of-hours GP services are under threat of being cut.

Out-of-hours GP services have already been closed temporarily at weekends due to staffing shortages. As Jackie Baillie stated, a report by NHS Greater Glasgow and Clyde recommends the withdrawal of out-of-hours GP services on weekdays. Alternative out-of-hours services would involve people travelling all the way to Paisley, to the Royal Alexandra hospital, which can be more than an hour away by bus. I do not see how forcing people who have a health issue to travel all the way to Paisley will deliver better care. In particular, access to healthcare for people who have disabilities or parents with young children will suffer from restrictions on out-of-hours GP services. Local residents certainly do not think it will improve the service, and they are its users.

As Jackie Baillie said, those who have campaigned to save local services in the Vale of Leven will be here on Thursday. Hospitalwatch has been campaigning for 13 years. The campaigners will have with them a bed sheet that has been signed by thousands of their supporters, some of whom attended the vigil last week. It will be presented to the Cabinet Secretary for Health and Sport to demonstrate the strength of local support, particularly for those who live further north and will be most affected by having to travel further south to Paisley.

I hope that the cabinet secretary will consider the impact that such a cut would have on people in and around the Vale of Leven. After all, the Scottish Government’s 2015 independent review of out-of-hours primary care services states that they should be

“Person-centred ... Intelligence-led”

and

“fair and accessible to all”.

Restricting out-of-hours care in the Vale of Leven will not achieve that. It will exacerbate health inequalities that are already a serious problem across this country, particularly in west and central Scotland.

I respect the fact that NHS Greater Glasgow and Clyde made the proposal but, as Anas Sarwar said, it was made within a financial context. If the Cabinet Secretary for Health and Sport will not step in and protect local services, how many more hospitals will face the same problems as the Vale of Leven? It is deeply worrying to see staff shortages driving the need to cut local health services.

The public sector pay cap is preventing hospitals from getting and keeping the professionals that they need to deliver healthcare. As my colleague Alison Johnstone said earlier this month, it is clear that the public sector pay freeze is negatively impacting staff retention. The NHS in Scotland faces severe workforce shortages and, with a retirement boom on the horizon, pressures on healthcare will only increase.

It is imperative that funding in this area increases by above the rate of inflation and keeps up with demand. Anything less is unacceptable. In that way, we can ensure that services such as out-of-hours GP services that should be accessible locally remain accessible locally. That is certainly what we will be fighting for at the Vale of Leven.

17:43  

I declare an interest, in that I have a daughter who works in the NHS.

I thank Jackie Baillie for bringing the debate to the chamber. The debate has far-reaching implications for the Vale of Leven hospital and for how Parliament approaches healthcare needs across Scotland. I can completely empathise with the stance that Jackie Baillie, Maurice Corry and Stuart McMillan have taken. Protecting local services in their areas and supporting their constituents is entirely right.

The proposed changes at the Vale of Leven hospital and the on-going review have been raised often in the chamber; I have spoken previously in a debate on the subject. My position now is as it was then: it is unsustainable to have a blanket policy that states that no services can change or move. It is still my view and the view of the Scottish Conservatives that a significant change in the services that are provided in a community should be brought to the cabinet secretary’s office and such a decision should rest with her.

We have a rapidly changing health need that we are struggling to keep up with. With reference to the Vale of Leven, as with other similar situations, we need to consider community services in the round and not through a narrow prism. It is time that we considered the long-term future of hospitals and how they fit into the package of community care. Should they be places for acute services such as A and E and neonatal units, with once-in-a-lifetime treatments and operations such as hip replacements taking place in area hospitals where specialists are working?

However, primary care within the Vale of Leven is the subject of the motion, so I would ask what other provisions are available outside the hospital to complement or supplement the specific needs that have been highlighted. The truth is that there are others in the chamber who know better than me. However, investment in primary care is essential if we are to have a sustainable NHS service.

The Scottish Conservatives have called for increased funding to be invested directly with GPs to help alleviate the very issue that the motion highlights. The RCGP has said that 7.2 per cent of the healthcare budget is currently spent on general practice in Scotland, which is less than the percentage that is spent in the rest of the United Kingdom. Even then, I would suggest that not enough is being spent throughout the UK.

We have to make primary care an attractive proposition for doctors, not only as a good career option when they graduate from medical school but as a working lifetime option. GPs, more than any other healthcare professionals, can build up a trusting and knowledgeable relationship with communities over years of service to those communities.

Continuity of care is an essential element of the effectiveness of our front-line NHS staff and Jackie Baillie highlights in her motion that that is sadly lacking. Whether that is through poor workforce planning, as has often been discussed and debated in the chamber, lack of GP training and recruitment, or even the general running down of services in the Vale of Leven, I am not able to say.

Investment in primary care is supposed to alleviate pressure on hospitals, but in this case we have primary care being delivered from a secondary care site. However, it is clear that there is a breakdown in the GP services that the hospital can provide, which has to be to the detriment of patients requiring out-of-hours care.

I have not supported the motion, mainly due to a lack of knowledge of this particular case. However, I can certainly support the focus on the overarching issues—lack of proper investment in primary care, specifically in GPs, lack of cohesive workforce planning and lack of long-term planning for our NHS services.

17:47  

I echo what Anas Sarwar said at the start of his speech about the staff response to the incident at Wishaw general. Wishaw is one of the hospitals that serve my constituency and it is where I had my two children. I commend the dedication of the staff who work there on our behalf.

Like others, I thank Jackie Baillie for lodging the motion. I will begin by setting the scene for national out-of-hours provision before returning to the points that she and others raised.

Daytime general practice and GP out-of-hours services across the country, such as those in Glasgow and at the Vale of Leven hospital, are facing challenges, including increasing demand. That is why, in February 2015, the Scottish Government commissioned Professor Sir Lewis Ritchie to review GP out-of-hours services. The review was commissioned precisely because we recognised the importance of primary care as the first point of contact in healthcare. That should also be the case for out-of-hours services.

Sir Lewis Ritchie’s November 2015 report “Pulling together: transforming urgent care for the people of Scotland” makes 28 specific recommendations that focus on the delivery of a model of care that is GP led and involves a multidisciplinary team working together at urgent care resource hubs across Scotland. The report received full cross-party parliamentary support and achieved a broad consensus for its key recommendations from key professional groups such as the Scottish general practitioners committee, the British Medical Association, the Royal College of Nursing, pharmacy services, GP out-of-hours services, NHS board chief executives and patient representatives.

Crucially, the report recognised that delivering the new model would take time and would require transformational change across the health and social care landscape. That journey has begun. In 2016, we asked integration joint boards to work with their delivery partners to set out how they would deliver the report’s recommendations locally. We provided £10 million of funding in 2016-17 and we will provide a further £10 million in the current financial year to support that work.

As part of an on-going peer-review process, Sir Lewis Ritchie has recently led a national engagement programme under which each IJB area has brought together key stakeholders, including staff and the public, to discuss progress. We are starting to see progress in a number of areas but, as I mentioned, it will take time to embed such transformational change.

The review that is taking place in Glasgow is being carried out in line with the recommendations in Sir Lewis Ritchie’s report. I make it clear that the review is being led by the Glasgow city health and social care partnership on behalf of the six greater Glasgow and Clyde integration authorities. The IJBs are in the initial stages of exploring options for the service as a whole across greater Glasgow and Clyde. I must be clear that they are only options at the moment—no decision has been made and no decision will be made until wider consultation is concluded.

We have been assured by the Glasgow city IJB that it will undertake extensive engagement with the community to shape a service that meets the needs of communities and is safe and sustainable in terms of human resources and finances. We expect nothing less than meaningful and robust engagement. The IJB will organise a number of half-day events in the first instance, the first of which is to take place by the end of June. That is why the point that Stuart McMillan raised is important. MSPs should actively seek to use the opportunities that are presented by the consultation process to ensure that the IJBs and health boards know exactly what the local challenges are.

Jackie Baillie raised legitimate points about car use and public transport, and Ross Greer raised legitimate issues about barriers that are faced by those with disabilities and the impact that important decisions can have on the most vulnerable groups in our society if they are not adequately engaged with. I know that Jackie Baillie will continue to engage in the consultation process.

I am encouraged by the minister’s comments on consultation. However, does she share my concern that local GPs who are responsible for delivering the service were not consulted and that one found out about the situation from Facebook?

I expect the IJBs and the health board to give GPs an adequate opportunity to feed into the process with their specialist knowledge and their in-depth awareness of the communities that they serve. We are actively encouraging the consultation process to engage with GPs to ensure that they can feed into the options consultation.

The service needs to develop in order to provide a quality, safe service to patients. As is the case across the country, the number of GPs who are willing to work in the out-of-hours period is challenging, and we need to work through those challenges to ensure that we have the right complement of staff and professionals so that we can support the people who need support, when they need it. Patient safety cannot be compromised and the onset of illness and the need for services does not recognise the clock.

We are taking action to deal with the challenges of GP recruitment, which is not an issue that solely affects Scotland. Our manifesto made it clear that we are committed to increasing the number of GPs who work in Scotland. Last year, we increased the number of general practice training places by a third and, for the first time, we made a recruitment bonus of £20,000 available to attract trainees in traditionally harder-to-fill posts. However, such measures go only so far in helping to increase GP numbers in the out-of-hours service.

That is another reason why, in November 2015, we published the national out-of-hours report. As many members have noted, we face workforce development issues, which is why 11 of the 28 recommendations in the report related to workforce issues. The recommendations covered the specific future contribution of not only the GP workforce but, importantly, the nursing, pharmaceutical and paramedical staff and other allied health professionals, as well as the social services workforce. The out-of-hours review that is being undertaken across Glasgow is taking all those workforce recommendations into account. For example, pilots are taking place to deploy advanced nurse practitioners in home visits.

With all that in mind, and in order to stabilise the service, the IJBs are required to explore options to deliver a sustainable and safe model of care. As I said, patient safety cannot be compromised. However, the continued provision of out-of-hours primary care services across the Clyde area, including services at the Vale of Leven, is a key priority for the Government. We want a high-quality out-of-hours service that fully meets patient needs. That is why we are investing £20 million over two years in delivering the recommendations of the 2015 report on creating a multidisciplinary team approach, using the skills of a range of highly trained professionals in the NHS and ensuring that patients are seen by the person who is best able to address their needs.

Many other points have been raised, but the debate is of such importance that I do not want to descend into the political point scoring that often happens in such debates—by, for instance, trading blows about who said what in their manifestos. I could say that we are much more willing to invest in the NHS than other parties or that it was our party that decided to end the uncertainty about the Vale of Leven hospital, whereas the previous Administration shut the hospital’s accident and emergency department. However, the debate is of such importance that we should unite as a Parliament in support of our NHS staff and GPs.

We must support the consultation process to ensure that, at the end of it, we have a sustainable service that meets the needs of the people whom we all care about—those who are most vulnerable and furthest away from consultation exercises. We must ensure that they can adequately shape NHS service delivery in their areas.

Meeting closed at 17:55.