Chamber and committees

The report will be published this morning at 11:00 on the University of Glasgow’s website and can be accessed through the following link:

https://www.gla.ac.uk/researchinstitutes/healthwellbeing/research/hehta/monklands/

Firstly, I want to reiterate the Government’s commitment to the replacement of University Hospital Monklands to ensure the continuing provision of the highest quality healthcare services, for the benefit of local people.

I would also like to thank the members of the Independent Review Panel for preparing this report which has been helpful to me in deciding the way forward.

The report makes three recommendations for NHS Lanarkshire to implement and eight recommendations for the Scottish Government. The key recommendations relate to NHS Lanarkshire and they have been asked to make provision for new independent (external) members to join the project board, to re-evaluate the top two scoring options for the site selection and to develop a clear vision for the existing site which takes account of the local community.

I have accepted the recommendations on adding independent members to the project board and developing a vision for the existing site. For the remaining recommendation on the site selection process, I have asked NHS Lanarkshire to broaden out the process and to work closely with the local planning authority to ensure that they can support and contribute to a more constructive, inclusive and open site option review with meaningful public engagement. This will mean that if there are any viable sites beyond Gartcosh and Glenmavis, they will be considered and it will ensure that the most appropriate site is identified through the option appraisal process and it is supported by the local community.

I have also asked that the option of re-providing on the existing site at Monklands be excluded from the re-evaluation as building a new hospital on an existing hospital site takes longer, costs more, risks infection and other patient safety issues, while creating performance and access issues during the long construction phase. There is therefore little point in including an option which will score poorly in the option appraisal process.

Of the eight recommendations for Scottish Government, six relate to technical guidance in the Scottish Capital Investment Manual which will be reflected in the next update of the manual and the remaining two is for guidance to be updated, which is already in the process of being undertaken.

We will continue to keep the progress of this important project under review.

As I outlined in S5W-23747 that while the short-life working group is expected to publish its initial findings in the autumn, I would provide an update on what improvements could be made now.

The Short Life Working group on mesh complications met for a third time last week (Friday 14 June) to examine what additional steps could be taken support women with mesh complications, including on the removal of mesh where clinically appropriate.

The group considered feedback on patient experience and care pathways. The Chair of the group has been in contact with Dr Dionysios K. Veronikis on my behalf and to obtain his agreement for specialists from Scotland to visit him and observe his expertise in his own clinic in the USA. We are also seeking to bring him to Scotland for a period of time to provide treatment, expert advice, and training. Such an arrangement would be subject to agreement and regulatory approval. As regulation in this area is reserved I have written to the UK Government’s Health Secretary and the General Medical Council (GMC) to highlight this case. The Chair of the group has already reviewed requirements and regulations stipulated by the GMC for visiting senior clinicians.

The group has also begun work to establish a national complex case review unit within the NHS in Scotland. This will be taken forward through our service design processes with a view to being established as soon as is practicable.

The group is working to enhance care pathways for patients with complications within individual boards to be enhanced, with each board tasked with setting out how this will be achieved – including the need for improved co-ordination with primary care services.

In the interim, for patients with mesh complications who have contacted the Scottish Government directly about their care I have asked that their cases be directed to the appropriate Accountable Officer within their health board area. I have been clear in my expectations the Accountable Officer will provide responses to each patient as quickly as possible and to support any woman who wishes to have a second opinion on their proposed care. Members should note that an NHS Board Accountable Officer in this regard is the Medical Director or their nominee.

All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .

In March I asked that an Accountable Officer short life working group be set up to examine the present course of care for women who experience mesh complications. As set out in response to a previous parliamentary question (S5W-22523 on 1 May 2019), the group has agreed a remit to consider what additional steps could be taken to offer choice to women who want – and are clinically suitable for – removal of mesh. The group will also review and identify areas of best practice in the United Kingdom and beyond, and if these are not already available, consider how these can be provided in Scotland. In doing this, the group will:

• consider the physical and psychological needs of women who experience complications following vaginal mesh surgery;
• consider sharing experience, techniques and learning with colleagues in Europe, the USA and elsewhere. For this to be successful it is important that surgeons and clinical teams engage with counterparts of proven merit and who are regarded by the professionals as leaders and innovators in their field
• review the course and organisation of care for patients suffering complications in Scotland with a broader UK perspective;
• examine the complex education and training requirements we must have to ensure a sustainable and resilient high quality service; and
• identify the resource requirements to provide the service our patients need.

To date the working group has met twice, and has begun to consider the matters set out above. Members have begun an exercise to benchmark the care pathways in each of their Health Boards against NICE guidelines published earlier this year, and have also started to consider the sharing of learning and experience with clinicians elsewhere. In respect of the latter, it has been agreed that a group of clinicians based in Scotland, including surgeons, a specialist nurse and physiotherapist, should undertake a series of visits to overseas clinicians in order to review, compare and contrast their practices with those currently in place in Scotland. The group will continue to progress arrangements for this. Furthermore, a protocol is being developed to ensure patients’ views are fed in to the group and are given its careful consideration.

The group aims to conclude its work in the autumn, at which point it will report to Health Board Chief Executives.

If a woman is concerned that she is experiencing complications after transvaginal mesh surgery, we would advise that:

• She should not hesitate to discuss her concerns with her GP or other clinicians involved in her care
• She can ask for a second opinion before making a decision about her care and treatment. Where possible, this request will be met, and her GP will be able to arrange this.

Advanced specialist services are currently provided in Scotland by two Mesh Complication Centres, one in NHS Lothian and in NHS Greater Glasgow and Clyde. These centres offer a range of treatments, including partial and full mesh removal, as well as non-surgical interventions. Patients should not hesitate to discuss with their GP their suitability for referral to these centres, regardless of their location, as regional and national referrals are accepted.

In a similar manner to above, if a patient is dissatisfied by the advice or with the care provided by the complication centre in either NHS Lothian or NHS Greater Glasgow and Clyde, then she can request to be reviewed by clinicians in the other centre.

Finally, a patient can make an individual request for treatment outside of Scotland. Clinicians will initially discuss any such request with the patient and, if agreed, will then refer it to the Health Board for consideration. The Health Board will review the application, in doing so considering whether the treatment requested can reasonably be provided in Scotland, and in due course will inform the clinician and patient whether the request is accepted.

All answers to written parliamentary questions are available on the Parliament’s website, the search facility for which can be found at http://www.parliament.scot/parliamentarybusiness/28877.aspx .

The Scottish Government does not have the information requested.

The site of the former Gartcosh steel rolling mill was subject to decontamination works at the same time as the M73 motorway was being constructed. This work was undertaken by Lanarkshire Enterprise (now Scottish Enterprise Lanarkshire) in partnership with North Lanarkshire Council. Consequently, the Scottish Government purchased a serviced site from Enterprise Lanarkshire.

You may therefore wish to contact Scottish Enterprise Lanarkshire and/or North Lanarkshire Council to see if they have any information on the costs associated with the works undertaken prior to the sale of the land, and subsequent construction of the Crime Campus.

Scottish Government officials offered support for employees of Healthcare Environmental Services Ltd (HES) as early as November 2018 through our PACE initiative. This offer of support was not accepted by the company until 27 December 2018 when HES made employees redundant. HES then agreed to a PACE event being organised for those employees. We asked HES if they would assist us to contact their employees but received no response. PACE Partners attended events on 3 and 4 January 2019 in Shotts where they saw 125 employees. On 10 January 2019 support was also offered to Dundee based employees where PACE Partners saw 6 employees.

There are many significant issues faced by the company, including a possible criminal investigation instigated by the Environmental Agency. It would therefore not be appropriate to undertake any form of review at this time.

The Government continues to support a replacement of University Hospital Monklands, to provide modern health facilities and a range of specialist services for the benefit of patients across Lanarkshire and those living with the Monklands catchment area.

I asked the Director General for Health and Social Care and Chief Executive of NHS Scotland to establish a review to provide me with an independent assessment of the process followed by NHS Lanarkshire including whether it had been consistent with best practice and meaningfully informed by the views of stakeholders.

I can now confirm the details of the review. The Terms of the Reference are to:

Provide an independent assessment of the process followed by NHS Lanarkshire to address:

• The concerns raised by elected representatives and local people about the quality of the option appraisal process and the wider engagement and consultation undertaken by the Board, and, in particular;
• Assess the quality of the information and analysis undertaken by the Board, and the robustness and accuracy of the evidence which informed the options appraisal process;
• Provide advice as to whether the Board’s process was fully in line with best practice and meaningfully informed at all relevant stages by the views of stakeholders, and to;
• Submit a report and recommendations to the Cabinet Secretary for Health and Sport by the end of February 2019, with initial findings to DG Health and Social Care by 15 February 2019. The recommendations should set out a clear set of actions to be implemented by NHS Lanarkshire in order to progress plans for the redevelopment of University Hospital Monklands, and may include any wider observations on the NHS Scotland consultation process more generally.

The Review Team will be chaired jointly by Professors Emma McIntosh and Olivia Wu, both Health Economists from the University of Glasgow. Dr Andrew Walker, also a Health Economist will provide additional input and advice. Dr Mike Higgins from the Golden Jubilee Foundation will provide clinical advice and planning input and analysis will be provided by John McNairney, Scottish Government Chief Planner, based in the Directorate for Local Government and Communities. The Team, can if they consider it appropriate, commission additional expert advice on an ad-hoc basis.

I have received assurance from the Chair of NHS Lanarkshire that they welcome the progress on confirming the Team and will co-operate fully and constructively in order to progress the plans for the redevelopment of University Hospital Monklands in the best interests of patients.

Professor Britton's report has been published today and can be viewed here: www.gov.scot/ISBN/9781787813342

The Scottish Government does not have this information to the level requested.

The Scottish Government purchased a serviced site from Enterprise Lanarkshire (now Scottish Enterprise Lanarkshire). The site had previously been de-contaminated by the enterprise company working in partnership with North Lanarkshire Council, although it is likely that some residual contamination would have remained. It is not possible to extrapolate accurate figures on the costs associated with decontamination due to the difficulties in separating out reclamation, decontamination and redial works costs.

In addition. the Scottish Government did incur some pre-enabling costs to provide for sub-surface ground clearance on the Campus site, and for putting in place road and utilities infrastructure. Again, it is not possible to draw from this those costs that would have been purely remedial in nature.

I have asked Colin McConnell, Chief Executive of the Scottish Prison Service, to respond. His response is as follows:

Scottish Prison Service (SPS) does not record the costs of housing differing categories of people in our care.

As a Key Performance Indicator, SPS publishes the Average Annual Cost per Prisoner Place in our Annual Report and Accounts. In 2017-18, the Average Annual Cost per Prisoner Place was £35,293.