Meeting of the Parliament

Meeting date: Wednesday, February 21, 2018

Official Report 909KB pdf

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St John’s Hospital Children’s Ward

The final item of business is a members’ business debate on motion S5M-10290, in the name of Neil Findlay, on St John’s children’s ward still being closed to out-of-hours in-patients. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that the children’s ward at St John’s Hospital, Livingston, was closed to out-of-hours inpatients on 7 July 2017 for the third time in five years; understands that the latest report from the Royal College of Paediatrics and Child Health has concluded that the area’s population should be served by a 24/7 inpatient service; believes that this reaffirms the college’s previous report on this matter; understands that the closure is due to an ongoing failure to recruit the appropriate staff, believes that, in its report, the college found the staff to be exhausted because of the continued pressure to maintain services with too few colleagues, and notes the view that NHS Lothian and the Scottish Government should set out a clear and realistic timetable for the establishment of a staffing model, which will both support the ward and its staff and end the closure for good.

17:20  

I say a big thanks to those members who signed the motion and enabled the debate to take place. There is an error in the motion: it says “out-of-hours inpatients” but it should say “all inpatients”; I apologise to the chamber for that.

I wish that there was no need for this debate. I wish that parents with desperately sick children from communities in the west of West Lothian, such as Blackridge, Whitburn, Armadale, Fauldhouse, Stoneyburn, Breich and Addiewell and beyond, did not have to endure long and sometimes life-threatening journeys to Edinburgh for treatment.

I wish that parents from Bathgate, the Calders and Livingston were not forced to drive past their local hospital, just a few minutes away, and travel on the chaotic Edinburgh bypass just to get treatment for their little ones, but they have no choice.

I wish that a decade-long promise by the Scottish National Party Government to keep healthcare local was more than a slogan on the long-since discarded election leaflets of the two cabinet secretaries who represent West Lothian—that it was a real promise that had been delivered for the residents of those constituencies.

Presiding Officer, six years ago the West Lothian Courier reported on a staffing crisis at St John’s hospital children’s ward. At that time it was about the withdrawal of paediatric trainees from the ward, and despite my representations to NHS Lothian and the dean who was responsible for the trainees, we have seen no progress in that regard.

The reality is that in the six years since those problems were first highlighted, things have got a whole lot worse instead of better. Three times we have seen the ward closed and reduced from a 24/7 in-patient service to an assessment centre. One of those times was because doctors who were a married couple took their holidays together. Why is it considered acceptable that a vital service is allowed to buckle because two members of staff—albeit quite naturally, and I do not condemn them for it at all—choose to take leave at the same time?

On each occasion on which there has been a closure, NHS Lothian has told me that it was doing all that it could to sort it out; it was scouring the globe for staff and it was just not possible to find any. The First Minister told me that it was just a temporary situation.

NHS Lothian also advised that, despite consultants being employed by NHS Lothian as a whole, it was unable to make them travel to Livingston or to work flexibly over different sites to provide a 24/7 service. Instead, children and families are expected to travel up to 33 miles when they need emergency treatment.

The latest closure is the longest and most worrying: almost 230 days ago the ward was closed to in-patients. From then until January, almost 500 children were sent to other hospitals and 414 of those were admitted to a ward. More than 3,000 children were sent home from the emergency department after midnight, and on 47 occasions taxis were paid to take them home, costing a total of almost £2,000.

The children who were sent to Edinburgh from St Johns did not have a grazed knee or a sprained ankle. They were children with very serious conditions, such as Mathew, who suffers from a serious respiratory problem; Frankie, who has a rare condition that causes him serious seizures that require very regular and urgent hospitalisation; and Kayden, who suffers from severe breathing difficulties and only last week had to be hospitalised at Wishaw general hospital. They are children for whom every minute in an ambulance and every second stuck in traffic or on the bypass puts their lives at risk.

Presiding Officer, over the last two years, NHS Lothian has twice brought in the Royal College of Paediatrics and Child Health to independently examine the need for the ward. On both occasions it has confirmed that St John’s needs a 24/7 children’s service. That is hardly a revelation, given that it sits in one of the youngest and fastest-growing communities in Scotland. Despite that confirmation, we find the situation getting worse instead of better.

I say to the cabinet secretary that the public have had enough. A few weeks ago, on a bitterly cold day, I was joined by families and children outside St John’s. Those parents contacted me because they wanted to demonstrate and vent their frustration at the situation, and I want to thank the mums, dads, grandparents, carers and children who came that day, as well as the thousands who have signed petitions, postcards and surveys calling for an end to this ridiculous situation. I will read out three quotations, which I can assure members are randomly selected, from some of the latest correspondence that I have had.

“The Scottish Government are fully accountable for this. They should be recruiting the necessary personnel to fill these posts.”

“There is no excuse for a hospital on your doorstep and not being able to use it for my three-year-old child.”

“I think this is an outrage. The ward should be open all the time.”

There are hundreds more.

If senior officers at NHS Lothian and ministers and civil servants in the Scottish Government do not have the ability or the initiative to resolve those problems after six years, maybe, just maybe, they should make way for people who can. Parents do not want to be fobbed off any longer. We need action to make that vital service sustainable—no more shrugs of the shoulders, no more platitudes, and no more absence of any sense of urgency—because children’s lives are at stake.

It is not a weakness to admit your failings, and we should all show humility and honesty at times, so I genuinely appeal to the cabinet secretary to seek help to resolve the issue from wherever it can be found, whether from other nations of the United Kingdom or from some of our international neighbours. I ask the Government to admit its failings, apologise for the mess and seek help to resolve this unacceptable situation now.

17:26  

I am grateful for the opportunity to add my voice to those calling for the return of a 24/7 service at the paediatric in-patient ward at St John’s hospital as soon as it is possible. I declare an interest, as my daughter-in-law recently gave birth to my first grandchild at St John’s, and I am thankful to the staff and the paediatricians for the care that my daughter-in-law and grandson received.

The report by the Royal College of Paediatrics and Child Health into the situation at St John’s hospital concluded—not once, but twice—that West Lothian, with the same population as Dundee and with a growing young population, merits and needs its own children’s ward. That recommendation was accepted by the Scottish Government and by NHS Lothian, and the updated report of September 2017 highlights the fact that

“The Health Board has tried extremely hard to make this arrangement succeed with four rounds of active consultant recruitment”.

However, there are two issues impacting on the success of the recruitment drive. First, there is a lack of paediatric consultants across the UK. The Royal College of Paediatrics and Child Health highlighted in 2017 that nearly a third of the UK’s 195 NHS trusts and health boards have temporarily closed paediatric wards due to shortages in child health professionals, the vast majority of vacancies being for consultants. Secondly, in relation to St John’s hospital, the royal college’s updated report states:

“It has a longstanding reputation as a unit that is under threat of closure ... This is a significant blight on recruitment.”

That is despite the Scottish Government and NHS Lothian accepting the recommendation that a 24/7 service should be delivered. It would be helpful if the cabinet secretary could highlight in her closing remarks what steps the Government is taking to ensure that NHS Lothian follows through on its commitment to respond to and implement the royal college’s recommendations.

West Lothian children have always had to travel to Edinburgh for particular types of care and treatment. That is well understood and accepted by the wider West Lothian community, but having the children’s ward at St John’s hospital prevents some children from having to be admitted to a hospital miles away from home. It also enables children who have had to receive serious and intensive treatment at the sick kids hospital or at Yorkhill to return to their local hospital for rehabilitation.

Lengthy hospital stays miles away from home have a well-documented impact on the wellbeing of children and a heavy financial and emotional cost to families. Therefore, treating children closer to home whenever possible is not just the right thing to do but the smart thing to do, and it is in everyone’s interests. That important point was made by the constituency MSP, Angela Constance, and others in the evidence that they submitted to the royal college when it was deliberating on paediatric services across the Lothians.

I will end by highlighting remarks that were made by the West Lothian constituency MSPs, Angela Constance and Fiona Hyslop. They said that St John’s hospital is a first-class hospital with a children’s ward that is held in high esteem by the local community. It is imperative that politicians do everything to support the recruitment of paediatricians and advanced nurse practitioners by being positive about the future and what the hospital offers. In our endeavours to protect and enhance local services, we must not create a negative message or what the royal college refers to as “blight.” That would be counterproductive and would do a disservice to the children and people of West Lothian.

I place on record my thanks and those of my colleagues to the doctors, nurses and wider support staff at the children’s ward at St John’s hospital, who do a tremendous job day in, day out in difficult circumstances. We stand by them in their quest to continue to deliver for the children of West Lothian.

I ask members to desist from shouting from a sedentary position at the back of the chamber.

17:31  

I congratulate my Lothian colleague Neil Findlay on securing today’s debate. I am pleased that Parliament is debating an issue of such importance to many families across West Lothian.

It is difficult to overstate the level of concern, frustration and anger felt by West Lothian residents at the continuing closure of the kids ward at St John’s hospital. When the latest closure announcement—the third in as many years—was made, last June, NHS Lothian and the Scottish Government indicated that a full service would be reinstated as soon as possible after the summer. The clear impression was given that we would see a 24/7 service resume last autumn, but, many months later, we appear to be nowhere nearer a reopening, and local people are understandably disappointed and annoyed.

Neil Findlay set out very effectively the impact that the closure has had on hundreds of families across West Lothian who have had to see their children admitted to Edinburgh sick kids hospital instead of St John’s, with all the extra travelling time, expense and stresses that that brings to parents who are already worried and anxious about the health of their child.

The closure has also piled extra pressure on the sick kids hospital and on overstretched ambulance services. On that point, a recent freedom of information request indicated that the number of patient journeys by ambulance from St John’s to the sick kids hospital increased fourfold when the ward was closed to in-patients compared to the number when it was fully open.

It is not only parents and families who are angry but the hard-working ambulance staff and the brilliant paediatric nurses, doctors and consultants at both the sick kids hospital and St John’s, some of whom I met on a recent visit. They have been let down by an abject failure over many years—despite warning after warning—by both NHS Lothian and the Scottish Government to put in place the robust, credible and long-term workforce plans that we must see at St John’s to allow the kids ward to operate sustainably on a full-time basis.

The inability to recruit sufficient consultants and tier 2s to cover the ward on a 24/7 basis is the fundamental short-term crisis that we need to resolve. I look forward to the minister updating the Parliament on what progress, if any, has been made on that and on what innovative approaches can be taken to develop and recruit the staff that we need at St John’s.

It is clear from the debate and from the past six years that the current approaches are not working and are not good enough. We need to see a longer-term approach that raises the profile and, more important, the prestige of the paediatric services at St John’s. That is why I have called on the Scottish deanery to launch a review of where paediatric training takes place in the south-east Scotland region, with a view to ensuring that trainee medics can choose to undertake part of their training at St John’s. When I visited them, the specialists there told me that that could help to make the unit a 24/7 unit once again

I hope that the deanery can show flexibility and look at all possible options and systems to allow that to take place, with St John’s children’s unit possibly being deemed a satellite of the sick kids hospital for training purposes. I believe that that would raise the status of children’s services at St John’s and provide more medics to assist the consultants team. It would also mean that medical students would have the experience of a hospital kids ward and that they could consider St John’s—which could present fantastic opportunities for an early career—and not just larger, more specialist hospitals such as the sick kids hospital when they were looking for full-time positions.

I will write to the deanery on that issue, and I would welcome the support of the cabinet secretary and other members for that initiative.

I welcome today’s debate. It is incredibly important to air these views and raise these issues in our Parliament. I am happy to give my full support to the motion and to my constituents across West Lothian, who want the sick kids ward restored on a 24/7 basis. As we have heard, the area’s population is growing and it clearly requires the level of paediatric service that is enjoyed in other parts of Scotland.

Above all, I hope that ministers will now take the decisive actions that are required to reopen the ward on a sustainable, long-term basis to give local families confidence that there will be no further closures and that West Lothian’s children will be treated in West Lothian.

17:35  

Like others, I congratulate Neil Findlay on bringing this important debate to the chamber.

At the outset, I say to Gordon MacDonald that what is letting down service users are the continued closure of the ward and the continued inaction of the Scottish Government and the health board, not the individuals who are campaigning to keep the ward open. Actually, I think that it is an insult to suggest that those campaigners, many of whom are parents who need the ward for their children and who are campaigning voluntarily and in their own time, are somehow scaremongering or letting down the local community. I pay tribute to all those who are out there on the streets, campaigning on this issue, but the reality is that they should not be campaigning. Year after year, they were promised that their ward was safe, would be open, fully resourced and fully staffed and would provide the care that their children deserved. It is a shame that we are now 230 days into this continuing closure.

I would like to say that St John’s is an isolated case, but sadly it is not. We need only look at the decision on the paediatric ward at the Royal Alexandra hospital, which, it was promised, would remain open, but is now closed. Aside from paediatrics, there have also been campaigns with regard to maternity services at the Vale of Leven hospital and Inverclyde royal hospital. In those cases, local campaigners who, during the election, were promised that their service would remain open are having to take to the streets and sign petitions to protect it.

Fundamentally, this debate and other debates that we have had on NHS services come down to the integrity of this Government, public trust, the transparency of our health boards, an on-going workforce crisis, the continued cuts that health boards are having to make and the vital services that people need locally. The reality is that this is not happening in isolation. In response to freedom of information requests, health boards across Scotland have said that over the next four years they expect to make £1.5 billion of cuts. That will impact on services. We also have a workforce crisis, with consultant vacancies across the country as well as 2,500 nursing vacancies. Our already overstretched, undervalued and underresourced NHS staff are having even more pressure piled on top of them.

The Government often hides behind what it claims is expert opinion, but what are the experts saying about this? The Royal College of Paediatrics and Child Health has made it very clear that St John’s requires a 24/7 in-patient service. Again, I put on record my thanks to those at the RCPCH and all the staff at St John’s who continue to go above and beyond.

We repeatedly hear the excuse that wards cannot remain open because of safety issues. My direct question to the cabinet secretary is: why have these wards been allowed to become unsafe on this Government’s watch? It is simply not acceptable. I note that this debate is happening on the same day that a survey was published, showing that two thirds of NHS board members do not believe that their NHS board is transparent with the public. It is a complete shame and, quite frankly, a sham for the people whom the boards are supposed to serve, and it is incumbent on the cabinet secretary to address those issues head on.

We have heard platitudes, warm words and promises before, but people will judge the cabinet secretary and the Government on their actions. I hope that the cabinet secretary will today set out a clear, realistic and honest timetable for reopening the ward and tell us how she will address the workforce issues—not just at St John’s but across Scotland—that are letting down too many of our patients.

17:40  

I am sure that everyone in the chamber believes that the on-going closure of St John’s in-patient paediatric service is unacceptable. We all accept that it is hugely distressing to staff, patients and their families. I, too, thank Neil Findlay for bringing the debate to the chamber.

In June last year, I attended a meeting with other concerned local politicians and NHS Lothian in the civic centre in Livingston. We sought assurances that the closure would be short term. It is fair to say that NHS Lothian could not provide an exact date for when the ward would reopen, but we are dismayed to find ourselves debating the issue in the chamber nine months later, with no resolution in sight.

We know that NHS Lothian has recruited one paediatrician, and has confirmed that an offer has been made to another candidate, but that will not solve the staffing shortages at St John’s immediately. I, too, reiterate that I fully support the recommendations from the Royal College of Paediatrics and Child Health on the future of St John’s. Gordon MacDonald made the point that the review team reported that the population, activity and demand for a full obstetrics service in West Lothian merits the retention of in-patient paediatrics at St John’s. I say to prospective consultants, who might be put off from applying due to uncertainty about the unit’s future, that the campaigning on the issue simply demonstrates the need for the service in the hospital, and that people in West Lothian and in this Parliament would warmly welcome them.

West Lothian is one of the fastest-growing parts of Scotland. It is a popular place to bring up a family, and families cannot afford to lose this vital service. The closure of the service at St John’s, as we have heard, puts pressure on the sick kids, our ambulance staff and other services, too. It is the year of young people in Scotland, and it reflects badly on us that, in 2018, young patients in West Lothian do not have access to a local in-patient service. Telling families that they are not unique and that the problem affects the whole of the UK is little comfort.

I ask the Government to really focus on the issue, because we need to get it right. I do not see any specific proposals in the Government’s health and social care workforce plans that would address the serious shortage of paediatricians in Scotland. There are calls for changes to the paediatric training status of St John’s. I support changes that would help to us to resolve the closure in a safe and effective manner. Equally, I understand that bringing more postgraduate trainees into the hospital would not necessarily allow the service’s hours to be extended.

New proposals to improve working across sites in NHS Lothian must be brought forward. It is unacceptable for such a needed facility to be closed to in-patients for this length of time. While recruitment is on-going, NHS Lothian, and potentially other health boards, should work to provide cover from other facilities. If we think that it is acceptable for unwell children to be taxied over to Edinburgh, we have to consider arrangements that could be put in place to support staff who could work on a temporary basis in St John’s.

We also have to ensure that families get appropriate help with travel expenses and other immediate costs. I visited the family support and financial inclusion service at the Royal hospital for children in Glasgow and learned about the financial support that it gives to families that often arrive in real distress, with a sick child, at any time of day or night, and worry about what will happen next. I would like that approach to be embedded in every major children’s hospital in Scotland, with reliable funding. I would like assurances that families with sick children in West Lothian will have support with expenses, and that they will know where to get that support.

Again, I stress that, fundamentally, the recruitment issues come down to a shortage of qualified doctors. We have to bring adequate numbers of students through our medical schools. We need to improve and widen access to medical degrees. I know that universities in Scotland are leading some great work. For example, the reach programme targets secondary schools with low rates of progression and encourages pupils into higher education.

However, we need to do more. Will the cabinet secretary inform us what action will be taken that has not been taken to date? Action is long overdue and it is needed now.

17:44  

I congratulate Neil Findlay on bringing this important debate to Parliament and the campaigners who are fighting tirelessly to keep the issue in the forefront of our minds, not least for the benefit of my constituents who have regular cause to use the children’s ward at St John’s.

It is fair to say that the Government enjoys the support of every party and every member in the Parliament in its laudable aim of making Scotland the best place in the world to grow up in, but we will forever be adrift of that ambition when one of the principal children’s wards to serve not just West Lothian but communities within the confines of our nation’s capital can experience such a consistent manifestation of abject distress. That state of affairs gives light to many failures of Government policy. The fact that those children who require admission are transferred to Edinburgh sick kids hospital impacts not only on their lives but on the capacity of that hospital. It is a depressing situation.

It is depressing, too, that the challenges that the children’s ward at St John’s faces have again been raised for debate by an Opposition member rather than in Government time. I ask the cabinet secretary to reflect on that and to seek to hold a Government debate on the matter.

We are talking about a can that has been kicked down the road for six years. My friend and colleague and predecessor as a Lib Dem MSP, Alison McInnes, said in 2012:

“Parents deserve to have faith that St John’s is operating at world-class levels and not surviving from day to day.”

Six years on, the children’s ward at St John’s is still surviving from day to day. Closures and partial service reductions happened in 2012, in 2015 and, as we now know, more extensively in 2017 and 2018.

In many ways, the situation at the children’s ward at St John’s represents a microcosm of problems that exist throughout the NHS as a result of the upward pressure that is exerted on every department and every hospital and primary care setting. There is unmet demand, patient inconvenience and discomfort, and inadequate workforce planning. The Government’s record on workforce planning and child health in general is not great. Youngsters face two-year waits for first-line treatment in child and adolescent mental health services. Children’s wards have been closed in other parts of the country—Anas Sarwar rightly mentioned the Royal Alexandra hospital—and there are other examples of the part-time provision that we see at St John’s.

The treatment of our children should be the first priority not just of the Cabinet Secretary for Health and Sport but of the First Minister and the Government in its entirety. It should be the alpha and the omega of every consideration of healthcare spending and healthcare priorities. We are talking about the lives and the welfare of some of the most vulnerable children in our society, some of whom are critically unwell and many of whom are on uncertain journeys. At such times, people need certainty in the care that we can offer them. Despite that, we hear that 400 children have been transferred to an unknown destination, which has often turned out to be the Edinburgh sick kids hospital.

We know that the demand is there—we have heard a lot about that in the debate. The Royal College of Paediatrics and Child Health rightly suggests that the population that is currently served by the children’s ward at St John’s is adequate enough to sustain 24/7 service provision; in fact, such provision is required. Three thousand children a year use that facility, 1,000 or more of whom require overnight care. We are not talking about a rural area or an island community—the area in question is just a short drive from this chamber—yet for the past six years the Government has been found wanting in dealing with the staffing crisis that we in the Parliament have known about all that time. We have lurched from crisis to crisis.

I am proud to stand alongside Neil Findlay, other Opposition members and the campaigners in the gallery and outside who want to see action, not words. Enough is enough.

17:49  

I, too, thank Neil Findlay for bringing this important debate to the chamber. Together with him and other local politicians, I have previously been updated in person on the issue, but it has now dragged on beyond comprehension. When we sat together at the civic centre in Livingston in early summer last year to be updated on the third prolonged period of closure of the children’s ward in six years, one dared to hope that a solution might be in sight.

Some progress seems to have been made. Last month, we learned that a sixth new consultant was to join the team—and possibly a seventh—but that was still not enough to provide a safe and stable working rota. Safety must, of course, be paramount. My understanding is that the Royal College of Paediatrics and Child Health has said that in-patient services should remain suspended until such time as an eighth consultant has been employed.

However, the appointments that I have just spoken about came one month after the ward was shut down entirely for two days in December. Progress was supposed to indicate moving towards option 1, rather than moving away from it by closing the ward altogether.

The review of paediatric in-patient services in Lothian that was conducted in 2016 rightly concluded that in-patient children’s services should be retained at St John’s for the long term. That makes sense if we consider the local need, which my colleague Miles Briggs and others have already touched on. Those who know Lothian, and West Lothian in particular, know it as a growing area, popular with young families. The population is expected to grow by well over 10,000 over the next two decades, so the need is increasing rather than decreasing.

When the review was undertaken, the team was told that the children’s ward often came very close to capacity, and the second review into paediatric services concluded that there is “no quick fix”. However, to have ended up in such a dire set of circumstances in the first place is surely unacceptable. The Health and Sport Committee inquiry in December 2016 stated—diplomatically, perhaps—that since previous concerns had been raised years ago,

“planning does not seem to have become more successful.”

The reality appears to be that it has been getting worse.

If indeed there is no quick fix, surely the pragmatic approach that has been advanced by Opposition parties today should be fully considered by the Scottish Government. Adding flexibility by giving teaching accreditation for paediatrics to St John’s, which was mentioned by Miles Briggs, might not only replenish staff levels in the here and now but raise the profile of the ward to ensure future staffing sustainability. Embedding some stability in staff levels could be brought about in that way by turning St John’s into a paediatric teaching hospital. That could provide a service that is so desperately needed by the people of West Lothian, and ensure its continuance. I look forward to hearing what the cabinet secretary has to say to that specific proposal.

17:52  

I welcome the opportunity to respond on this important topic and thank Neil Findlay for bringing the debate to Parliament. I will begin by explaining why an interim model of service for the in-patient paediatric ward at St John’s hospital has been implemented.

Last July, the Scottish Government was advised by NHS Lothian that staffing levels for the ward were fragile and at risk, such that there would be no backup available if a member of staff was absent at short notice—for example, if they fell ill. That could have caused confusion and anxiety for parents and staff, and possible delays to emergency care. Therefore, the board’s chief executive, supported by the medical director, took the decision to implement an interim model in the best interests and for the safety of children and their families.

It is important to stress that the decision that was taken by the board to implement an interim model has resulted in the majority of children’s services being maintained at St John’s. The children’s ward is open 8.00 am to 8.00 pm five days a week, and provides a short-stay paediatric assessment service. Although the original plan was for children to be redirected to the Royal hospital for sick children at weekends, the board has been able to maintain a daytime weekend rota on all but three occasions since July 2017, and the paediatric ward has remained open for day-surgery activities as well as planned day-case procedures and programmed investigations. Paediatric out-patient services, neonatal services and community child health services have all been unaffected, and the accident and emergency service at St John’s continues.

So, a wide range of children’s services continue to be available in West Lothian and the vast majority of children who require services have continued to receive them locally at St John’s.

For the children who have to travel, it is important that support is provided. In response to Alison Johnstone’s question, I can confirm that that is the case. The board should be making parents aware of that.

I want to respond to Miles Briggs’s comments about the position of St John’s as a training facility. First, it is important to be clear that any decision about training status rests with the dean of postgraduate medicine at NHS Education for Scotland, in accordance with the standards that are set out by the General Medical Council. Members should also note that St John’s is already a recognised training facility. There are currently six trainees in the paediatric unit at St John’s. Those doctors are at a relatively junior level and need to acquire skills and experience in paediatrics.

I am advised that NHS Lothian has recently met the training programme directors to explore the placement of ST3—specialist trainee year 3—trainees for daytime experience within the unit, and further details of the experience that might be delivered to those trainees have recently been provided by the unit and are being actively considered by the training committee. If ST3 trainees are placed within St John’s on a daytime basis, I am advised that they will not be able to participate in the out-of-hours service because patient throughput does not provide the educational opportunities that such trainees need and therefore would not meet GMC standards. However, I am happy to ensure that members are kept informed of progress in the discussions, because I think that it would be an important step forward.

NHS Lothian has taken a number of steps to improve consultant recruitment at St John’s, in line with the college’s recommendations. I understand that, following extensive recruitment campaigns, six new consultants are now in post and interviews in January this year have resulted in an offer being made to another candidate. The board is now, as required, in the process of completing the necessary pre-employment checks, and is hopeful of a successful outcome. That is heartening and demonstrates the board’s determination to put in place a safe and sustainable rota to allow the return to a 24/7 service. The board remains committed to recruiting an eighth consultant in order to meet fully the recommendations in the Royal College of Paediatrics and Child Health’s 2016 report.

I am also aware of the board’s commitment to strengthening its advanced nurse practitioner workforce. Two internal members of staff are currently being trained in that role within the children’s ward. On top of that, NHS Lothian intends to rerun an advertising campaign for qualified practitioners while also running an internal campaign offering nurses the opportunity to train in the role, following consideration by the board in April. As I have said, NHS Lothian remains committed to reinstating the 24/7 service and I believe that the recruitment efforts to date demonstrate that; I do not think that those are the actions of a board that is shrugging its shoulders.

It is important, given the fragility of the service—which Neil Findlay mentioned in his speech—to recognise that to avoid that fragility in the future, we have to make sure that the RCPCH’s recommendations are delivered. It seems to me that the recruitment efforts and success so far have got the board quite far down the road towards implementing the recommendations. That should give us confidence that it will complete the journey.

The RCPCH recognised in 2017 that there is no quick fix and that a long-term solution is needed, which will depend on successful recruitment of consultants and advanced nurse practitioners. As I have outlined, the board has been absolutely focused on that. The key recommendations were that the board should develop a 3-year strategy and action plan towards full implementation of the RCPCH report of 2016; that it should increase the number of advanced nurse practitioners; and that it should maintain and strengthen the short-stay paediatric assessment unit. All those recommendations are in hand.

The issue is that the RCPCH report was in 2016 and the situation has been going on for six years. The cabinet secretary says that there is no quick fix; surely people can expect progress, after such a long time, in ensuring that the service is back up to full speed?

I have just taken quite some time to outline the progress that has been made. The college said that eight consultants would be required to get back to a 24/7 service. The board is in the process of appointing the seventh consultant. I do not think that that says to any reasonable person that no progress has been made. Getting seven out of eight consultants shows that progress is being made. Yes, the board has to recruit the eighth consultant, and yes, it has to make sure that the advanced nursing staff are there. However, to say that no progress has been made is not a reasonable assessment of the situation.

Will the cabinet secretary take an intervention?

No, thank you.

The paediatric programme board was set up to implement the recommendations of the college’s report of 2016, and it has been working hard to do so. It has been formulating a strategic plan and vision for services at St John’s which, again, is important if we are to recruit to the hospital people who could go anywhere in the world. There has to be a good vision for the service and we have to promote the hospital in a positive light. The board has had some success because many of the posts have been recruited on a network basis, which I think has made them more attractive. However, that vision for the hospital is important.

Will the cabinet secretary take an intervention?

Just a second.

Options to be developed by the programme board, through wider involvement from clinical stakeholders, will be finalised at a workshop in early March. Those options will be presented at the NHS Lothian board meeting in April. Again, there is a sense of momentum in that, and the board is looking at what else can be done.

The cabinet secretary was just closing, but if she is willing she may take the intervention.

I thank the cabinet secretary for taking my intervention.

As you have heard today, there is a lot of frustration among members of all parties at the lack of progress and the lack of information being provided. Will you commit to updating Parliament on the issue, so that we can progress it, and to take it to NHS Lothian? In my time as a member of the Scottish Parliament, the lack of information from NHS Lothian on the issue has been pretty shocking, and we have been kept in the dark on it for too long.

I remind members that they should always speak through the chair rather than having direct conversations.

First of all, we always make NHS Lothian aware of issues that are raised during debates. Of course I will be happy to do that. I am aware that NHS Lothian provides regular briefings to MSPs. Those are opportunities to hear some of the detail, but I can certainly feed that back and make sure that it the board provides information. Communication—not only to MSPs, but to the public—is important, as is knowing that progress is being made in the recruitment efforts.

I end by emphasising the Government’s on-going commitment to a fully sustainable, safe and high-quality NHS, of which the workforce is a crucial element. That will be helped by the £400 million increase in the budget for 2018-19 for which some of us have just voted at decision time.

I have asked NHS Lothian to keep me closely apprised of the outcome of its on-going recruitment efforts and have been assured that recruitment continues to be of the very highest priority.

I thank everyone for their contributions to the debate. I will be very happy to make sure that members are kept fully informed of the recruitment efforts with a view to returning St John’s to a 24/7 service as soon as possible.

On a point of order, Presiding Officer.

First of all, I should say that that concludes the debate.

I am sure that the cabinet secretary did not mean to mislead Parliament, so I put on the record that NHS Lothian used to have regular briefings for members but, to my knowledge, there has not been one for nine months or a year. I have written to NHS Lothian twice about that, but have not had a response.

That was not a point of order, but I understand that the cabinet secretary is quite happy to respond with her point of view on it.

I am certainly happy to suggest to NHS Lothian that it might want to brief elected members regularly. However, there is also an onus on elected members to ask NHS Lothian to meet them and to brief them fully. I imagine that it would be quite happy to do so, should the member request a meeting.

Meeting closed at 18:03.