Meeting of the Parliament

Meeting date: Tuesday, January 23, 2018

Official Report 905KB pdf

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Health Service Changes (NHS Greater Glasgow and Clyde)

The next item of business is a statement by Shona Robison on the decisions on major service change proposals in Glasgow and Clyde. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions.

14:26  

I welcome the opportunity to inform members of the decisions that I announced on Friday 19 January on service change proposals submitted to me by the chairman of NHS Greater Glasgow and Clyde.

On 14 March 2017, NHS Greater Glasgow and Clyde submitted major service change proposals for Clyde in-patient and day-case paediatric services. That was followed on 16 August by the board’s submission of major service change proposals for rehabilitation services in the north-east of Glasgow, including Lightburn hospital.

Before I turn to the detail of each proposal, I will explain my decision-making process. Given the significance of the proposals, I took appropriate time to consider them. I asked for, and received, advice, including expert clinical views. I also visited the paediatric ward at the Royal Alexandra hospital, the new Royal hospital for children on the Queen Elizabeth university hospital campus and Lightburn hospital.

Alongside those visits, I met local stakeholders, including campaigners seeking the retention of paediatric services in ward 15, as well as patients and carers. In considering the proposals for Lightburn hospital, I met the local Parkinson’s group. I also received reports from the Scottish health council confirming that NHS Greater Glasgow and Clyde had complied with and met established guidance on involving, engaging and consulting with local people, thereby providing them with the opportunity to make their views known.

I will now address my decision in relation to the Lightburn hospital service change proposals. I make it clear that I have carefully considered all the available information and all the representations made to me. In doing so, I have had to consider whether the board had made a compelling case in the best interests of patients and whether the board had credible and viable plans for the provision of high-quality local services.

I have been consistently clear during the board’s review process that the final proposals had to effectively address the concerns that resulted in our rejection of the previous Lightburn closure proposals in 2011. Local people have raised concerns that those concerns had not been addressed in the current proposals.

In considering the proposals, my paramount concern was that, if they were implemented, they would result in the removal of a significant and highly valued healthcare facility in one of the most deprived communities in Scotland. I accept local clinicians’ views and have given very careful consideration to them and to their support for the closure of Lightburn hospital. However, I had to balance those views against my concerns that the proposals for the replacement of local community and support services are not yet sufficiently developed to support the closure.

I make it clear that it was not an easy decision. I fully agree that healthcare services cannot be static and that reform will sometimes be necessary. In my letter to the board setting out my decision, I have acknowledged and welcomed its commitment to work with other planning partners to develop, as a priority, a health and social care hub in east Glasgow.

I have reiterated to the board that engagement with and involvement of the local community is of paramount importance in future planning. Of course, that applies to all NHS boards that are considering service redesign; I will take the opportunity to reinforce that at my next meeting with NHS chairs.

I turn to my decision to approve the board’s proposals to transfer in-patient and day-case paediatric services from ward 15 at the Royal Alexandra hospital in Paisley to the Royal hospital for children in Glasgow.

I gave long and hard consideration to the proposal. It has been one of the most difficult decisions that I have been required to make in my time as health secretary.

As with my consideration of the Lightburn proposal, I have carefully considered all the information that is available to me and all the representations that have been made to me, including the board submissions, advice and evidence that officials provided, and expert clinical advice.

My judgment had to be on whether the board had made a compelling case in the best interests of patient care, whether it had credible and viable plans for the provision of high-quality local services and whether the proposals were consistent with national guidance.

Having taken time to come to a decision, I have approved the board’s proposals. In coming to that decision, I recognised that only in-patient and day-case services will transfer and the majority of patient cases will continue to be seen and treated locally. I stress that the accident and emergency departments at both RAH and Inverclyde royal hospital will continue to receive paediatric patients who self-present and that the out-patient clinics and specialist community paediatric services will also continue.

The board made a compelling case for the proposals, which attracted overwhelming clinical support. Only today, I received a letter from the lead paediatric clinicians and the chief nurse for paediatrics and neonatology at RAH and the Royal hospital for children, in which they reiterated their clinical support for the proposals. They told me that the change will help to implement the standards that the Royal College of Paediatrics and Child Health set to ensure that high-quality healthcare is delivered to children and young people, and that

“the implementation of these standards will contribute to better outcomes for children and young people”.

They also highlight the benefit to patient care of access to dedicated on-site, sub-specialty medical teams such as cardiology, neurology, nephrology and respiratory medicine teams—to name but a few.

There is further support in the submission of Action for Sick Children Scotland—now Children’s Health Scotland—to the board’s consultation, in which the charity concluded:

“the most compelling argument is that clinical standards are there to support the best quality healthcare for all the children of Scotland and we feel that this would be best achieved by moving Ward 15 to the Royal Hospital for children.”

The local clinicians also offer the reassurance on emergency care that they do not

“see any risk to future patients affected by the change in an emergency pathway that directs General Practitioners and Scottish Ambulance Service to RHC instead of either RAH or RHC. The change is clear for all concerned.”

From the representations that have been received and the meetings that I have attended, I recognise that many local people, particularly in the Paisley area, will be deeply disappointed by the decision. I recognise that the services that families have received from ward 15 have been highly valued and that there are understandable concerns about access to the specialised services that are to be transferred to the Royal hospital for children and about how such services will be integrated into the out-patient and community services that will continue to be provided locally. There are also issues to do with transport and financial support, and family support and information services.

That is why I approved the proposals on two conditions. Condition 1 is that the health board must maintain and continue to improve community-based paediatric services, and must maintain local provision. Condition 2 is that the board must work directly with families from the Paisley area to complete specific, individual treatment/service access plans before service changes are made, and ensure that there is a full understanding of what services and support will be available to people, and from where.

The letter from the Glasgow clinicians gives an assurance that the open-access families who currently attend ward 15 will be fully involved in planning how the changes will affect their children and that specific concerns will be addressed on an individual basis. I have spoken to the board chair and reiterated the conditions that I set out in my letter of approval, and I have received a letter from him that gives me assurance on them.

I hope that local families, members of the campaign group and members of the Scottish Parliament will understand that I have made this decision in good faith, informed by all the available evidence and representations. With the underpinning conditions that I have put in place, I believe that the decision is in the best interests of children across the Clyde area.

Thank you, cabinet secretary. We turn now to questions.

I thank the cabinet secretary for the advance copy of her statement.

On 1 May 2016, Nicola Sturgeon promised the public, in relation to ward 15 at the RAH:

“There’s no proposals to close that particular ward. I believe in local services for local people.”

Here we are today, two years on.

Yet, at that time, NHS Greater Glasgow and Clyde had begun looking into moving in-patient paediatric services from RAH, initially in 2011, when Nicola Sturgeon was the Cabinet Secretary for Health and Sport. The closure of the ward to in-patients had been on the board’s list of preferred options since 2012, also when she was the health secretary. The board stepped up efforts to centralise services after the opening of Glasgow’s new Royal hospital for children in 2015, when she was the First Minister.

Did the First Minister forget all of that when she promised, at a public event in 2016, that she would not close the ward, or did she intend to attempt to mislead the public before an election? I believe that today will go down as Nicola Sturgeon’s and the health secretary’s Nick Clegg moment in this Parliament. Now, we see the health secretary and the SNP back benchers hanging their heads in shame in order to justify the decision to Parliament, breaking a key election pledge that was made to families across the west of Scotland.

Does this ward closure, coming on top of the SNP’s failure over children’s hospital services and the on-going incidents that we have seen as well as the closure of the kids’ in-patient ward at St John’s hospital in Livingston, not demonstrate that the public cannot trust a word that the First Minister or the SNP Government says when it comes to our local health services?

First, I will address the issue that Miles Briggs raised about the First Minister’s comments on 1 May 2016. Let me say two things very clearly about that. NHS Greater Glasgow and Clyde approved its proposals on 18 October 2016, well after the comments that were referred to had been made. More importantly, the Scottish Government received the submission on 14 March 2017, almost a year later. That was the first time that I saw the clinical advice on which I have based my decision—and it is that clinical advice that is absolutely critical.

I have based my decision on the clear clinical view—including that of the very clinicians who work with the kids on ward 15—that this decision, as I said in my statement, is about delivering better outcomes for children and young people. Therefore, when Miles Briggs or anyone else says that I am wrong in my decision, they must also be saying that those clinicians are wrong in their decision.

I am not sure on what basis Miles Briggs is able to say that or what experience or evidence he can put forward to say that those local clinicians are wrong. As a politician, I cannot say that those local clinicians are wrong. That is why I accepted their evidence and this decision, despite how difficult that was.

Let me reiterate that, for all those families, plans will be put in place before the closure goes ahead. I hope that that is some reassurance to the families concerned.

I thank the cabinet secretary for advance sight of her statement, and I pay tribute to the save Lightburn campaign and the kids need our ward campaign. They are local residents and service users who are fighting tirelessly to protect their local services—services that, during the election, they were promised would stay open. Sadly, while one group is celebrating for now, the other is rightly distraught and dismayed.

The reality is that we should never have been here in the first place. When it was faced with a leaked cuts paper, the Government denied that any proposals to close Lightburn hospital or the RAH paediatric ward even existed. Neil Bibby was called a liar. Paul Martin was called a liar. Kezia Dugdale was called a liar. The campaigners were accused of scaremongering. Yet, the closure is now confirmed and 8,000 patient cases will be transferred to the already overstretched Queen Elizabeth university hospital as a result of cuts that were imposed by the Government and a workforce crisis that is being overseen by the cabinet secretary.

Not a single Scottish National Party MSP has the backbone to call out the cabinet secretary’s decision for what it is. Where were the local MSPs, George Adam, Tom Arthur and Derek Mackay? Nowhere. Where was the local MP, Mhairi Black? Nowhere. When Nicola Sturgeon was confronted by a local resident live on national television, she said:

“There are no plans to close this ward. I pledge to keep hospital services local.”

The cabinet secretary’s decision is a betrayal of local people. How can we trust a word that she or her Government says ever again?

As I said to Miles Briggs, the submission from the board came to me on 14 March 2017. That was the first time that I saw the clinical advice on which I have based my decision. If Anas Sarwar is saying that that is the wrong decision, he must also be saying that the local clinicians who have treated the children in question for many years are wrong in their clinical judgment, because that is what I, as a politician, have based my decision on. If Anas Sarwar thinks that he knows better than those local clinicians, he had better say what evidence he has that makes his position stack up.

Anas Sarwar mentioned the cuts paper. I will say two things about that. The issue of finance is quite important here. In relation to ward 15 at the RAH, it is estimated that about £840,000 will be reinvested in local paediatric services at the RAH and the Royal hospital for children. Every penny of that money will be reinvested in paediatric services at those hospitals. If I had wanted to save money, I would have given the Lightburn proposal the go-ahead, because it would have saved £4 million.

My decision is nothing to do with money; it is to do with the clinicians’ view of what will provide better outcomes for children and young people. As a politician, I cannot ignore the clinicians who tell me that the decision that I have taken will provide better outcomes for children and young people. I challenge any politician in this place to ignore that clinical advice.

Does the cabinet secretary agree that the decisions that have been announced on NHS Greater Glasgow and Clyde’s major service change proposals show that the review process is robust and evidence based and that, when there are good reasons—ones that are in line with the Scottish Government’s national clinical strategy and other policies—to overturn health board proposals, as in the case of Lightburn hospital, the process reaches the correct decisions?

Yes. The Lightburn proposals were not sufficiently developed to be viable or credible. In essence, the east end hub is a good idea but it must be developed. We want the Lightburn site to be considered as one of the sites for that hub, but there is far more work for NHS Greater Glasgow and Clyde to do in developing the hub proposal. I think we would all agree that the proposal has some merit, but it was at such an early stage that I could not possibly have approved it in the form in which it came to me.

When does the cabinet secretary expect the agreement process for families whose children currently receive treatment in ward 15 of the RAH to conclude? What will happen if agreements cannot be reached?

I have made it clear to the board and its chairman, John Brown, that plans for those families who have complex health needs—of whom there are around 200, many of whom are on the open-access agreement—must be in place before the changes go ahead. John Brown has written back to me to agree that, and, in their letter, the clinicians also say that that is important.

The plans need to make clear how the families will access the new hospital and what local services will still be provided to them. When I approved the proposal, I made it clear that it was a condition of my doing so that all those plans needed to be in place, and I will certainly hold the board to that.

Over 17,000 people supported the campaign to stop the closure of the kids ward, including NHS staff and patients with direct first-hand experience of the excellent care that it provides—parents such as Karen Meikle, who told the Paisley Daily Express today about what it means for her eight-year-old son, who has a life-limiting condition.

The way in which SNP politicians nationally and locally have behaved has left local families feeling totally betrayed and without any trust left in the Government. Throughout the process, the cabinet secretary assured families that she would listen. Families could not have been clearer. Why have they been ignored?

The cabinet secretary has snubbed parents with this announcement. Will the cabinet secretary agree to come to Paisley and explain her decision directly to the parents affected, or will she snub them again?

I did not snub the parents. I met the parents and listened to their concerns. I also listened to the local doctors who have been involved in treating those same children. I had to make a decision, and the decision I made was based on the very clear local clinical advice from those doctors who know the children well: that this was in the best interests of those children, and that they would get better, not worse, outcomes from being treated at the new children’s hospital. No politician would ignore that clinical advice.

It is important that the board now gets on and develops those plans, so that the families have assurance on the access arrangements that they will have at the state-of-the-art new hospital, less than 7 miles away.

Last year, I visited the hospital. I learned about the work that the family support and information service does to support patients and their wider families. I met parents who had taken their child to hospital, their child was admitted immediately and they found themselves practically living in the hospital for weeks.

I was surprised that much of that important work was largely funded by and reliant on charitable donations. Given that this major service change will generate increased demand in the hospital, will the cabinet secretary take steps to ensure that the service is fully funded and sustainable, so that those families who are travelling further, leaving home for longer and leaving caring responsibilities behind will be properly supported?

I thank Alison Johnstone for her question and reassure her that part of the commitment that the board has given on the reinvestment of the £840,000 is to make sure that there is a build-up of local services, not just at the RHC but also at the RAH. Part of that is about ensuring that there are plans in place for those families, for travel or subsistence or for any other matter. It is important that they know about the plans.

I reiterate that, where emergency care is required, the clinicians are clear that the change in the emergency pathway that directs general practitioners and the Scottish Ambulance Service to the RHC is a better and safer model. There is then clarity about where children are to go in an emergency.

A lot of the care, particularly out-patient facilities and local community paediatric services, will continue to be delivered locally. For children accessing A and E services in the Paisley area, 86 per cent will continue to be seen at the front door of the RAH. The vast majority of children in that area going through A and E will continue in the same way as they do at the moment.

In her statement, the cabinet secretary said of her decision to close the children’s ward at the RAH:

“it has been one of the most difficult that I have been required to make in my time as Health Secretary”.

That reflection should give us the measure of how significant a decision the closure is, not just for the cabinet secretary but for the families who rely on the ward and those members in this chamber who have fought to save it.

Will the Government now commit to honouring those motions already agreed to in this chamber to bring such decisions to Parliament before they are taken, to allow members to debate and scrutinise the proposals so that, in particular, we might give better voice to the people whom such closures will affect?

These are difficult decisions. I met the parents and families and I understand the strength of their feeling. However, as the cabinet secretary who is required to make those difficult decisions, I have to take a step back from that. As a politician, I rely on the expertise of those who know the children well and who can give me the best advice about the most effective and safest care. In this case, or in any other, the clinical advice is critical.

That has to be the decision-making process, otherwise proposals for service change that could raise patient safety issues could be brought for debate on the floor of the Parliament. Are decisions about patient safety going to be made on the basis of a vote in this place? I do not think that that is a credible or safe way to make changes to our health service. The decision rests with me and I have made the decision on the basis of what the clinicians have told me is in the best interests of, and will bring about the best outcomes for, those children and young people. I have made no other considerations. I hope that every politician in this place will understand that we cannot ignore that.

I do not think that there is a paediatric specialist in the Parliament—I am not one—so I rely on the expertise of those who have advised me. That is the basis of my decision and that is why it is the right decision.

I remind members that I am the parliamentary liaison officer to the Cabinet Secretary for Health and Sport.

The cabinet secretary has mentioned several times the clinical advice that she received. Can she explain to the Parliament what weight she gave that advice from clinicians as opposed to the other advice that she heard?

I had a meeting with the clinicians at the hospital and what I heard directly from them was compelling. It was about the fact that they would be able to provide better outcomes for the children and young people because of the range of back-up services that are at the state-of-the-art new children’s hospital that is less than 7 miles away. That evidence and guidance was very clear to me and, as a politician, I rely on that.

Subsequent to that meeting, clinicians sent me a letter—I received it this morning—reiterating what they had said and the importance of working with the families on the plans, particularly those families who have been on what we have called the open access arrangements.

The clinical advice has been compelling and, as a politician, I cannot ignore it. That advice—nothing else—was the basis of my decision and it is why I had to make the decision that I made.

The cabinet secretary said in her statement that both accident and emergency departments at the RAH and Inverclyde would continue to receive paediatric patients who self-present, but she did not explicitly state that those hospitals would continue to accept all forms of emergency cases, including those presented by ambulance. Will the cabinet secretary confirm that there are no plans to divert any emergency care from Inverclyde to the RHC? Can she outline any scenarios under which a decision might be taken to take a patient to the RHC instead of the nearest accident and emergency department?

That happens already. The Scottish Ambulance Service already takes those children who will require the services of the RHC directly to the RHC. Those decisions will be made on the basis of clinical decision making, which depends on what the child’s illness is.

When children are concerned, the risk is managed very carefully indeed and the service always errs on the side of caution. That has always been the case for all our local hospitals. When we have a state-of-the-art hospital with all those back-up services, such as the one we have in Glasgow, if the service is not absolutely sure what is wrong with a child, it will always err on the side of caution and go straight to the children’s hospital. I would have thought that people would understand that that is the right thing to do.

However, I reiterate that in the case of self-referrers—parents who turn up with their child through the door of the RAH or indeed any other local hospital—the process will continue as it is and 86 per cent of those children will be seen and treated within the RAH. I hope that that reassures the member.

As it is one of the main concerns raised by my constituents, can the cabinet secretary assure them and reiterate that plans will be put in place for the open-door families, including on transport links, before any service changes are made to ward 15 at the RAH?

The issue that George Adam raises is very important, because the families that he refers to who are on open-access, or open-door, arrangements are families who have children with complex health needs. Therefore, it is important that plans to ensure continuity of care and treatment are put in place. The board has given me that assurance, as have the clinicians who work with the children every day, in the here and now. I confirm to George Adam that I expect the arrangements to be in place before the change goes ahead.

There is no getting away from the fact that when the First Minister was asked in a television debate whether the children’s ward at the RAH would close she was clear that she would not close the ward.

The cabinet secretary knows that there were proposals to close the ward before May 2016. The First Minister has given similar commitments to my local community about the Vale of Leven hospital and the vision for the Vale.

Did the cabinet secretary consult the First Minister about her decision? Was the First Minister copied in to the minute of the decision? Was the minute ever circulated? This is, fundamentally, a matter of trust. The key question for me is whether we can now trust anything that the First Minister tells us.

As I have said now on three occasions, no proposal to close a particular ward had come to us. The proposals came to the Scottish Government only on 14 March 2017. That was the point at which we saw the clinical evidence in favour of the decision. The decision is based on clinical evidence alone and that is the first time I saw that clinical evidence—

Really?

Yes. Really. The first time I saw the clinical evidence was after 14 March, and speaking to the local clinicians has been a fundamental part of my decision making. The decision is my decision; it is required to be my decision. Of course, the First Minister has been made aware of my decision and she accepts it fully.

I refer members to my entry in the register of members’ interests. I am a mental health nurse with an honorary contract with NHS Greater Glasgow and Clyde.

Given the welcome decision to reject the closure of Lightburn hospital, how does the cabinet secretary expect the board and planning partners to take forward provision of health and social care in partnership with the local community?

A lot of work has to be done around Lightburn. The hub was at a very early stage and not in a viable form to approve. Within it is the concept of something quite good and quite exciting—the idea that people have a range of services that are not currently available locally in the east end of Glasgow under one roof, under the hub model. However, far more work on the detail is required.

I have said to the chair that I expect the board to develop the proposal with its partners—in particular, the local authority, but also the local community and organisations including the local Parkinson’s group. I expect all such organisations and the local community to be fully involved in the development of a viable proposal for the future hub in the east end of Glasgow.

In 2016, Nicola Sturgeon said live on TV during an election debate that there were no plans to close the children’s ward at the RAH in Paisley.

or six years, there have been staffing problems on top of staffing problems at the children’s ward of St John’s hospital in Livingston, with assurances being given that it would not be closed. How can parents, children, grandparents and local people who joined me on Friday at a protest at St John’s believe a word that the cabinet secretary or the First Minister say about the future of children’s services in Livingston, given their blatant betrayal of the people of Paisley?

The only person who is talking about the closure of the paediatric ward at St John’s is Neil Findlay, which is rather surprising. As he knows, in October last year, NHS Lothian received a report from the Royal College of Paediatrics and Child Health that concluded that the preferred option for it and for NHS Lothian continued to be the 24-hour consultant and tier 2 cover model at St John’s. The college recognised that development of that model is a long-term solution that requires a successful recruitment campaign, which NHS Lothian has been working hard to carry out, and with which it has had quite a lot of success—as Neil Findlay well knows. I had hoped that he would get behind NHS Lothian. The clinical advice to me is that the service should continue: no proposal has come to me with clinical advice that the ward in St John’s should close.

Neil Findlay would be better focusing on supporting his local hospital in its recruitment campaign than on scaremongering, which could put people off. [Interruption.] It is a serious point: are doctors who are considering whether to apply for a post that covers St John’s likely to be encouraged by what Neil Findlay is saying? I suggest that he should be very careful and should encourage people to apply for the posts rather than doing the opposite. I am sure that the clinicians at St John’s would want him to do that, too.

Does the cabinet secretary agree that the key people for health provision in the east end of Glasgow are the people of the east end of Glasgow? Does she also agree that, given the better transport links at the Parkhead hospital site, it is the best place for a new hub and other health facilities?

I have said to the chair and the board that, in taking forward the proposal and developing it into a viable proposition, they should continue to explore the Parkhead and Lightburn sites. The important thing is that, as well as developing something that meets the needs that are met by the existing local services in the east end of Glasgow, the board looks at what further services can be developed in what is one of the poorest communities in the city. The board has a really exciting opportunity to do that, but it has to engage the local community properly. That is the challenge that I have put back to the chair and the board.