The next petition is PE643, which we will take together with PE689, PE707 and PE718, as they are all on the same topic of hospital closure consultation and consultant-led maternity services. These are all new petitions. We have a trio of MSPs here—how blessed we are at this late stage in the day—and our practice is to allow them to say a few words. I ask you to be brief and to indicate to which petition you are referring.Is somebody here to talk to PE643, in the name of Dorothy-Grace Elder, on hospital closures?
Official Report · Committee
Petitions
Health Service Configuration (Consultation) (PE707) Maternity Services (Island and Rural Communities) (PE718)
Speakers
Choose an MSP to read only their contributions- Christine Grahame SNP 18
- Shona Robison SNP 4
- Sandra White SNP 2
- Jamie Stone LD 2
- Duncan McNeil Lab 2
- Mike Rumbles LD 2
- Dr Jean Turner Ind 2
- Helen Eadie Lab 2
- Pauline McNeill Lab 1
- Kate Maclean Lab 1
- Janis Hughes Lab 1
- David Davidson Con 1
The record
41 contributionsI am here to talk to PE707 and PE643. It is important to emphasise that millions of pounds of public money have been provided to the Queen Mother's hospital. We should be aware of that if we are going to close it down. The equipment, and the money that is used to buy equipment, will be sucked straight into the health service. We should also flag up the prospect of more petitions being submitted, and the fact that there were thousands of names on the Evening Times petition, which led directly to petition PE707.I thank the committee for inviting me along and allowing me to speak. As I am normally the one who sends petitions to you, I hope that you do not give me a hard time of it. I suggest that somebody on this committee should submit a petition to turn down the heating in this room—I admire members' fortitude in sitting through this heat.Pauline McNeill and others will raise other aspects, but my point is on guidelines and consultation, which are important. The Minister for Health and Community Care has said that he will consider them carefully when he makes his decision. In fact, I think that a guidelines working group has been set up.Not only I, but other MSPs, the public and clinicians, feel that decisions were taken by Greater Glasgow NHS Board that did not go through formal consultation and did not follow proper guidelines. For example, regional planning, which is part of the report by the expert group on acute maternity services, has not been taken into consideration. The health board consultation document cites EGAMA, but there are two EGAMS reports, which are contradictory, and the document does not mention the differences between them. We should be looking at that.I wrote to the minister about the report by the British Association of Paediatric Surgeons. Peter Raine, who wrote part of that report, told the health board that although it said that it had quoted from the 1999 BAPS report, it had actually quoted from the 2002 BAPS report. Mr Raine e-mailed the health board two weeks before 35,000 copies of the consultation document were circulated throughout hospitals and the health board—the consultation was also reported in a national newspaper—with that mistake in it.Since then, I have written to the minister and the deputy minister, Tom McCabe, to point out what has happened. I received a reply from the deputy minister—thankfully—and I can certainly circulate copies. He says:"If … a Health Board had either wilfully or accidentally made a false statement, my colleagues and I would wish to know" so that they could "determine what, if any, action would be appropriate".In his reply to the Public Petitions Committee, which members have in front of them, Sir John Arbuthnott says that there was a "minor" error. I do not think that the error is minor, given that a warning was given two weeks before the consultation document was circulated; I think that it is a big error. The committee should take cognisance of that. As I have said, the error is still being quoted. Clinicians have raised concerns. They wished to come along to the Public Petitions Committee to give evidence but were not able to because there were so many petitions.Obviously, I cannot tell the committee what to do; you have to make up your own minds. However, considering the EGAMS report, the BAPS report, the lack of consultation and the mistakes that have been made, I would say that the consultation has been flawed. I would like the clinicians who lodged PE707 either to come to the committee or to submit a written report. Perhaps the minister could come along and clarify some of the points that I have raised.
I think that we will leave it to the committee to decide on that.
I acknowledged that, convener; I was only making some suggestions.
Duncan McNeil and others have asked what is proper consultation and what is not. We are well aware of the difficulties.I will work my way along the line of witnesses. Jamie Stone is next.
First of all, I thank members for allowing me to come to the committee today. I hope that I do not bore you by repeating myself.
Heaven forfend, Jamie. You are never boring.
Members have heard me on this subject before. Three and a half years ago, the NHS in the Highlands proposed downgrading the maternity unit in Caithness to a midwife-led unit. Indeed, the very last question that Donald Dewar ever answered was a supplementary question that I put to him during First Minister's question time on that very subject. The Executive backed off then but the issue is back on the agenda now.What makes the situation so desperate and so singular is this: taking women and their unborn children well over 100 miles from Caithness down to Inverness and back again poses huge safety problems. What if the weather is inclement? What if the roads are blocked? What if the helicopter cannot fly? To put the situation in a central Scotland context, it is the equivalent of asking women in Glasgow to go to Carlisle to have their children. It is an absolutely huge issue in Caithness. Caithnessians will not take this lying down.At a meeting of Highland NHS Board, I was very struck by a contribution that was made by the Church of Scotland parish minister from Wick, who said that it came down to a human rights issue. Marbled through EGAMS is mention of risk, risk assessment and the minimisation of danger. It is admitted in EGAMS that midwife-led services in very remote areas are untested.Professor Andrew Calder, who was a party to the EGAMS report, was asked to carry out a review of maternity services in the Highlands. In his report, he outlined the transportation and inclement weather difficulties and the dangers associated with them. However, when he concluded that, inter alia, consideration should be given to having a midwife-led unit, he did not attempt to answer the question of transportation. I put it to the committee that in areas as remote as Caithness, even with the finest ambulances in the world, and even with a fleet of helicopters, when the weather comes in, the weather comes in and you simply cannot move people. I talked to somebody the other day whose family had lost children who died with the mother in an ambulance on that journey in the bad old days.I have put these points to ministers and Tom McCabe has been good enough to admit on the record in the press that distance is the big issue. As I say, it is the equivalent of Glasgow women having to go all the way to Carlisle.Highland NHS Board has backed off somewhat, in as much as it has conceded that it will consider some sort of hub-and-spokes rotating service, incorporating consultants. However, the bottom line is that, in view of the unacceptability of increasing the risk, we must endeavour not to accept that.Finally, I reiterate to the committee that surely women who live in really remote areas, such as John o' Groats, Canisbay or Bettyhill, have just as much right to a decent—indeed, the best—maternity service as women who live in Fife, Lothian or wherever. The issue is about weather and distance and will not go away. Indeed, I believe that it is so fundamental that it transcends the responsibility of NHS Highland; it involves ministers and the Parliament.
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I want to speak to petition PE707, in the name of Professor Dan Young, on maternity services. The petition has been signed and submitted to the Public Petitions Committee by five eminent retired professors who worked at Yorkhill in the Royal hospital for sick children and the Queen Mother's hospital.Three issues arise from the petition, the first of which is the quality of the consultation process. In that respect, I urge the committee to include some of the aspects of this petition in the work that it has already been carrying out. The issue is not about the process itself but about the quality of expert opinion. Although these professors, who are eminent in their own field and have run the service, gave evidence in the consultation process, they cannot see where that evidence appears in the paperwork that was given to board members. The important distinction to make is that that evidence was expert, not public, opinion. The professors want the committee to address that aspect of the quality of the consultation process. After all, if an expert opinion has been given, it should be easy to find out where it has ended up and the extent to which it was taken into account.Secondly, the petition asks the committee to examine the model of care at Yorkhill with the Royal hospital for sick children and the Queen Mother's hospital, particularly in relation to the delivery of a national service. There is work to be done on the delivery of children's services in Scotland. Although national services are delivered not by NHS Greater Glasgow but under the direct auspices of the Scottish Executive, the health board appears to have taken a decision on the future of children's services on behalf of every MSP around this table and beyond. As a result, the professors are asking the Parliament to examine whether all of us—not just me as a Glasgow constituency MSP with an interest in the matter—have a stake if we lose that model of care.I will not talk about the conclusion that the board reached, because that is not the issue in question. However, there is a feeling that the decision was based on inaccurate information, which again highlights the very question of the quality of the process. An example of the inaccurate information that was released in the name of NHS Greater Glasgow was its claim that there are two foetal medicine departments in the city. There is only one such department, which is based at the Queen Mother's hospital. It has delivered training not only for the whole UK but worldwide and is the only referral centre for foetal medicine.Moreover, the day before the decision was taken, board members received a minority report that was signed by almost 30 doctors and which stated that the plan following the closure of the hospital would be impossible to implement. Again, that report should have been made available to decision makers well before any decision was taken. Such incidents highlight the serious problem at the heart of this matter: the quality of the consultation process. Finally, the expert evidence of paediatricians such as Charles Skeoch contains a warning that transporting neonates to the extent allowed in the implementation plan raises serious issues with regard to the morbidity of children.I have tried to steer away from expressing my feelings about the closure and ask the committee to add some of the issues that have been raised to its on-going work. I know that committee members are concerned about the quality of the consultation process and that the minister has still to respond. I do not want to add to the committee's work load; however, I would be very grateful if it could consider the distinct and important points about the quality of the process; the accuracy of the information on which decisions were based; the work that needs to be done on the model of care for children's services; and how we deal with expert rather than public opinion.
I thank members for the very clear exposition of their cases.
As far as the minister's response is concerned, petition PE707 calls on the Scottish Parliament to"consider a new legal framework for consultation".Malcolm Chisholm notes in his letter that that is part of the petition. He says:"It would not be appropriate for me to make any comment … at the current time",but that he is"taking careful note of all representations made."He says that he"will need to be satisfied that Greater Glasgow NHS Board has fully engaged with stakeholders"before he approves any proposals. That takes care of one bit of petition PE707.Another part of the petition concerns expert advice. Later in his letter, the minister says that he"will … ensure that the guidance provides advice on the selection of expert advice",in particular when"the provision of a national service is affected".Without going into the decision that is to be made locally, the minister's response covers the points in that petition.
After listening to what has been said today and reading the copious paperwork that accompanied the petitions, I think that the petitions could be split into two groups of two petitions. Petitions PE689 and PE718 are about the availability of consultant-led maternity services and petitions PE643 and PE707 are about consultation. I do not know whether we could take on board the petitions about consultant-led maternity services during our work-force planning deliberations. We could question people on that in the areas that we visit for our inquiry. We must understand that such decisions are consultant led. That is one driver of our work and of the inquiry that we are about to undertake.Petitions PE643 and PE707 deal with consultation in the NHS, on which the committee's predecessor laboured long and hard in the previous session. The previous committee took the strong view that it would be inappropriate to involve itself in local decisions by health boards. However, we took a view on consultation in general and investigated it further. At that time, we obtained from the minister a commitment to guidelines, which I understand that we are about to see. Those guidelines are likely to say that end-process consultation is unacceptable and that boards must give their reasons for not choosing a particular option.I am not saying that that means that consultation will be good, because the problem that we have always had is not so much with the consultation process, which has become more comprehensive, as with the cognisance that is taken of comments that are made during a consultation and how all the comments are evaluated, whether they be from expert witnesses or from the public. The issue is more how the outcome of a consultation process is evaluated. I am interested to hear other members' views on that.
The petitions are timely, given the committee's work on work-force planning. I agree with Janis Hughes that we need to separate issues that relate to work-force planning and fit them in with our inquiry. That will include talking to the petitioners in more depth about the issues that they have raised when we go to our respective areas.
I do not know whether members are aware that when the committee undertakes that inquiry, we will divide into three groups of three to make informal visits from 25 to 27 May. We have not set a structure for that, but we could take informal soundings that will inform the structure of our formal evidence-taking sessions, which our work plan says will commence on 7 September. That is in train. It is difficult to track what other committees are doing.
It would be useful if the clerks pulled out what can fit in with our inquiry into work-force planning. However, there are clearly remaining issues that do not fit in with that inquiry, which we cannot just leave hanging. I was struck by what Pauline McNeill said about the quality of the consultation process. There are issues on which we need to go back to the ministers. There are clear concerns about the weighting that is being given to some bits of evidence and not to others—if they materialise. I do not think that we can allow that just to pass.As we are in the difficult position of waiting for a decision from Malcolm Chisholm, there is a limit to how far we can go. However, I draw members' attention to something that the minister announced today—the expert group to plan for NHS service change, which will establish a national framework for the reconfiguration and redesign of services. Some might say—as I would—that that should have been in place before health boards around the country started to embark on the rationalisation and centralisation of services. The press release states:"The group will not decide on current or imminent major service reviews by Health Boards. However, its work will complement future planning by Boards by giving a strategic national focus for the reconfiguration and redesign of services."We need to take that specific issue up with the minister. Surely he cannot be saying that, from a point in the future, things will be done differently, with a strategic national focus, but that everything that is done until then will be done on an ad hoc basis and in a piecemeal manner. We should either write to the minister or ask him to give evidence to the committee, as he has taken the initiative on this. It could be argued—to be controversial—that what is going on and the decisions that are being taken around the country fly in the face of what the expert group may come up with. We do not know, as we have not heard what the expert group is going to say—it will reveal its deliberations in the next few months. There is a strong argument that there should be a pause until the expert group reports.Those are all issues that we could put to the Minister for Health and Community Care. He has put the cat among the pigeons with his announcement today, and we should, as a minimum, have him before the committee to discuss how the expert group will impact on what is going on around the country at the moment.
Can you give us the number of that Scottish Executive press release?
It is on the Executive's website.
I am told that the minister wrote to me today, but I have not seen the letter yet.
There is a letter.
On the point that Shona Robison has raised, I think that it is urgent that the committee call for a moratorium on any closure until the matter has been properly debated. It is fairly obvious that the piecemeal approach is hitting a national issue—access to services throughout Scotland. It is not a matter just for individual health boards, because when the National Health Service Reform (Scotland) Bill is passed, there will be a duty on health boards to look after patients from other health board areas. In other words, it is vital that the left hand and the right hand start working together.I agree with the minister's letter that the subject of petition PE643 is not necessarily an issue of note for the committee to take any further. Many hospitals have acquired pieces of kit through public donation, and so on. The real issue is access to services and whether those services can be manned. That brings us back to our work-force planning exercise. However, there is an issue in the letter on which we could ask the minister to respond further. He takes a simplistic approach on page 1 of the letter, on which he cites"declining birth-rate, changes in practice and impending changes to clinicians' working patterns".This is to do with access and getting hold of clinicians. In fact, more and more people are having their first child later in life, which is far more complex. That complexity is a factor in the requirement to be able to access consultant care.I received a very moving letter from a lady who lives to the north of Wick but who, until recently, lived on the outskirts of Aberdeen. She and her husband were going to start a family but discovered that there were going to be no consultant services there. She was advised that she would have to live in Inverness for the eight to 10 weeks—if not 12 weeks—before the scheduled birth, because of the risks of her age, which was 35. She has been very public about that. The issue is far more complex than the minister seems to acknowledge, and much of it is to do with work-force planning. Pauline McNeill made a comment about a centre of excellence; that is a national issue and not just one for Greater Glasgow NHS Board.
We all have a great deal of sympathy for those who experience the frustrations of the consultation process. That is reflected in Professor Young's petition and in the petition in the name of Dorothy-Grace Elder.The National Health Service Reform (Scotland) Bill gives us the opportunity to raise those issues with the minister and I expect members to take advantage of that opportunity during the stage 3 debate. As well as that, when he is making his final decision on Glasgow, the minister has to take into consideration the quality of the consultation. There is a statutory requirement for that, so the committee might be being a wee bit previous on the Glasgow issue. It is certainly something that we have discussed and been aware of for some time.Of course consultation is important and we have made some progress in the National Health Service Reform (Scotland) Bill. However, it is not enough progress and, as I suggested to the minister when he gave evidence to the committee, it does not deal adequately with issues such as the redesign of maternity services. On such issues we almost have to go outside the standard consultation. I believe that, although others might not support me.However, consultation being the way it is, the minister has announced another review group today. As I understand it, consultant-led facilities at Caithness general hospital, Vale of Leven hospital and the Rankin memorial hospital in my constituency are being taken away irrespective of consultation. It is a dangerous game when politicians start to call for moratoriums or standstills. We face a difficult issue. It is easy to say that we should stop something, but the challenge is to ensure that we can get proper cover for mothers in those hospitals. The three areas that we are talking about are operating under a contingency plan and do not have sufficient skills to enable them to carry on delivering safe procedures. That is the reality of the situation. I do not know how we can create a moratorium in those three areas. I just pose the question.Thankfully, the work-force planning inquiry gives us an opportunity to roll the issue up. We could consider several areas when we are out and about and touching base with people who have concerns. We could also consider case studies and the impact of the issues in areas such as Argyll and Clyde and Caithness. We could focus on maternity services. That is what drove me to call for a work-force planning inquiry, so I hope that we can bring others into the inquiry.
Before I bring other members in, I point out that the minister is before the committee next week. We could certainly slot in an item to deal with the quality of consultation and the issues raised by the minister's letter about the setting up of the expert advisory group. If the committee agrees, I could put that on the agenda rather than write to the minister. He will be here anyway, so we could just extend the session.
We should put the general issues on the agenda. With all due respect to the members from Glasgow, this is not just an issue for Glasgow. There is an issue with the quality of consultation and how we engage the public and redesign consultation. I do not think that the committee is in a position to evaluate the evidence that was given, but we have to remind the minister that we are aware of what petition PE707 says about expert opinion and doubt about the quality of evidence.
I am trying to be helpful by separating the issue of the withdrawal of certain services, which is a staffing issue, from the consultation issues and the letter of April 2004 about the national framework for service change and the expert advisory group. As the minister is to appear before the committee, the sharpest way to deal with the matter is to question him then. We can extend the session and move on to the matter after addressing the budget process. Do members agree?
Members indicated agreement.
Do Mike Rumbles, Jean Turner and Helen Eadie want to come back in, or can we come to a view?
No. I have a contribution to make to the debate.
That is fine—I have no problem with that. I was just thinking about the time, as usual, and about whether there is anything additional to say.
Petition PE707 calls on the Scottish Parliament"to urge the Scottish Executive to consider a new legal frame work for consultation"and Dorothy-Grace Elder's petition PE643 calls on the Parliament"to take the necessary steps to improve public consultation".I agree that that is exactly what we are doing at stage 3 of the National Health Service Reform (Scotland) Bill. As the minister says,"The guidance will be underpinned by a new duty upon NHS Boards to involve the public which will be established by the NHS Reform (Scotland) Bill."As MSPs, we are doing that as we go through the process; the petitions are addressed by the work that we are doing collectively at stage 3. To put it crudely, I think that those two petitions are ticked. They should be noted, we should thank the petitioners for raising the issue, and the petitions should be concluded—that is the best way to proceed.The other petitions that are before us, PE689 and PE718, are similar. PE718 calls on the Parliament"to urge the Scottish Executive to urgently review the provision of maternity services for Scotland's island and rural communities."Jamie Stone's petition PE689 calls on the Parliament"to ensure the availability of consultant-led maternity services throughout Scotland."The key word is availability. It is a national petition, and it hits the nail on the head in relation to what we are trying to do in our consultation. I am conscious that the committee has sat formally—I am not talking about going out on fact-finding missions—only in Edinburgh. If we are serious about the consultation and if we are to consider the effect of the availability of services throughout Scotland, we should leave Edinburgh. To take the two new petitions as examples, we could go to Rothesay or north of Inverness, perhaps to Wick. We should get out there and take evidence in the September sessions to which the convener referred rather than be focused here in Edinburgh.
If we decide to subsume the petitions in whole or in part into our work-force planning inquiry, they will be closed down, because the inquiry will end the petitions. I am quite happy to hear from other members, but I am trying to move things along.
I will try to be as quick as possible because I know that you are dying to close the meeting.
No, not at all.
What really concerns me about the consultation process, which is important, is that although we are frequently told that doctors hold such-and-such an opinion, we know that many doctors have other opinions. The latter seem to be secret and are lost to the public. I do not know how we as a committee can bring out the information that is given in the consultation process so that we can see all the evidence. I wonder whether that information is also withheld from the minister, who has to make a decision about a national institution. Is he privy to that information? Perhaps Pauline McNeill and Sandra White know the answer to that.
Malcolm Chisholm states in the final paragraph of his letter that it is vital that there will be a"duty and the guidance will expect Boards to inform, engage and consult with the public in the relevant area(s)".
To clarify matters for the Official Report, Malcolm Chisholm states that in his letter to Michael McMahon.
The important bit of what he says is that boards will be expected to"feed back the results of the consultation, including reasons for the eventual decision and explanations of how the public's views were taken into account."It is important for us all to remember that.I very much agree with what Duncan McNeil said. It would be inappropriate for us to engage in a moratorium and it is right that such matters should be embraced in our inquiry.In answer to what David Davidson said, section 3 of the letter from Greater Glasgow NHS Board clearly brings out how vital expert consultant-led assistance is in the event of a difficult child birth and that it would want to be sure that any delivery takes place in a maternity hospital with an on–site intensive treatment unit. David Davidson made an important point, but it has been covered in the response from Greater Glasgow NHS Board.
I want to draw the discussion to a conclusion. Petitions PE643 and PE707 are on consultation. In respect of those petitions and the letter of April 2004, with the announcement by the minister, do members agree that we will question the minister with regard to consultation processes after we have asked him about the budget process?
Members indicated agreement.
Petitions PE689 and PE718 relate to work-force planning and so on. Do members agree that we should let the petitioners know what our plans are for our first informal foray and for informal evidence-taking sessions, at which they are welcome to give evidence? We will take on the petitions as part of our inquiry. The two petitions will be closed down at that stage, as we will have taken them on board as part of the inquiry. Are members content with that proposal?
Members indicated agreement.
That deals with those four petitions. I thank members for waiting and for speaking to them.
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