New Petitions

The reason why I have lodged the petition is that it relates to the single biggest issue in the north of Scotland. Two years ago, NHS Highland considered downgrading the consultant-led maternity service for the north of Scotland to a midwife-led service. There was a huge campaign to ensure that the service was kept at the standard that we have enjoyed and two years ago, we thought that we had won the battle. However, to our dismay the EGAMS report has given NHS Highland the opportunity to revisit the issue.Our concern is that the north of Scotland is remote. If the consultant-led service were downgraded to a midwife-led service, that would lead to a hugely increased number of pregnant mothers having to travel all the way to Inverness, which is a long distance from places such as John O'Groats, Canisbay, Wick, Thurso and Bettyhill, on the north coast of Sutherland. In the event that the weather is inclement, which it is with monotonous regularity every winter, and the A9 is blocked, people cannot make the journey. Equally, there are a number of days every year when the weather is so bad that the emergency helicopter cannot fly. Therefore, we think that the risk posed to mother and unborn, or born, child would reach an unacceptable level. On a bad day, the situation would be a tragedy waiting to happen.There is also the issue of peer support. A single mum from a poor background in Wick would have to undertake a 200-mile return journey to Inverness to have their child and it would be almost impossible for her friends and relations to visit her—which is so important in the first days after birth—because it might be beyond their pocket. NHS Highland decided to revisit the matter because of a risk highlighted by EGAMS around paediatric cover at Caithness general hospital in Wick. Our reaction is that if there is a perceived problem with paediatric cover not being at the correct level, the cover should be raised to the correct level. We do not sell a car simply because it has one soft tyre; we repair the tyre.The consultant-led service is valued in every way. If we take away a key service, we act against economic development—people would think twice before moving to Caithness or Sutherland, because of the lack of access to the service. Highland Council is with us on the issue. It is deeply worried, and I believe that it will seek a meeting on health and enterprise issues with Malcolm Chisholm and Jim Wallace. Some 7,462 signatures represent a huge proportion of the county of Caithness's population. I have never known a petition to be signed by such a high proportion of people in a community.As I said, the issue is the single biggest issue in the north of Scotland. It is hugely important. Downgrading the service would be terrible. EGAMS refers in its report to the fact that midwife-led services in remoter parts are untested and distance has not been considered. I put it to members that medical systems and arrangements can come and go, but geography and the weather cannot be altered, no matter what is done—they are entirely in the hands of the Almighty.We lodged the petition because the issue is important to a special area of Scotland that has difficulties as a result of distances and the weather. We believe that the issue should be put on the Parliament's agenda and I hope that the committee will take it further and bring it to the attention of ministers, if that is possible. The convener knows that I have continually raised the matter in the Parliament through questions and supplementary questions. Indeed, around three years ago, the last question that the late Donald Dewar answered was a supplementary question on the service, which I asked.

I am sure that most people would be concerned about what you say about distances if maternity services were to be lost in the north of Scotland. What alternative provision would there be if a mother and child had to be transferred from Wick or Thurso in the far north, for example?

I do not think that there is an alternative. If the service was downgraded to a midwife-led service and there were urgent or potential difficulties with new-born children, people would have to go to Raigmore hospital, which is a huge distance, as you know. Even the ambulance service in Wick has said that it doubts that it could cope with the transport of people up and down to Raigmore. I cannot see an alternative. We must fight to save the service.

Alternative provision is quite a distance away. How many miles are we talking about if Raigmore hospital is the nearest consultant-led facility?

I am acquainted with such arguments. I represent a remote community in which the distance to Raigmore can be around 150 miles. I understand that midwives are concerned about their responsibilities if they do not have a consultant at hand to deal with emergencies. If a new-born child requires resuscitation, they will not have the skills to provide it and they think that the proposals put too much responsibility on them. Do you have anything to say about that?

Therefore, the proposal to have midwife-led maternity services, at least in remote locations, is not in the best interests of patients. Is it financially driven?

I emphasise that the EGAMS report refers in passing to distance, but it does not really address the issue. I must go further and say that the minister, Malcolm Chisholm, has conceded in his answers that distance is an issue in this case. Dianne Laing is quite right; we take the view that we already enjoy the service. I do not think that money is the issue—if it is, it is up to NHS Highland to tell me, you and the Executive that it needs help. In fairness, the Executive is pretty good at recognising issues of remoteness and peripherality. If the argument was presented correctly, the Executive would be supportive.The risk assessment is being undertaken at the behest of NHS Highland, and I hope that it will conclude in our favour. However, the indications thus far are not good, and it is no coincidence that the issue is being revisited only two years after the previous review, at which time we were assured that the future was safeguarded.

I will try to pick my way through your comments. I very much agree that the problem is Scotland-wide, although it seems to surface in different parts of Scotland in different ways. During the Lesley Riddoch programme about the Queen Mum's hospital, I tried frantically to ring in to say, "What about Caithness general hospital?", but my call was not selected. It seems that health authorities in different parts of Scotland have seized on EGAMS and exclaimed, "Aha! The very tool that we have been seeking!" That is most unfortunate and I do not believe that it was the intention of ministers, who, I suspect, will have to consider the issue on a Scotland-wide basis.You were also entirely correct when you talked about the regional approach in Scotland. In my submission to Highland NHS Board, I made the point that the board should think beyond its boundaries. Orkney is now just a short ride away from Caithness on the new ferry, so why should not Highland NHS Board continue to run a consultant-led service in Wick, increase paediatric cover and increase the provision for Orkney mums? That could be doable—okay, the ferry cannot sail in the worst weather, but nevertheless the service would be available for most of the year, which would be an improvement.You asked about the detail of antenatal provision and quite correctly hinted that the poorest people in society have the greatest problems. That statistic is unfortunate, but correct. By definition, the poorest people are those who are the least able to pay, the least likely to have a car and the least likely to have wealthy relations who can visit. In Wick, it is precisely the most vulnerable people in society who are the most affected. Who will look after the two older kids of a single mum while she is down in Inverness? I agree that there will be a level of cover for such mums in terms of facilities such as ultrasound, but surely we should be trying at all times to improve our health service, particularly for the poorest in society. Given the amount of money that we spend, it should be possible to do so.One good example of improvement to the service in Caithness is the introduction of a renal unit, which has saved people from having to travel huge distances for dialysis—well done, Highland NHS Board. People of all political persuasions should be seeking to improve services, whether they are in Glasgow or the most remote parts of the Highlands. A poor person is a poor person, no matter where they live, and people should not be disadvantaged because they live right up on the north coast, in Strathy or Canisbay. Those people have the same right to a high-quality NHS service as people who live in Edinburgh, Dundee or Stirling.

I should have brought that statistic with me.

The issue comes back to the risk assessment, which will be kicked off on 15 December. We will all make our case on the paediatric front. I understand your argument, but for the cost of providing the paediatric care—oh yes, make no mistake about the fact that additional costs would be involved—Caithness would be able to offer the grade of service that one would expect.

I accept that point—it is glaringly evident. It is interesting that the issue was not addressed some years ago.

I would have said that the number was at about that level, but I wanted to give the accurate figure. There is a steady stream of births each week. It is a cheerful wee unit.

The problem is that the present level of paediatric cover is perceived as a risk and is stated as such in the EGAMS report. Therefore, it is time to revisit the issue. My own belief is that one could think laterally on the matter. In order to tackle the problem, there is no reason why we could not have a sort of roving consultant who would oversee perhaps Orkney, Shetland and Caithness on a circular basis.Jackie Baillie is quite right that the review is not cost driven, but NHS Highland has referred to the working time directive, which, as we all know, impacts on general practitioners and consultants. That is why I think that the issue comes directly back to ministers. We will probably have to revisit how we tackle this one.I agree that there is a cost attached to paediatric cover, but we just need to up the level of cover. We need to put in just two or three staff, possibly with a circulating consultant paediatrician.

We have to make the attempt and I am not convinced that we have done that. The NHS in the Highlands owes a great deal to people coming into Scotland from other countries. I believe that one of the ways to get people is to advertise abroad. Let us face it; it is a good career move for a trained paediatrician to come here.We can think outside the box on this. We might have to legislate, but we can further empower health authorities to attract the right people. It is about golden hellos and selling the advantages. There are advantages to living in the far north, such as the beauty, golf and fishing—or, in John Farquhar Munro's case, poaching. I hope that the official report will strike that from the record.We should seek people from outside the country and the Scottish Executive should acknowledge that the most far-flung areas have a problem that we must tackle. I know that ministers are willing to do that, but it is a matter of getting the problem high enough up the agenda. Ministers have to address myriad issues—Jackie Baillie will know that from her experience.

I will have to be careful about how I put this, but I have been told up-front in private meetings with NHS Highland that I am wasting my time because they are not going to do what the petition asks. I do not know whether I am covered by parliamentary privilege in the committee, but I have been told that point blank. My reply is that I will oppose the proposal tooth and nail. My fear is that it is a foregone conclusion.NHS Highland tried to withdraw services two years ago. Dianne Laing will recall that there were vast public meetings in Caithness. It backed off at that point, but now it has seized on the EGAMS report. In the Highlands, there is a tendency to centralise on Inverness. It is no accident that Inverness is the fastest-growing city in Scotland, but in growing so fast, it is sucking resources out of other parts of the Highlands. That is a problem for the Government in Scotland and it should be addressed. I hope that you accept my answer to your first question as being truthful—I can put my hand on my heart and say that that is what was said.Your second question was about what the committee should do with the petition. I am not as familiar with the workings of the Public Petitions Committee as I should be. I would have hoped that my petition might have generated some correspondence with the minister. Whatever the committee's deliberations amount to, the petition could be discussed by a committee that will listen sympathetically to the case that I am bringing before Parliament, which is not just about Caithness.

That was deliberate.

In our submission to the Health Committee, we should point out that there is doubt about the review's conclusion that midwife-led care was neither less safe nor less effective than consultant-level care.