The next petition is PE718. I invite members also to note petition PE689, which is a current petition. The petitions are related. We received responses on PE689, which, as members will recall, Jamie Stone brought to the committee some time ago. I seek the committee's agreement that, rather than discuss the same issue later in the meeting, we consider both petitions together, and that we consider the new petition in conjunction with the response that we received to the previous petition, as they are on very similar matters.Members indicated agreement.
Official Report · Committee
New Petitions
Maternity Services (Island and Rural Communities) (PE718) Consultant-led Maternity Services (PE689)
Speakers
Choose an MSP to read only their contributions- Michael McMahon Lab 8
- George Lyon LD 3
- Carolyn Leckie SSP 3
- Jamie Stone LD 2
- John Scott Con 2
- Jackie Baillie Lab 1
- Sandra White SNP 1
- John Farquhar Munro LD 1
- Linda Fabiani SNP 1
The record
22 contributionsPE718 is from Freda Ferguson, on behalf of the Rothesay Maternity User Group. The petition calls on Parliament to urge the Scottish Executive to review urgently the provision of maternity services for Scotland's island and rural communities.To refresh members' memories, the petitioners behind PE689 call on Parliament to ensure the availability of consultant-led maternity services throughout Scotland. The committee agreed to seek the views of the Executive, which launched "A Framework for maternity services in Scotland" in February 2001, and subsequently established an expert group on acute maternity services at the beginning of 2002. The Executive states:"Both the framework and the Expert Group's report provide a strategic direction and a framework for the implementation to help ensure that NHS Boards in Scotland continue to provide modern, safe maternity services appropriate for the needs of women and families in Scotland."The response also refers to the specific issue of Caithness general hospital. However, as the committee is aware, the Executive has no remit to become involved in individual decisions of NHS boards. George Lyon is here to speak to petition PE718 and Jamie Stone has joined us to consider the response to petition PE689.
I give Freda Ferguson's apologies; she is unable to be here because of a previous engagement.Petition PE718 is on behalf of the Rothesay Maternity User Group. It covers a different issue from the petition that my colleague Jamie Stone will speak about in that it expresses concern about the proposed removal of an out-of-hours midwife maternity service, which at present is staffed with a full rota. The service is to be replaced with an on-call service at night, with no full-time midwifery service in place. The issue concerns the whole of Argyll and Bute because the proposal to downgrade the out-of-hours service from full time to on call affects Oban and Bute. There is general concern about the impact throughout Argyll and Bute, and there is particular concern that the impact on Bute will be that there will be more evacuations by air at night of mothers-to-be who have unexpected problems or babies that arrive at short notice. There are fears that delays may occur in receiving expert attention if emergencies happen out of hours because people will have to wait for the on-call midwife to get to the hospital to provide treatment.There are also fears that the move will lead to fewer babies being delivered locally. One key concern is that the number of births on the island has declined year on year because mothers have been encouraged to go to the mainland to have their babies delivered at the consultant-led service, which used to be at Inverclyde royal hospital, but which is now in Paisley. Figures that the Rothesay Maternity User Group presented to Argyll and Clyde NHS Board show that there are more births between 6 pm and 6 am than there are during the day. That reinforces the point that there is a need for a fully staffed midwifery service at night.I hear the same concerns from Oban, which is in the north end of my constituency. The genuine concern is that the service will not meet the needs of local mothers and that the change will lead to more mothers being airlifted from the island at night. People are concerned that the move will lead to a poorer service and to a reduction in its availability, so the petition has been submitted to Parliament to seek its support.As I said, the issue is different from that which Jamie Stone has raised because we do not have a consultant-led service in our bit of the world. The Royal Alexandra hospital in Paisley is the nearest consultant-led service. I ask the committee to consider the petition seriously and to take action on behalf of my constituents.
I ask Jamie Stone whether he has any comments on the reply to his petition from the Executive.
Yes. I would like to mention two fairly fundamental flaws, which should be of concern to the Public Petitions Committee and the Health Committee. Highland NHS Board asked Professor Andrew Calder to write a report on the future of maternity services in the area. Members will recall that I and others made great play of the issue of distance and the fact that inclement weather sometimes means that roads are blocked and aircraft cannot fly. At my party conference last weekend, I met a gentleman whose sister-in-law and her child had died in an ambulance not so long ago before the consultant-led service was introduced.Professor Calder was asked to write a report. In that report, he flagged up at some length the dangers that are involved. He flagged up the fact that the road is long and that there are hold-ups, and he mentioned snow, aircraft, the fact that there are many minor roads that have passing places and so on, but he did not address those specific issues in his conclusions and recommendations. It is a matter of public record that when I pushed him on the matter, he said that it was a matter for Highland NHS Board to consider but, on balance, he thought that downgrading to a midwife-led service would be best.I will come to the nub of the matter. Professor Calder was given a clear remit by NHS Highland and four terms of reference. I will furnish the clerks with copies of his report. First, his team was invited to consider"The balance of risk between the current consultant led service and of not having this service in the future."When members have copies of the report, they will see that Professor Calder has not attempted to address that matter—they can take that from me. I am being forensic when I say I am afraid that that would invalidate the report for a lawyer. Professor Calder has not stuck to his terms of reference.I have copies of other documents that I will supply to the clerks. NHS Highland is due to meet next Tuesday to consider the report. Highland Council and Highland and Islands Enterprise have come out strongly on the matter and said that there is a much wider issue, in that there is a social and economic context to the matter. They have commissioned a social and economic impact report, as is right and proper.NHS Highland met and considered Calder's report in Wick on 16 March, when I made the point to which I have just referred; that is, that he had not addressed the issue of distance. NHS Highland's minutes of the meeting report the recommendation that"a meeting be organised between Highland Council and NHS Highland to discuss the scope and timing of the Council/HIE sponsored 360 degree study."No decision was taken on Professor Calder's recommendations. However, an item on the agenda for next Tuesday's meeting is:"That the board asks the Deputy Chief Executive (Modernisation) to lead work to … assess how the ‘stringent conditions' relating to Option D may be met with a view to consultation".The board is asked to"agree with the conclusions of the report that options A, B and E are not viable option to consult on."The status quo and all the other options are therefore out of the window. The board is saying that it wants to go down the midwife-led route, despite the fact that only days earlier, it agreed that it would meet the council and Highlands and Islands Enterprise in respect of sponsoring a 360-degree study. The danger is that a decision will be taken next Tuesday.There is a contradiction in what NHS Highland has said. It said that we should consider social and economic impacts, but a few days later, it recommended a route to take—never mind the study. From a legal point of view, the two flaws demonstrate something about which we should be greatly concerned.I do not have a vote on the committee and I hope that I am not wrecking my case by paying tribute to Carolyn Leckie and others, but there is cross-party support on the matter. I have seen the biggest demonstrations on the matter that any of us has ever seen in Caithness and I ask members earnestly and from the bottom of my heart to remit the matter to the Health Committee or to think of appropriate stronger action. The matter should be of major concern to the committeeTom McCabe was in Wick on Friday. The Inverness Courier reported that he said:"Our view would be when this arrives on the health minister's desk it will be objectively assessed against the EGAMs report and we would not want to do anything whatsoever that would make services available to women here in Wick any less safe than they were in the past."I have questioned the safety issue, which I do not believe Professor Calder addressed. I have also pointed out fundamental inconsistencies in NHS Highland's modus operandi.
I have some questions to George Lyon about the Rothesay service. When you talk about a move to an on-call service, from where will it be on call? Will it be from the community midwives' homes? How many are on an on-call rota? How many births are there? How many people are likely to be called out overnight? Would you explain a wee bit more about why a move from a rostered hospital-based overnight service to an on-call service from home would lead to more airlifts, so that I understand matters better?
I do not have the figures with me for the number of births, but I will pass it to the committee for information. The mothers are concerned about the delay in rostering the midwives out if there is an emergency and about the temptation to proceed with an airlift rather than deal with a birth in the local hospital. They are also concerned that mothers will, because of the move to an on-call service, be encouraged to go to hospital on the mainland for the birth rather than stay on the island. Those are the three concerns that mothers on the island have.
I understand that last point clearly: that is part of the problem in Wick. What concerns me greatly about the move towards centralisation in maternity services is that it is going full steam ahead without all factors being taken into account and without any reasonable attempt being made to resolve the problems that are being used to justify closure and centralisation. It is as if the outcome has been decided before the process has begun.I have a couple of questions to ask Jamie Stone before I say what I think should happen. In the Calder report—which is flawed, as Jamie Stone pointed out—references are made to midwives raising concerns, but those concerns are not documented. That relates to the wider issues that we have been looking at in terms of consultation, obtaining evidence from experts and that evidence not being properly documented in the public domain, with the result that the public cannot examine the rationale behind that evidence being discounted. This is another example of midwives documenting their concerns about a proposal in relation to Wick, but we cannot see those concerns or ask questions on them. There is no rationale in the Calder report for why the midwives' concerns have been discounted; therefore, the public do not have the opportunity to examine the matter.However, on Tuesday, the health board may well decide to close the unit at Wick and to replace it—which is in effect what it is doing—with a midwife-led unit. That will have an impact on the hospital's ability to continue as a general hospital. I have read some assurances in our papers, but they are cheap. If there is the change to a midwife-led unit, that will—as the Calder report acknowledges—impact seriously on the anaesthetic service; if there is no anaesthetic service, the hospital in Wick cannot operate as a general hospital.Because of the urgency of the situation and its relevance to all the other issues that relate to maternity services throughout the country, we cannot afford to wait for the formal outcome of the consultation by NHS Highland on the hospital in Wick. All such issues are relevant to the Health Committee's deliberations on maternity services. My view is that the process should be stopped and be left up for grabs, because the economic impact has not been examined. I ask that both petitions be referred immediately to the Health Committee, which is in a position to do something by trying to get such issues sorted out.
I will take some points from other committee members and then allow Jamie Stone to respond. We are combining our consideration of the petitions because we have received a response from the Scottish Executive to the earlier petition. We need to focus on that as well, rather than try to explore individually the circumstances of Rothesay and Wick—although I accept fully that that is why George Lyon and Jamie Stone are here. It is legitimate for us to explore those circumstances, but there is a wider point and we have received a response from the Scottish Executive on the earlier petition. I therefore ask members to focus on that.
link
I am not going to ask questions; I just think that there are similarities in principle between both petitions, which they also have in common with the petitions about the Queen Mother's hospital. I want to talk about generalities rather than specifics.It strikes me that distance and access are key issues that underpin a number of the petitions that we are considering, particularly those on maternity services. The reduction in quality and the consequent impact on the safety of women and their children is an equally important underlying issue. The notion that health boards have preset agendas has been illustrated by the discussion that Highland NHS Board is about to have.As many of the points that have already been made suggest, a real bugbear for many of us is the distinct lack of regional planning. Whether we are talking about Rothesay, Caithness, the Vale of Leven or the Queen Mother's in Glasgow, common themes are emerging. For that reason, I strongly support our passing petitions PE689 and PE718 to the Health Committee. As others have said, decisions will be made in the near future so it would be helpful to ask the Health Committee to consider matters in the round.
My first question is for George Lyon. The Rothesay situation is slightly different, because it involves a night-time service, but it is linked to the lack of regional planning. I wonder whether George Lyon or the people of Rothesay are aware that, because of the situation at the Vale of Leven, the Royal Alexandra hospital in the Paisley area is sometimes full to capacity. That will undoubtedly have a direct impact on anyone in Rothesay if the night-time service is closed.I remember Jamie Stone's involvement in PE689. The theme that runs through all the closures—as I would call them—is references to the report by the expert group on acute maternity services. As we in the Glasgow area know to our cost, there are actually two equally good reports that contradict each other. In relation to George Lyon's case, I would like to know whether two expert reports have been received or just one—the clinical report of EGAMS—and how that affects regional planning.I agree with Carolyn Leckie and Jackie Baillie that we should forward the petitions to the Health Committee, but I am concerned that the recess starts next week, which means that the Health Committee will not meet next week. I think that Jamie Stone mentioned that Highland NHS Board's meeting is on Tuesday. I wonder how Parliament being in recess will affect the situation.We will go on to deal with the petitions about the Queen Mum's. My concern is that we are seeing the same pattern all over the country. I know that the committee cannot recommend that there be a moratorium on closures—it is for individual MSPs to lodge motions on such matters—but I would prefer us to up the ante. Rather than just send the petitions to the Health Committee, I would like us also to send them to the Minister for Health and Community Care and to tell him of our concerns. We should enclose a copy of the Official Report of today's meeting.Such reductions in services are happening all over the country. We will be in recess next week, so what will happen if Highland NHS Board meets before the Health Committee meets? The minister must be aware of just how difficult it is for people to get their heads round what the health boards are doing. Similar things are happening all over Scotland. There must be a moratorium. I hope that the Minister for Health and Community Care will consider all the issues to do with all the maternity closures in Scotland. We as a committee cannot ask him to do that but I, as an individual, can. The need for a moratorium should be examined. The people who have lodged petitions cannot all be wrong. Something is wrong; I think that the health boards are wrong. I would like the petitions to be sent to the minister, along with an explanation of our concerns. If we send them only to the Health Committee, it might be too late.
There is a difficulty with that. We have already had a response from the minister on one of the petitions. We can keep the petition live and ask the minister about it or we can refer it to another committee, but we cannot do both. The fact that we have already received an answer from the minister rules out the possibility of our going back to him. Either we do nothing with the petition or we take it forward.
The convener is correct. The response that we have had from the minister merely states that any decision that is taken by health boards will have to be approved by him. We have no idea what changes are being proposed.George Lyon and Mr Stone will accept that a similar position with regard to maternity services is developing all over the country, in urban as well as in rural areas. There is a wide-ranging debate throughout the country about the best provision of maternity services. That is the purpose of the exercise and the petition addresses that. Do you agree that the diminution of the consultant-led facility in maternity units and its replacement by a midwife-led one is putting a tremendous responsibility on midwives? For example, if they do not have professional back-up for the resuscitation of a newborn child, they are in a vulnerable position. Do you have a view on that?
Argyll and Bute has never had a consultant-led service. We have always relied on midwife-led maternity services throughout the constituency. Of the two consultant-led units that were referred to, the one in the Vale of Leven served the north of the constituency and the one in Inverclyde served the south of the constituency. The key issues are distance, access, the safety of mothers and the need for an open decision-making process. Those issues have not been addressed in the discussions on changes to the service in Rothesay. An exacerbating factor is that the Inverclyde consultant-led service has closed. It was always the nearest consultant-led service for Kyle and the Rothesay area. The move from Inverclyde to the Royal Alexandria hospital in Paisley has created significant problems for my constituents in terms of accessibility because it is difficult to get there by public transport. The amount of time that it takes to get to Paisley is an exacerbating factor.The worry is that, if we lose a fully staffed service at night, the temptation will be to recommend that women go up the road to Paisley rather than hang around, in case a baby starts to arrive during the night. Human nature is such that an expectant mother will always agree that that would be the best course of action because she will not want any risks to be taken with her baby. Therefore, the service will be further eroded. Over the past 10 years, the number of babies that are born locally has declined steeply because of the rule that first-time expectant mothers over a certain age are automatically sent to the mainland. In some ways, that is wrong.
I will take John Scott first; then I will say something before I come back to Carolyn Leckie.
I have a great deal of sympathy with what George Lyon and Jamie Stone are saying and I agree with what Carolyn Leckie said. As I have said previously, there is inadequate strategic thinking about the location of maternity services. That is illustrated by what has been said about women who previously went to Inverclyde now having to go to Paisley. There is a similar situation further south, in Ayrshire. Probably as we speak, an announcement is being made about the relocation of paediatric services away from Ayr—it is almost certain to happen—to Crosshouse hospital in Kilmarnock.Paediatric, neo-natal and maternity services are all linked and we are centralising everything in the central belt in the name of clinical excellence and supposed improvement in services, but that does not have regard to the strategic siting of consultant-led facilities. Not only Rothesay, but areas such as Greenock and Ayr are becoming peripheral areas, which the Executive must address. Health boards are acting independently of one another, which means that there will be an anomalous situation in which maternity hospitals will be concentrated in the Glasgow area and much of the rest of Scotland will not be served at all.
I will make a comment that I hope is helpful, although I am not sure whether it will be. We are discussing a new petition and a current petition together because the issues raised by the two communities that produced those petitions are connected.We have also received responses to two other current petitions on maternity services in Glasgow—PE643 and PE707. Before we conclude our discussion on petitions PE718 and PE689, I suggest that we move straight to discussing the two petitions on the merits of the consultation on the Queen Mother's maternity hospital.Without pre-empting what we will decide on either set of petitions, I will say that the comments that Jackie Baillie, Sandra White, Carolyn Leckie especially and John Scott just made suggest that general concerns are felt about maternity services reviews and the direction in which consultations are going. I will give Jamie Stone the chance to respond to comments that have been made, then Carolyn Leckie will speak, after which we will move on to the two current petitions. Do members agree to that proposal?Members indicated agreement.
I apologise for having to leave shortly.
I too will have to leave soon.
John Farquhar Munro asked about midwives. Carolyn Leckie is correct to say that deep unhappiness is felt in that profession in the far north about the fact that midwives would be left exposed if consultants were more than 100 miles away.I will go to the nub of the issue. The convener said that the Executive's response was about the EGAMS report. That is the light to which any health authority's proposals will be held. The EGAMS report is marbled with talk of risk, risk minimisation and risk assessment. I repeat that although Professor Calder was called on to assess"The balance of risk between the current consultant led service and of not having this service in the future",he failed to do that. Worse still, NHS Highland has turned a blind eye to that.I will quote again today's edition of the Caithness Courier, which says:"Mr McCabe"—on the record—"admitted the rurality of Caithness was a concern that still had to be addressed and suggested that the NHS Highland board should await the impact assessment commissioned by the Highland Council and Highlands and Islands Enterprise before deciding whether to approve plans to downgrade consultant-led maternity services in Caithness."The minister then talks about transport. However, on the agenda of next Tuesday's NHS Highland meeting, there it is—a fait accompli.I must be careful about my language, but I have extraordinary concerns about the process. The board should at least take a long look and have a long think, because a snap judgment is being made. I have just uncovered—by privilege—that that leaves the board open to the suggestion that the decision was made long ago.
I will make a couple of points that it is important to place on record. I have an addition to Jackie Baillie's litany of common themes, because another common theme that is emerging is selective reference to and implementation of the EGAMS report. The report requires maternity units to deliver one-to-one midwifery care in labour for all women, but not all maternity units do that. It also refers to local access. Serious concern is being expressed that that is not being implemented appropriately or that the wrong judgments are being made in many areas about the value of such access.Some health boards have manipulated the report to justify what they are doing, because the problem is a lack of planning: there are not enough bodies in the system to deliver enough consultant cover. The trend is to view the report from the wrong end of the telescope and to think that the only solution to a lack of consultant cover is to centralise. In Caithness, no attempt has been made to examine consultant rotation in and out of Raigmore hospital to ensure that skills are updated, or to consider consultants' contracts in NHS Highland.In response to John Farquhar Munro, I say that midwifery care is not inferior care. It is appropriate care for women who need midwifery care. I would like more women to be looked after in pregnancy and childbirth exclusively by midwives, because research shows that that makes outcomes better. People should have access to appropriate care when they need it; if midwifery care is not appropriate for them, they need to have access to consultant care.If women have a fear that they cannot access consultant care quickly and locally, their outcomes are likely to be worse because they are less likely to have midwifery care throughout their pregnancy and when they are in labour, as George Lyon said. They will err on the side of caution and go where they can get consultant care. The arguments that are being put forward by health boards that the system of midwifery-led care will be better are true, but not in the context that is being proposed by the health boards. In my opinion, the reverse will be the case because women will travel to access the consultant care and there will be even fewer home births than there are at the moment—and there are very few just now—and fewer births that are conducted only by midwives. That point needs to be hammered home.
Your view is on the record. Before we come to a decision on the two petitions that we are discussing, PE689 and PE718, we will move to item 3 on our agenda to deal with the two related current petitions, as we agreed earlier.
In this meeting
Everything on 31 Mar 2004 →- Scottish Parliament Public Petitions Committee Wednesday 31 March 2004 (Morning) Petitions · 1
- Items in Private Procedure · 2
- New Petitions Petitions · 66
- New Petitions Petitions · 45
- New Petitions Petitions · 34
- New Petitions Petitions · 5
- New Petitions Petitions · 17
- New Petitions Petitions · 22
- Current Petitions Petitions · 11
- Current Petitions Petitions · 7
- Current Petitions Petitions · 5
- Current Petitions Petitions · 7
- Current Petitions Petitions · 3
- Current Petitions Petitions · 3
- Committee Event Committee business · 17
The type of each item (debate, statement, questions, members’ business and so on) and the times shown are worked out by this site from headings, the chair’s opening words and the Official Report’s running timestamps. They are not the Parliament’s own classification. Text: the Scottish Parliament Official Report.