Heart Transplant Unit

– in the Scottish Parliament at 11:28 am on 24th May 2000.

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Photo of George Reid George Reid Scottish National Party 11:28 am, 24th May 2000

The previous debate overran slightly, so speeches in this debate will be trimmed a little. This item of business is a debate on motion S1M-888, in the name of Kay Ullrich, on the Scottish heart transplant unit, and an amendment to that motion.

Photo of Kay Ullrich Kay Ullrich Scottish National Party 11:39 am, 24th May 2000

First, I am disappointed that the Executive has sought to delete a motion that seeks simply the Parliament's agreement that Scotland urgently needs a fully functioning, well maintained and fully staffed heart transplant unit. The Executive amendment is, quite frankly, nothing more than an inappropriate indulgence in party politics and an amendment for an amendment's sake.

The SNP has chosen to use its parliamentary time to debate the crisis at Scotland's heart transplant unit because we want answers to the many questions that have been raised since the problems at the unit first became public at the beginning of the month. Since then, there has been a great deal of speculation, fingers of blame have been pointed in all directions and conflicting statements have been made by the people involved, with the result that the whole issue is still shrouded in mystery.

Notwithstanding the announcements made this week, there are still many questions that need answers. Indeed, unfortunately, the announcement on the three cardiac surgeons identified by the unit raises even more questions. Today's debate therefore gives the minister the opportunity to answer the questions that have been raised.

Photo of Kay Ullrich Kay Ullrich Scottish National Party

No. The member should save her questions for the minister.

I hope that the minister will be able to show the way forward for the future of transplant surgery in Scotland.

We are not looking for scapegoats. I insist: this issue is far too important for party political posturing. Members from all parties are as anxious as I am to hear the minister's response to the debate. It is also of note that a petition containing more than 10,000 signatures will be presented to the Parliament in the next half hour by patients and staff from the unit. I therefore hope that the minister will take the opportunity to provide the answers that we all seek.

It is important that we do not forget the people at the centre of the crisis—the 26 seriously ill people from all over Scotland who are on the heart transplant waiting list and the more than 200 people who have received their heart transplant and now depend on the Glasgow unit for post-operative care and long-term monitoring.

The situation first came to public attention on 3 May. With every passing day since then, it becomes more obvious that the problem did not start with the resignation of the unit's sole transplant surgeon. To address the situation truly, it is necessary to examine the history of the transplant unit since it was set up in December 1991. At that time, the heart transplant unit had two consultant surgeons capable of performing transplants. That continued until 1995, when the unit was left with only one permanent consultant. It was at that stage that alarm bells should have started to ring. Given the stressful nature of being on call 24 hours a day, seven days a week, did not it occur to the trust that the situation was not sustainable?

However, we must realise that the buck did not stop with the trust or the health board. In April 1993, responsibility for the unit's funding was transferred from the health board and the unit became a centrally funded national facility under the direct control of the Scottish Office, now the Scottish Executive. Perhaps someone on the Tory benches could enlighten us as to what was done back in 1995. It is also pertinent to ask the minister what has happened to the funding for the second consultant surgeon? Did it continue despite only one surgeon being in place? Was it cut? Was it used for other purposes? If so, what purposes?

Perhaps the minister might also take the opportunity to address the statement she made in a parliamentary answer to a colleague's question on the availability of qualified lung transplant surgeons in Scotland a couple of weeks ago: that there are no such surgeons in the country. How does the minister reconcile that answer with the comments of Professor David Wheatley, founder of the heart transplant unit and professor of cardiac surgery at the University of Glasgow, who stated that four of the consultant cardiac surgeons currently employed within North Glasgow University Hospitals NHS Trust had relatively recent specialist training in heart and heart-lung transplantation.

Who is correct—the minister or Professor Wheatley? Do we or do we not have surgeons in Scotland who are capable of heart-lung transplantation? That, as the minister knows, is crucial for the future viability of the unit.

Thanks to the efforts of the fourth estate and the statements made over the past few days by Professor Wheatley, we now know that the situation at the transplant unit worsened considerably last summer when, despite the protestations of the trust's management to the contrary, the sole surgeon at the unit was asking for another surgeon to be appointed. That was denied. The bitter irony is that a surgeon who had completed his training and who wanted to be appointed as a consultant at the Glasgow unit is now a consultant at the Freeman hospital in Newcastle and will probably find himself carrying out heart transplants on patients sent from Glasgow.

Was the Minister for Health and Community Care informed of the situation last summer? If she was, what action did she take then? If she was not informed, why not? The surgeon in question was told categorically that he had no chance of a permanent job in Glasgow. Who are we to believe—the trust, which says it has advertised in vain for 18 months, or a clearly committed surgeon?

We have to question the trust's statements on its actions when yesterday in the press we read that the three surgeons who will form the new transplant team after training at the Freeman

"got together last year when the transplant service's problems were becoming apparent and drafted a proposal to become involved".

They said that they

"have not been impressed by the way it has all been handled."

Will the minister tell us why, given the situation described by the three surgeons, the trust has apparently been having so much difficulty recruiting replacements? Will she accept that when, last summer, those three surgeons made their offer to become involved they were available and that if their offer had been taken up we would today have a fully functioning heart transplant unit in Scotland, rather than having to wait another year before transplant operations can resume at the Glasgow unit?

To come to what is already known and accepted as fact, since January this year heart transplant surgery in Scotland has been suspended. That is a fact we all now know but that was kept quiet for the past five months. Again I have to ask the minister, was she informed of the situation? If she was, what action did she take? If she was not, as the health minister directly responsible for that national unit, why not?

To give the minister the benefit of the doubt, I ask why, with a clear 18 months of growing crisis in Scotland's heart transplant unit, it took her until 8 May to issue an ultimatum instructing the trust to present an action plan in two days. In the circumstances, that decision seems woefully late and appears to have been little more than an attempt to be seen to be doing something. That poses another question that the minister must answer today. It is now clear that even though the decision to suspend heart transplant surgery in Scotland was taken in Glasgow in January this year, GPs were not told—they still have to be told—staff have been left in the dark and, most disgracefully, the patients whose lives depend on the unit have had to rely on the newspapers for information.

Given Scotland's appalling record of coronary heart disease, we require a commitment from the minister today that, irrespective of the review of transplant services in England and Wales, heart transplant surgery will continue to be available in Scotland to Scottish patients.

I move,

That the Parliament agrees that Scotland urgently needs a fully functioning and well-maintained and staffed heart transplant unit.

Photo of Patricia Ferguson Patricia Ferguson Labour

Before I call the minister, I emphasise that I will adhere to time limits very strictly as very little time for the debate remains.

Photo of Susan Deacon Susan Deacon Labour 11:48 am, 24th May 2000

I am pleased to have the opportunity today to set out the facts about Scotland's heart transplant service, which is what the patients who depend on the service and staff at the unit want to hear. I am very concerned—I know this from first-hand experience—that the patients and staff in the unit have been caused a great deal of unnecessary worry by the rumour, speculation and misinformation that have surrounded debate on the future of the unit. Sadly, I fear that we have heard more of that today. For their sake, I want to put an end to that worry.

I make it clear that the unit has lost a transplant surgeon and one of its transplant co-ordinators, but that it has not closed and is not closing. There have never been any plans to end the service. I am bound to question the motives of those who have persisted in suggesting otherwise, despite repeated assurances.

I recognise that the decision by the transplant surgeon, Mr Naik, to take up another post is a loss to the service. I recognise his contribution and dedication to the service and the high regard in which he was held by patients, but to behave as if he alone was the service is to do an enormous injustice to all the other members of the team at the Glasgow unit.

It is understandable that debate on this issue has concentrated on the heart transplant operation, which is, of course, the central part of the treatment, but it is not the only service that is performed by the unit. I will explain the different stages of a heart transplantation service, from the patient's point of view. First of all, they need to be assessed to find out whether they should go on the waiting list. Once they are on the waiting list, they need to be looked after until a suitable heart becomes available. Once they have had a heart transplant and have left hospital, they need to be followed up with regular care and check-ups—not for weeks or months, but for a lifetime.

Most of those stages and most of the unit's patients do not depend on a transplant surgeon. They need cardiologists and nurses—a whole team of staff. Nearly all of that team is still in place in Glasgow. The vast majority of the patients of the heart transplant unit will continue to receive the same service at the Scottish transplant unit in Glasgow. I regret that certain politicians have not seen fit to make that point clear.

Photo of Kay Ullrich Kay Ullrich Scottish National Party

Will the minister tell us at what stage she became aware of the crisis in the heart transplant unit? Was it last summer, in January, or on 8 May when she issued her ultimatum?

Photo of Susan Deacon Susan Deacon Labour

If the SNP's health spokesperson would like to listen to the facts, perhaps her questions will be answered.

I will focus on what I think is most important: the people who depend on the service of the unit and the people who are awaiting transplantation. I will quantify that. Nine patients are undergoing assessment at the Scottish unit, where the assessment of patients will continue to be provided. There are about 150 patients who have already had their transplant. Follow-up care for those patients will continue to be provided at the Scottish unit. There are 25 patients who have been assessed and are awaiting transplants. Should a suitable organ become available—it is important to remember that organ availability is the limiting factor in this procedure—transplant for those patients will be undertaken at the Freeman hospital in Newcastle. Indeed, two such operations have taken place under those arrangements in the past two weeks.

Photo of Susan Deacon Susan Deacon Labour

Although I do not seek for a moment to minimise the real needs and genuine concerns of the 25 patients on the waiting list, I think that it is important that they be reassured that the quality of their care is not being, and will not be, compromised. I note that the North Glasgow University Hospitals NHS Trust has contacted all patients directly—whatever stage they are at—to explain the position to them.

Photo of Susan Deacon Susan Deacon Labour

I will address some of the wider issues in the debate and some of the points that have been raised. There are two legitimate questions to be asked: first, why has the present situation arisen; secondly, what have we done and what are we doing about it? I will answer the second question first.

The heart transplant service is a designated national service. It is funded centrally and the service is commissioned at a national level, on behalf of the Scottish Executive, by the national services division of the Common Services Agency. As soon as the rumours about Mr Naik's departure started, the most pressing thing for the Executive, the NSD and the trust to do was to put in place arrangements to ensure that Scottish patients waiting for a heart transplant could still get one, if the right organ became available.

Photo of Kay Ullrich Kay Ullrich Scottish National Party

Is the minister saying that she did not become aware of Mr Naik's departure until the rumours started hitting the press at the beginning of May? Can she explain why she was kept in the dark and heard about it only when it was made public at the beginning of May?

Photo of Susan Deacon Susan Deacon Labour

Not for the first time, Mrs Ullrich's account of the history of the matter is a strange patchwork of misinformation. I am setting out what has been done by the Executive and I will return to the point about why the situation arose. I suggest that Opposition members listen to some of those facts—they may learn something.

The transplant unit in Newcastle was contacted when it became clear that there was a need to do so. The unit agreed to merge the waiting lists for the Newcastle and Scotland patients. Newcastle also agreed to help with retrieval arrangements should a donor become available in Scotland. I stress that when any patient on that list is operated upon depends on only two things: the clinically assessed priority of the patient and the availability of a suitable donor organ. It is more than regrettable that politicians have sought to suggest otherwise.

Under the arrangements I have described, two Scottish patients have been given a new heart. That proves the importance of effective co-operation with our partners in other parts of the UK. Newcastle is also helping to support the assessment and follow-up work in Glasgow. Clinicians from Newcastle have met many of the patients in the unit. I want to put on record the huge debt of gratitude that we and the heart transplant patients in Scotland owe them. That is why I mention it specifically in my amendment.

Having put those interim arrangements in place, our next priority was to make long-term arrangements to establish a full transplantation service in Scotland. That is why I have asked the North Glasgow Universities NHS Trust to produce an action plan outlining its proposals. I received that plan 10 days ago. This week, the North Glasgow Universities NHS Trust was able to announce the arrangements to be put in place.

Photo of Susan Deacon Susan Deacon Labour

Three of the trust's cardiac surgeons have agreed to take part in the heart transplant programme. All three surgeons already have experience in heart transplantation, but will go to the Freeman hospital in Newcastle to update their existing skills. No compromise in quality is involved. They will be fully competent to undertake heart transplants and they will be released for training in a way that does not disrupt the cardiac surgical programme in Glasgow.

The trust estimates that it may take up to a year to complete that process. Clearly, if it can be done more quickly without compromising patient care, it will be. The important thing is to get it right, both now and in the future. I remind members that there is a national—indeed international—shortage of heart transplant surgeons. They cannot be recruited at the drop of a hat, which is one of the reasons why the present situation arose. The arrangements that are being put in place provide the best means of resuming the full service as soon as possible.

I will end by saying something about why the situation has arisen.

Photo of Susan Deacon Susan Deacon Labour

It is certainly the case that the unit should not have been dependent on only one heart transplant surgeon. Various steps were taken to try to change that, but the situation did not exist because of lack of funding, as some have suggested. Sadly, not for the first time—and probably not the last—in the history of the NHS, recruitment problems, personalities, management issues and medical politics have all played their part.

Photo of Susan Deacon Susan Deacon Labour

I know that there are lessons to be learned and I have always made that view clear. I am pleased that those lessons are being learned and acted upon already. Under the new arrangements, the long-term future of the service will not only be secure, but will be strengthened.

Photo of Susan Deacon Susan Deacon Labour

That should be the message from today's debate. I suggest that politicians across the chamber would do well to act in the best interests of the patients who depend on the service and of the staff who provide it—by sending out that message.

I move amendment S1M-888.1, to leave out from "agrees" to end and insert:

"welcomes the arrangements which are being put in place to secure the long-term future of the heart transplantation service in Scotland; notes the efforts being made to minimise the effect of change on patients; welcomes the commitment of staff at the North Glasgow University Hospitals NHS Trust to continue with high quality support, assessment and follow-up of transplant patients in the interim period; notes the effective co-operation with the Freeman Hospital in Newcastle and arrangements for transplant patients, and notes the importance of patients and the public being reassured that interim arrangements are in place and that steps are being taken for the long-term."

Photo of Michael Russell Michael Russell Scottish National Party

On a point of order. The Presiding Officer should consider whether it is in order for a member—far less a minister—to commit herself to answering a specific question during her speech, presumably to put off interventions, and then not to answer that question. That shows contempt for the Parliament.

Photo of Patricia Ferguson Patricia Ferguson Labour

That is not a point of order, Mr Russell.

I would be grateful if members would not indulge in banter across the chamber.

Photo of Mary Scanlon Mary Scanlon Conservative 11:58 am, 24th May 2000

I am pleased to have an opportunity to debate the Scottish heart transplant unit and I commend Kay Ullrich for bringing forward this topic for debate today. Conservative members will support Kay Ullrich's motion because we want a fully functioning and well-maintained heart transplant unit; but we will also support the Executive's amendment, because it addresses some of the current problems in order to achieve future stability of the service.

There are underlying problems with the Scottish heart transplant unit that have to be addressed. I wish to raise three issues in the short time that is available today. The first concerns the management and the current problems. It seems strange that the whole unit depended on one man. I do not intend to mention any names today, but they are all fairly obvious from recent newspaper articles. We have professional clinicians talking about the lack of enthusiasm of others. We have heard of professionals being marginalised from decisions as they watched the unit grind to a halt. We have heard of a young surgeon who wanted to stay but who was told there was no place for him, and we hear about there being no confidence in the trust to solve the unit's problems.

There are allegedly four surgeons who have been trained for heart transplant surgery—two in Australia and two at the Freeman hospital. We have to ask the management of the North Glasgow University Hospitals NHS Trust why they were not employed. Where was the clear line of management and where is the clear forward planning? Those issues have brought this debate to the chamber today. The minister promised last month that health service managers would have their salaries cut if their performance did not come up to standard. Will she consider cutting the salaries of the management of the North Glasgow University Hospitals NHS Trust for their complacency or incompetence?

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

Does the member concede that since 1993 this matter has been a national responsibility and that if blame is to be attributed anywhere it is not to the trust, but to those at a national level who should have been monitoring the situation?

Photo of Mary Scanlon Mary Scanlon Conservative

That is my next point, but there is no doubt that job advertisements, manpower planning, human relations and personnel issues are the responsibility of the trust, not of the Executive—although I take Mr Hamilton's point.

My second point is about funding. The unit receives hypothecated funding. There is no gain for the North Glasgow University Hospitals NHS Trust in failing to fill these posts. With no financial gain, we can only assume that there was a lack of commitment and enthusiasm. Kay Ullrich made a point about accountability and transparency. Why have no transplants been carried out in Scotland's only heart transplant unit since January? Who is monitoring the unit? When our only unit does not carry out heart transplants for four months, surely alarm bells have to start ringing.

Photo of Mary Scanlon Mary Scanlon Conservative

In a minute.

Although the amendment goes only so far, I commend it because it addresses many issues—although in future better monitoring must be in place.

Photo of Cathie Craigie Cathie Craigie Labour

The answer to the question: why have no transplants been carried out since January is that there were no suitable hearts for any of the people on the waiting list in Scotland.

Photo of Mary Scanlon Mary Scanlon Conservative

I did not hear a word that; I gave way to Richard Simpson.

Photo of Richard Simpson Richard Simpson Labour

Cathie made the point eloquently. The problem since January has been donor availability. That is why there have been no heart transplants. It is not a question of the service being suspended, as was suggested by Kay Ullrich.

Photo of Mary Scanlon Mary Scanlon Conservative

We must draw attention to the fact that this issue came to the public's attention only when hearts were being turned away. That may have been another problem, but that was when the issue was highlighted in the press.

My third and final point concerns how the present situation affects patients. We are talking about patients who are already seriously ill being told to travel even further, not only for their operation but for the first phase of post-operative care. One patient from Inverness, who has to travel to Glasgow, finds it difficult to make that long journey. His journey to Glasgow is probably equivalent to travelling from the central belt down to Newcastle. That constituent, who is on income support, has often been unable to afford the journey and the meals, and he certainly cannot afford the overnight stays.

Under the current arrangements in the national health service, there are no additional means of funding these patients. As has been mentioned today, it is the aftercare that keeps patients alive. My constituent has picked up colds and flu on the train and on the bus, which has meant additional stays in the heart transplant unit in Glasgow. Whatever we may think, patients are worried that there will be a lack of continuity and consistency. The additional travelling puts a severe strain on patients.

We need not only a commitment from the Executive; we need to ensure that the management is capable of ensuring that staff and resources are in place to serve heart transplant patients in Scotland and, in future, lung transplant patients.

Photo of Robert Brown Robert Brown Liberal Democrat 12:05 pm, 24th May 2000

It is important to keep the background to the debate in perspective; what we are really debating is a miracle of modern science. Ten or 15 years ago, we would not have had this debate, because there was no Scottish heart transplant centre; indeed, heart transplants themselves were still front-page news. People simply died, not least in Glasgow, with its tragically high level of coronary heart disease. The change in a short time from a science fiction perspective of medicine to routine medicine is the first point that the chamber should take into account.

The second point is the issue of specialisation. In any line of work, particularly in medicine, specialisation is the key—not just the specialism, as was mentioned earlier, of one super-duper expert. It is far better to have a large number of experts, providing mutual support and back-up, developing techniques and striking sparks off each other. It is now recognised that a unit needs three or four consultants to provide a proper off-duty roster and to make the unit manageable. A team approach, involving physicians to take over the pre-operative assessment and the post-operative follow-up, provides a supportive environment for a transplanter. In fact, across the United Kingdom, the whole thing operates by way of co-operation between units.

Photo of Richard Simpson Richard Simpson Labour

I am grateful to the member for giving way on that important point. Is he aware that lung transplant patients already go south? Is he also aware that a pancreas-bowel transplant—a new operation, which is one of the first in the United Kingdom and in which a colleague of mine was involved—was recently carried out in England and that Scottish patients travel for that?

Robert Brown's point about the necessity of a weight of clinical material is extremely well made—it is only since the early 1990s that that has been available. The number of cases in Scotland has justified a unit; it is only barely justified at present.

Photo of Robert Brown Robert Brown Liberal Democrat

I am grateful to Richard Simpson for that information. It backs up the point I was trying to make, which is that this issue is really dealt with on a UK basis. That is why the Freeman hospital, in my home town of Newcastle, was able so readily to step into the breach left by the resignation of Mr Naik. Incidentally, comments suggesting that the current crisis stemmed in some way from his domestic problems are unacceptable.

It is clear from media comment by some of the leading figures in the saga that the trust had not developed a proper strategy for the future of the service. Perhaps that raises a question about whether the needs of tertiary hospital services, albeit those provided by the trust, should be assessed and monitored at a national level by the Scottish national health service executive.

Photo of Dorothy-Grace Elder Dorothy-Grace Elder Independent

I thank Mr Brown for his courtesy in giving way.

As there is, unfortunately, no point in expecting an answer from the minister, I must ask him—as his party is a member of the coalition—whether he knows when the minister was first informed of this crisis.

Photo of Robert Brown Robert Brown Liberal Democrat

I fail to see why Dorothy-Grace Elder thinks I can answer that question. That is a matter for the minister. I am trying to contribute to a serious debate; I do not want to be diverted by interruptions of that sort.

It is clear that, based on one or two consultants carrying out only about 25 transplants a year, the unit was not viable in the long term. The Royal College of Surgeons recommends that a unit has at least 50 transplants a year to enable surgeons to retain skill levels.

Personality issues might be involved, but hindsight is a great thing and I am not prepared to castigate the trust for not developing a strategy for the Scottish unit based on lessons that are only now beginning to emerge from the review of the service in England. Behind this debate, we can smell two agendas. The first is the important one of the future of the Scottish heart transplant unit in Glasgow. The second is the one that has been behind SNP members' speeches today: that any self-respecting nation must have a heart transplant unit of its own.

I strongly believe that the Glasgow unit should remain open and be fully staffed as soon as possible, but the issue is not one of national virility; it is one of best patient care. Transplantation is organised on a UK basis by a body called the United Kingdom Transplant Co-ordinators Association. It matches and allocates organs to patients, maintains waiting lists and the NHS organ-donor register. Significantly, the organisation carries out the same function for the Republic of Ireland. We were rightly warned in yesterday's papers that the window of opportunity to restore the transplant service in Glasgow might be short because of the national review of the required number of units. That time must be used to rebuild while Scottish patients are being treated with care and expertise in Newcastle, to whose Freeman hospital this chamber is extremely grateful.

Once again, we have a demonstration of what can be achieved by the Scottish Parliament working in partnership with the rest of the UK on an issue that concerns us all. I support the Executive amendment.

Photo of Sandra White Sandra White Scottish National Party 12:12 pm, 24th May 2000

I want to put on the record that this situation does not affect only Glasgow, but the whole of Scotland. It is imperative that the heart unit remains in Scotland.

Kay Ullrich has asked some searching questions. I hope, for the benefit of those awaiting and receiving treatment in Glasgow or in Newcastle, that we can get the answers to those questions.

In a press release, the minister said:

"I am pleased that the recent cloud of uncertainty surrounding the future of the service has now been lifted."

Yet in reply to my questions last Thursday, the minister said:

"There are issues about the past."—[Official Report, 18 May 2000; Vol 6, c 841.]

The minister cannot have it both ways. The minister's department is responsible for the funding of this unit. That means that she should know exactly what is going on. It is not good enough for her to come along here today and tell us that she realised the trouble that the unit was in only when the press made her aware of it. She should have known of the problems months, if not years, ago.

Why was the situation not picked up on sooner? Why was Mr Pillay, a surgeon who is now in Newcastle, told that there was no chance of a permanent job when he asked to stay in Glasgow? We are now told that a surgeon is being recruited. If the minister had had her finger on the pulse, she would have been able to tell that surgeon that he could have that job. The minister is shaking her head but that is not good enough. We need answers.

The trust says that the unit will be operational within a year. Neither I, the public nor the surgeons on the front page of the Evening Times believe that we can wait a year. Patients must be seen before the end of this year.

Will the minister give the Parliament, and the people of Glasgow and Scotland a pledge that this unit—

Photo of Sandra White Sandra White Scottish National Party

I am sorry, I have only three minutes.

Will the minister give a pledge that this unit will be operational by the end of this year and ensure that the facility remains in Glasgow and in Scotland?

Photo of Pauline McNeill Pauline McNeill Labour 12:14 pm, 24th May 2000

Yesterday morning, I visited the heart transplant unit in Glasgow, just to make sure that it is still functioning. Five heart transplant patients were being attended to in ward 67, which houses the unit, and the charge nurse explained that he did his training in Freeman hospital before he returned to Glasgow. This is indeed a specialist field.

Dr Teresa McDonagh, transplant physician and heart failure specialist, is overseeing the out-patients department along with Dr Arule, who, having worked alongside Mr Naik, the transplant and cardiac surgeon, provides continuity. I say that because anyone listening to Sandra White would think that the unit had already closed and had no future. It seems that nothing short of the minister performing the operations herself will do as far as she is concerned.

Photo of Pauline McNeill Pauline McNeill Labour

No, I am not taking any interventions.

There is no doubt that transplant patients in Scotland, some of whom are here today and have waited too long for this debate, which has now overrun, are worried about the continuity of this service. Although they deserve to hear what goes on in this Parliament, their concerns are not helped by the SNP's hype, which causes only alarm.

Photo of Richard Simpson Richard Simpson Labour

Does Pauline McNeill agree that Sandra White's suggestion in her intervention that this unit should be opened by December, no matter what the public safety issues are, is nothing short of abominable?

Photo of Pauline McNeill Pauline McNeill Labour

This debate has exposed the SNP's ignorance—

Photo of Pauline McNeill Pauline McNeill Labour

They know nothing about the issues.

Photo of Pauline McNeill Pauline McNeill Labour

I am not giving way to Sandra White, so why is she speaking over me?

Photo of Patricia Ferguson Patricia Ferguson Labour

We have a point of order. Will you address it to your microphone, Ms White?

Photo of Sandra White Sandra White Scottish National Party

On a point of order, Presiding Officer. I did not make that suggestion in my intervention, as Richard Simpson claimed. I made it in my speech.

Photo of Patricia Ferguson Patricia Ferguson Labour

That is not a point of order.

Pauline McNeill, your time will be adjusted accordingly.

Photo of Pauline McNeill Pauline McNeill Labour

There is no doubt that many patients here today will miss the dedicated and hard-working Mr Naik, who has literally saved their lives. However, I hope that we all agree that this Parliament's first priority is to work together and ensure that our national heart transplant unit remains in Scotland, reconstructed, reshaped and better than before. Questions need to be asked and the trust should be accountable; however, we should get some more facts on the table. Transplant patients who are now on the waiting list will be no worse off while they wait. Hearts are matched to people's suitability and how ill they are; it is not a matter of where people live or how long they have been waiting.

As Richard Simpson pointed out, the safest clinical option for patients is to travel to Newcastle, where the expertise lies at the moment. Mary Scanlon has raised valid concerns about travel that the Parliament should address, as patients who come from Inverness to Glasgow travel as far as patients who go from Glasgow to Newcastle. That said, the pre-operative and post-operative assessments are still carried out in Scotland by Scottish doctors, and members who show their ignorance in this debate should remember that the only surgical element is the transplant itself. Medical doctors should be involved before and after the operation.

There has been some misinformation about the three surgeons who, after delicate negotiations with the trust, have now agreed to come forward. Although all cardiac surgeons train for transplantation, there is a national shortage of surgeons. They do not grow on trees, as the SNP seems to think. The Parliament should give credit to the surgeons who have changed the direction of their careers because they altruistically believe that there should be a heart transplant unit in Scotland.

I am sorry that this debate has been too short and that my colleagues will not have a chance to get in. It is a shame that we have overrun.

Photo of Patricia Ferguson Patricia Ferguson Labour

I apologise to those members who wanted to speak in this debate and whom it has not been possible for me to call.

Photo of Donald Gorrie Donald Gorrie Liberal Democrat 12:18 pm, 24th May 2000

As Robert Brown said, we need to consider this issue in the context of the UK and Ireland. In the UK, there must be an efficient system of heart and lung transplants and of the other specialties. The idea of drawing a line around Scotland is not realistic. However, it is clear that Glasgow is a suitable place to have a heart transplant unit. The area that I represent has a poor health record, especially in regard to heart disease. It would be sensible for any UK network to include a good unit in Glasgow, with several people working in it as a team, as Robert Brown said.

The first task is to set up a UK network. The second task is to re-establish fully the unit in Glasgow and to get it working flat out, making use of the talents of the people there. The third task is to find out whether there has been any failure of planning and organisation in the relevant health authorities, and to determine how to deal with that better in the future. The role of the Minister for Health and Community Care, in dealing with local health bodies and ensuring that they deliver what is asked of them, is an important one. I hope that there will be a thorough review, so that we will learn from any mistakes that have been made.

As Pauline McNeill said, we must salute the qualities, talents and dedication of those who work in the unit in Glasgow, or who have offered to work there in future. All members will agree on that, and I hope that we can set aside the political rhetoric and rally round to re-establish a really good unit in Glasgow along the lines that are set out in the Executive's amendment. I agree fully with the words of that amendment, and that is not always the case.

Photo of Ben Wallace Ben Wallace Conservative 12:21 pm, 24th May 2000

The Conservative party considered the SNP's motion and the Executive's amendment, and could disagree with little in either. The Conservatives pay tribute to those in Newcastle who have helped in this situation, and to the three surgeons who have offered to step in to keep the service going in Glasgow.

Conservative members do not doubt the Executive's commitment to maintaining heart transplant services in Scotland, nor do we feel that, in this case, a lack of substantial funding has been the problem. However, the fact remains that the problem has been allowed to develop, which means that, for at least a year, patients will have to experience the discomfort of having to travel to Newcastle.

I am no expert on the details of heart transplants, but I recognise that surgeons and their support teams work long hours and must always respond to situations according to the availability of organs. We would like the health trust to provide some answers, and seek reassurances from the Minister for Health and Community Care. Conservative members would like to know why, for example, a highly qualified young surgeon was told that there was no job for him when, all along, the trust was looking for a supporting post to that of Mr Naik, who has now left. We would also like to know why the lead surgeon had to work as a one-man band for such a long period, and why the minister was not involved sooner.

I seek assurance from the minister that she will give us guarantees about after-care for the patients who are now using the Glasgow unit. The Scottish Conservative party asks the minister whether the fact that her highlighted priorities are heart disease and its treatment means that she will work to resist the UK's, or England's, review of heart transplant services, the guidelines on which could mean that Scotland's services would become unviable? Will the minister consider allowing local pay deal supplements, to attract needed specialists in struggling areas? Will she consider the way in which consultants' pay could be made more flexible, to attract younger doctors to specialist areas in which there is a shortage?

It would be folly indeed to make this a nationalist issue. The number of organ donors and the availability of organs are not issues of boundaries. Heart transplants are not carried out on a one-heart-fits-all basis, and donors are sought from throughout Europe. Organ availability dictates what counts as the best treatment. We should note that many sovereign countries of the size of Scotland do not attempt heart transplants at all, not because they are unable to carry out such surgery, but because—in the patients' interests—the service and the many consultants are better provided by a bigger country with more assets.

Photo of Richard Simpson Richard Simpson Labour

Is Ben Wallace aware that for a number of years Norway was sending most of its patients who needed heart operations to Glasgow? He is correct to say that a country of 5 million people cannot sustain facilities for many types of transplant, although I hope that we can sustain a heart transplant unit.

Photo of Ben Wallace Ben Wallace Conservative

Dr Simpson's point proves that a bigger country that has better assets would provide better treatment. United Kingdom co-ordination of transplants would be better for the people of Scotland, England and Wales.

The Conservative Government set up the transplant unit in 1992 and we think now as we did then—it is better to fund consultants centrally. It would be a shame if the unit in Glasgow were to close because of bad management practices when Glasgow has such a pressing need for good, high-profile cardiac treatment.

The Conservatives support the motion and the amendment and urge that the real problem be tackled, which is to get Glasgow's heart unit back online as soon as possible. That will be in the best interests of patients.

Photo of Susan Deacon Susan Deacon Labour 12:25 pm, 24th May 2000

It is sad that in many respects the debate has been characterised by the SNP's approach to health issues, rather than by the needs and interests of the people who are concerned. The Opposition's approach to the debate has, sadly, been simplistic and selective. They have used the language of slogans and scapegoats, rather than that of solutions and substance. I firmly believe that the matter is too important to be dealt with in such a way.

I do not have time to give a detailed rebuttal of all the points that have been raised, although I would love to be able to do so. My main concern is to set out the facts for patients and for staff, especially in relation to future support. If SNP members were as interested in the issue as they claim that they are and if they really wanted to deal with the matter constructively, they would do what other members have done. They would enter into constructive dialogue with me, the trust and the others who are involved in the service instead of whipping up fear and anxiety in those who can least afford that.

The history of the issue is complex. The Scottish Executive, via its national services division, has actively pursued concerns and has attempted to rectify the unsatisfactory situation of the single-handed surgeon arrangement for more than 18 months. While the SNP might live in a world of quick fixes, the rest of us live in the real world.

Photo of Susan Deacon Susan Deacon Labour

We know that the issues are difficult to solve. I repeat the point that I made earlier. There is a complex cocktail of recruitment problems, personalities, management issues and medical politics, all of which have contributed to the situation.

It is crucial, as many speakers have said, that lessons are learned. Opportunities must be utilised and we must move forward. It is sad that certain SNP members have chosen to focus on the past—I am interested in the future. If, as they claim, SNP members are interested in patients, will they join me in giving a clear message? We are putting arrangements in place to secure the future of the unit, we have put patients' interests at the heart of our efforts and we are determined to ensure that Scots will have access to a high-quality service.

Mrs Ullrich, the SNP health spokesperson, said that the issue is too important for party politics. Why then, as recently as last Thursday in the chamber, did Sandra White claim that the unit would close, despite repeated reassurances to the contrary? Why did Mrs Ullrich claim two weeks ago in the press that Scots would go to the back of the queue, despite clear reassurances to the contrary and despite the fact that each case is dealt with on the basis of clinical need? Does she not know? Does she not care? Is she more interested in headlines than in health? Perhaps it is about time that we were told the answers to those questions in the chamber.

Photo of Patricia Ferguson Patricia Ferguson Labour

Order. The minister has indicated that she is not taking interventions.

Photo of Susan Deacon Susan Deacon Labour

I have set out clearly, fully and openly the facts of the issue as far as time has permitted. I repeat the point: effective interim arrangements are in place for patients and effective arrangements are being put in place for the longer term. Lessons are being learned for the future and those lessons are being acted on. This is a difficult situation, but it is one in which we are now looking to the future and moving forward. It is a situation to be managed, not another crisis to be manufactured on the SNP benches. It is an important service, providing vital support for seriously ill people. They deserve to be dealt with sensitively and responsibly, and I repeat my pledge to do just that.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party 12:29 pm, 24th May 2000

It is ironic that a minister as obsessed with dialogue as Susan Deacon is would not take an intervention during her speech. Perhaps she has misunderstood the point of parliamentary debate. If she thinks that it is about constructive dialogue, that is what the SNP has sought today and that is why we have lodged our motion.

Pauline McNeill made great play of the fact that the Executive was taking the matter seriously. If that is true, why has it taken the SNP to bring this debate to the chamber? What has been the Executive leadership on the issue, or has it been non-existent?

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

No, thank you. Pauline McNeill now appears willing to answer for the Executive, which strikes me as an interesting example of self-promotion.

The minister said that she wanted to talk about the role of patients in this case. The 10,000 patients who have signed a petition are disgusted with the minister's response so far and with the absence of answers, clarity, transparency and accountability. That is what they thought this Parliament was about. That is what they wanted from the minister, but it is what they have palpably failed to receive.

Let us go back through some of the basic facts. The minister is trying to turn this into a debate in which the SNP answers all the questions. I understood that we asked the questions and she gave the answers. That is why she is the Minister for Health and Community Care and we are the Opposition.

Throughout the debate, the minister has attempted to pass responsibility from the national Government to the local trust. Since 1993, the responsibility for that issue has been with central Government. As Sandra White said, this is a national service. It is based in Glasgow, but it is a service for Scotland. That is why this issue is important today in Scotland's national Parliament. A national service needs national answers from our national minister. The problem is not to do with the mismanagement of the trust, and it is disingenuous of the minister to try to pass the blame or smear it across.

The minister told us that she was interested in giving us facts and clarity. In the interests of constructive dialogue, as I believe she wants to call it, let us have some answers to the questions that Kay Ullrich asked but which the minister never answered.

Let us run through the facts. There has been one consultant since 1995. The post has been advertised for 18 months. There have been no transplants since January. A surgeon who applied for that job but did not get it then went to Newcastle where, ironically, the same consultant will now perform operations on the same patients as he would have done in Scotland. Bizarrely, three surgeons came forward last year to offer the very same service that has now been offered, but the minister does not seem to know what responsibilities she has.

The minister talked about her ability to learn lessons. If that is true, when did she become aware of the depth of the problem? Was it when she first came into office a year ago? If it was then, why did it take until 8 May this year to get any decisive action? Why will she not give us answer about how the case proceeded? I will give way to the minister if she will answer these questions.

When did she know the position? When did she know that there was one consultant? When did she know that there was a structural weakness in the service that was being provided because one person was in that post with no backup? Does she not think that, as the Minister for Health and Community Care, she should be taking care of such a serious management issue? If the minister would like to answer those questions, I shall now give way.

I think that the fact that the minister has remained seated tells us her answer. Either she knew and chose not to act, which, frankly, is a disgrace, or she did not know and her department does not even bother to tell her about issues of this magnitude. In many ways, that would be more troubling. If we have reached the stage where the system does not work and the minister who is accountable to this Parliament is not told about the depth of the crisis, this is a sorry day.

The minister talked about the role that she has played in trying to reassure families. Her press release, which says that she is putting families first, states:

"The Scottish Executive has worked very hard to address the concerns of patients and families".

When we consider that 10,000 people submitted a petition to this Parliament outlining the fact that the Executive has not taken the responsibility and the leadership, that people have been disadvantaged in this regard and enormous worry has been caused, I suggest to the minister that there is a lot more to be done.

As the minister wants to talk about patients, I will quote from Anne Dundas of the transplant patients support group, who comments on the minister's breathless announcement in the press release. She said:

"This announcement is telling us nothing that we didn't already know.

It doesn't bring forward the day when they start doing transplants in Glasgow.

Glasgow has to get the operation running as soon as possible. We have the worst record on heart disease in the world and we cannot allow this unit to lose its work to any other city."

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

No, thank you.

That is the position that patients and families are taking and if the minister really wants to be seen as in touch with patients and the NHS that is the concession that she will have to make.

It was interesting that Dr Simpson rose there, because we have heard several different stories on the Executive's long-term commitment to the unit. The minister said that the unit was absolutely safe, that it was wrong of us to scaremonger about it and that there was no diminution of commitment towards the transplant service.

We then heard from the Liberal Democrats that the SNP was trying to use this service being sited in Scotland as some kind of national virility symbol. That is absolute nonsense. When members consider the state of Scottish health, and the position of Scotland's health service, they will see that Scotland needs this unit more than anywhere. The league table for deaths from circulatory problems per 100,000 of the population shows that Scotland is third—within the UK Scotland is top by a mile.

Given that health is a fully devolved area, is it not right that people in Scotland should expect from the Scottish Minister for Health and Community Care a clear commitment that there will be long-term provision of this service? We heard from the Labour back benches that in fact that commitment was perhaps going to be less than the minister had intended. We heard that, apparently, this service can be done all over the United Kingdom and that that is more important than having it in Scotland.

Photo of Richard Simpson Richard Simpson Labour

I would be grateful if Duncan Hamilton would agree to correct one comment that he made in his speech, because it was seriously wrong. He suggested that Scottish patients would be disadvantaged by the events that have occurred. I cannot believe that he is trying to say that. For the sake of the patients who are in the balcony, I hope that he will correct that comment now. They are not disadvantaged; they are on a common list and they will receive excellent treatment at the unit in the Freeman hospital in Newcastle.

Photo of Duncan Hamilton Duncan Hamilton Scottish National Party

It is a sad day in this Parliament, when 10,000 people tell the Parliament that they will be disadvantaged and the Parliament tells them that they are wrong. They are the people who know.

I say to Dr Simpson, let us be clear what we are talking about. We are talking about 25 people who will now travel to Newcastle for an operation that could have been done in Scotland. The reason that it has not been done in Scotland is that this Executive could not get its act together and accept the offer of the three surgeons last year. That is the problem that must be addressed and that is what the minister has palpably failed to tell us throughout this debate.

When it comes to taking responsibility, I am afraid that this Executive does not know how to start. This is a national responsibility and there are unanswered questions. The minister has not told us, at any point in this debate, when she knew, what she knew, and if she did not know, why she did not know. Those outstanding questions deserve a response. We want to hear a long-term commitment from this Government. We got half a commitment from the minister and no commitment from the back benches. Everybody in this chamber, patients watching and Scotland watching will be very unhappy about the minister's performance today. Patients deserve a lot better in Scotland and the minister has let them down.

Meeting suspended until 14:30.

On resuming—