The next item of business is a debate on motion S1M-3375, in the name of Nicola Sturgeon, on the acute services review, and one amendment to that motion. As we prepare to start, the indication is that many more members wish to speak in the open part of the debate than we will be able to accommodate. We will do our best. I ask all members to stick as closely as possible to the advised speaking limits.
The debate is not and should not be party political. It is about the future of the national health service in Glasgow. There has been remarkable cross-party consensus in Glasgow on the issue over the past three years. For the sake of the thousands of people in Glasgow who look to the Parliament to listen and act, I sincerely hope that that unity can be maintained in the debate.
Glasgow's hospitals desperately need investment. With that investment must come modernisation. Health care today is not delivered as it was when the Victoria infirmary was built. Any plans for future hospital provision must reflect that.
Those of us who oppose the proposals that were put forward by the Greater Glasgow NHS Board and endorsed by the Minister for Health and Community Care are not neanderthals who are wedded to the old ways of doing things. We welcome the proposed £700 million that is earmarked for investment in Glasgow's hospitals and want the modernisation programme to start as quickly as possible. However, it is absolutely essential that we get that right. The proposals will affect not only our generation or the next; the hospitals that get the go-ahead now will serve the people of Glasgow for decades to come.
The health board's current plans are fundamentally flawed. In my view—and in that of the thousands in Glasgow who have made their views known again and again over a period of years—they are unacceptable. Three aspects of the acute services plan do not command any public confidence. The first is the proposal to centralise all in-patient services for the north and east of the city at Glasgow royal infirmary and remove all in-patient services from Stobhill hospital. Stobhill will become an ambulatory care—or day—hospital.
My colleague Fiona McLeod will cover the
Those who oppose the downgrading of Stobhill also raise a point of principle—local access to health services. I will return to that principle later, because the tension between local access to health care and the specialisation of clinical services is central to the debate.
The second bone of contention that arises from the acute services review is the proposal to close the Victoria infirmary, replace it with a day hospital and centralise all in-patient services at the Southern general hospital for the 350,000 people who live in south Glasgow. If that proposal goes ahead, the Southern general, with around 1,500 beds, will become the biggest hospital in the United Kingdom.
Concerns have been expressed about the sheer size of a redeveloped Southern general, but the real problem is with its location. For years, people in south Glasgow have argued that, if there is to be only one in-patient hospital for the whole area, it must be in a central location. The health board went through the motions of considering building a brand new hospital at Cowglen, but at no time was that a realistic option. The health board decided on day one of the acute services review that it wanted the Southern general to be the site of the in-patient hospital in south Glasgow. From then on, the process was skewed to achieving that end. The sham that masqueraded as a consultation exercise has left people in Glasgow feeling alienated from a decision-making process that impacts profoundly on their lives but does not listen to a word that they say.
It is important to put on record the fact that the Southern general is an excellent hospital. It serves patients in Govan and the surrounding areas extremely well. It has tremendous expertise in a number of areas. Recently I visited its spinal injuries unit, which treats patients from all over Scotland. The specialist care that it provides is second to none. However, the Southern general is entirely unacceptable as the site for the only in-patient hospital serving south Glasgow.
Is the member suggesting that the Southern general
I am not suggesting that the Southern general should close. In a moment I will address the point that the member makes.
The Southern general is on the absolute periphery of the proposed catchment area. For people living in areas such as Rutherglen, Shawlands, Pollokshaws and Castlemilk it is totally inaccessible. There are no bus or rail links. From parts of Ken Macintosh's Eastwood constituency, it can take up to an hour to get to the hospital by car at certain times of the day. The Southern general is at the mouth of the Clyde tunnel, which means that access will frequently be impeded by traffic congestion. It is situated right next door to a sewage works—hardly the right environment for sick or recuperating patients.
What is the alternative? I will now address the point that Johann Lamont makes. Some people would prefer a new hospital in a central location. I, along with others, support a two-hospital option, with in-patient services being retained at a rebuilt Victoria infirmary.
Earlier, I mentioned the tension between local accessibility and clinical specialisation. The health board—and, no doubt, the ministers responsible for health—argues that keeping in-patient services at Stobhill and at the Victoria would stand in the way of greater specialisation of services. I recognise the benefits of greater clinical specialisation, but I dispute the claim that specialisation can be achieved only by the centralisation of hospital services. By integrating clinical services between different hospitals within managed clinical networks, we can have the benefits of specialisation without losing local accessibility to hospitals. New technology makes the solution that I propose more possible.
I want to make some progress. If I have time, I will take an intervention from the member later.
The Scottish Executive press release that announced approval of the health board's plans cited
"difficulties in transferring information like lab results and x-rays between sites" as an argument for centralising services. That beggars belief. Surely by the end of the 10 years that it will take to complete investment in Glasgow's hospitals we will have mastered
In short, I do not accept that the only way forward for Glasgow is to centralise in-patient services. I know that there are others—even in the chamber—who disagree. That is one reason why my motion calls for an independent review of the health board's proposals.
I share some of Nicola Sturgeon's concerns and am pleased that she does not regard the issue as party political. I hope that we will have a chance to debate it properly.
The member appeared to indicate that she supports the retention of five in-patient sites in Glasgow—which is the status quo. Will she elaborate on that and clarify her position?
I said that I favour a two-hospital option for the south of Glasgow. I have called for an independent review because I believe that there are issues that still need to be considered. Some issues on which the people of Glasgow have expressed views have not yet been considered. My basic point is that we cannot go ahead now with proposals that the vast majority of people in Glasgow—including Glasgow MSPs—regard as unacceptable.
The Executive amendment refers to the retention of "named services" at Stobhill and the Victoria over the next five years. Perhaps this morning the minister will outline exactly what services he has in mind. Whatever those are, promising to keep services at the two hospitals for five years does not address people's concerns. After that period, the proposals that are so unacceptable to so many people now will go ahead, even if public opposition remains. What comfort is there in that?
My third reason for opposing the health board's plans is that they entail the reduction of accident and emergency departments from five to two. A city of the size and complexity of Glasgow should not be served by only two accident and emergency departments. Since 1991, the number of people treated in accident and emergency departments has increased steadily year on year. As we saw only a couple of weeks ago, waiting times are increasing. However, Greater Glasgow NHS Board believes that the 175,000 people who are seen every year in A and E at Stobhill, the Victoria and the Western infirmary can now safely be seen at the GRI and the Southern general. It believes that it is okay for people who live in the north-west of the city to have to travel through the Clyde tunnel on a journey that can take more than an hour at peak times or when Rangers Football Club is playing at home.
The Executive's amendment promises a review in two years' time, even though most people in Glasgow know that the proposals are wrong. What
The Executive's amendment offers nothing to allay the fears of the people in Glasgow, as I am sure every Glasgow MSP knows that in their heart. The people of Glasgow believe that the proposals are unacceptable. They have said so repeatedly, but the health board and the Minister for Health and Community Care have ignored them. Today they are asking Parliament to listen. I ask all MSPs, regardless of their party or position, to follow their conscience, put Glasgow first and support the motion in my name.
That the Parliament welcomes the proposed £700 million investment in the modernisation of Glasgow's hospitals; considers, however, that the plan by Greater Glasgow NHS Board for the re-structuring of acute services in Glasgow is unacceptable in its current form; is particularly concerned about the proposed number and location of in-patient hospitals and the reduction of accident and emergency departments from five to two, and calls upon the Minister for Health and Community Care to suspend his approval of the board's plan and to establish an independent expert group to conduct, within six months, an impartial review of the plan, with a view to identifying proposals which command greater public acceptance and which can be implemented within a rapid timeframe.
During the nine months for which I have been the Minister for Health and Community Care, I have devoted a great deal of thought to the matters before us today. I have discussed them many times with MSPs of all parties and others in Glasgow, including local campaigners at Stobhill and in the south-east health forum.
I recognise the strength of feeling around particular services in particular hospitals, but I have to take a view about what is right for greater Glasgow as a whole. My conclusion, which is shared by many but by no means all in Glasgow, is that we should press ahead with the necessary and long overdue process of modernisation and investment while at the same time setting in place a continuing process of monitoring and review.
I remind members that the investment is £700 million—the largest ever in the history of the health service in Glasgow—and it comes on top of the
The status quo is not an option, but the SNP motion before us today asks us to freeze the status quo for another half year or so. It sounded from Nicola Sturgeon's speech as though she wants to freeze it forever. The motion asks us to consider yet again the issue of three in-patient sites, when groups as diverse as the area medical committee and the Greater Glasgow Health Council tell us that three hospitals will be best for improving the quality of care.
Increased specialisation has clinical benefits for patients and such specialisation requires larger clinical teams and fewer in-patient sites. It will also mean more one-stop access and more consultant-delivered care, including, crucially, consultants on the floor of accident and emergency departments 24 hours a day.
However, it is not just three in-patient sites that are proposed but £120 million of investment in a new Victoria and a new Stobhill, which will carry out 85 per cent of current activity. There will be local access in every case where that is best, but there will be a better environment for a redesigned, more patient-friendly service. The hospitals will carry out all out-patient services, radiology and one-stop diagnosis, medical day care, day surgery, ophthalmology, renal dialysis, elderly day care, cardiac rehabilitation, dental services, treatment of minor injuries, medical oncology and so on.
I want to do everything to accelerate the development of those ambulatory care and diagnostic units with the full involvement of local people at every stage. However, even with that acceleration, the plan is long term and it must be flexible enough to take account of changing service demands and developing medical practice. That is why I support a continuing process of monitoring and review that creates a check at every stage to ensure that service moves are wise.
I welcome the minister's commitment that services will be retained for five years, but we have heard many times that services will be retained at particular facilities. Will the minister assure me that no services will be removed from Stobhill hospital during the five-year period and that the Auditor General for Scotland will conduct an independent review during and after the period?
I will describe the role of Audit Scotland in a minute. My amendment states that local people must have a role in continuing monitoring and review at Stobhill and Victoria hospitals and that any changes over the next five years will have to be monitored by them.
I think that Paul Martin will accept that changes that were made for clinical safety reasons would be acceptable to local people. I give him my assurance that in no other circumstances should the services that Greater Glasgow NHS Board has already named be moved in the next five years.
I do not have time to take another intervention at present.
I continue with the theme of monitoring and review. Greater Glasgow NHS Board is already committed to an annual review mechanism that will allow the board to see whether the key assumptions that underpin the strategy are valid each year or whether material changes are occurring that might require an overhaul of the planned strategy. I hope that members will welcome the role that Audit Scotland will play as an external independent auditor in that process.
Over and above the local monitoring that I described to Paul Martin, I also support a strong role for patient and community groups in the review of accident and emergency services, which I propose should take place in two years' time.
The decision about whether there should be two or three accident and emergency departments was the hardest for Glasgow and the most difficult for me. It is right that the assumptions that underpinned that decision should be looked at again when we are a bit nearer any changes to accident and emergency services. However, in the overall context of new developments in emergency care, the proposal to have two accident and emergency departments is reasonable. I will describe those developments after I take a brief intervention from Bill Butler.
I am grateful to the minister for giving way. I agree with Ms Sturgeon and with others who have said that people are concerned about the reduction in the number of accident and emergency departments to two. I believe that we should have three departments. The amendment in the minister's name says that the review will take place in two years. Will the minister accept the outcome of the review if it says that there should be three accident and emergency departments?
I am answering the point raised by Bill Butler.
I would certainly pay close heed to a review that said that there should be three accident and emergency departments. There will be no changes to accident and emergency services in the next two years. That is why it is far more important to have the review at a more appropriate time that is closer to the introduction of the proposed changes.
I will have to curtail my comments on new developments in emergency care. In the Glasgow proposals, emergency care is separated into different elements. The 90,000 people who attend accident and emergency departments with minor injuries will be dealt with in dedicated minor injuries units that will have shorter waiting times. There will be three new rapid access services for general practitioners to make emergency referrals to hospital, which will streamline arrangements for managing tens of thousands of patients. The new proposals will allow patients who have already been assessed by a GP to bypass accident and emergency departments entirely and get faster access to appropriate specialist teams.
I will have to curtail a lot of my material.
Under the proposals for Glasgow, we will have two accident and emergency departments, three acute receiving units, five minor injuries units and one children's accident and emergency department. That is the full picture of emergency care, but it is often not described.
Changes in the way in which ambulance services are delivered are also fundamental to the proposed configuration. I will have to cut my comments drastically, but I point out that by 2005, the number of paramedics working on front-line ambulances in Glasgow will almost double from the current 78 to 147, with a paramedic in each front-line ambulance crew.
I refer in passing to the work that has been commissioned to assess the broader transport implications of the proposals for staff, patients and visitors, about which members have asked questions. The results of that work will be
More generally, I have made it clear to Greater Glasgow NHS Board that I expect local people and local representatives to be fully involved in the detailed planning that will be required to turn all these proposals into reality. This is not the end of the debate, but it is time to move on and make change happen. Glasgow cannot wait any longer.
I move amendment S1M-3375.1, to leave out from "considers" to end and insert:
"accepts that the status quo is not an option and that improvements and modernisation must be progressed as soon as possible in order to enhance the quality of care; recognises that this is a long-term plan which must be flexible enough to take account of changing service demands and developing medical practice; supports an on-going monitoring and review process that includes external independent audit by Audit Scotland on an annual basis; endorses a commitment to keep named services at Stobhill and Victoria over the next five years and to have this locally monitored; gives high priority to the acceleration of ambulatory care and diagnostics developments in consultation with local communities; recognises the particular concern over the number of accident and emergency departments and supports a review of this in two years time that involves staff, patient and community groups, Glasgow Health Council and the Scottish Royal Colleges, and welcomes current developments in the Scottish Ambulance Service which will include the near doubling of paramedics in Glasgow by 2005 and one paramedic in the crew of each front-line ambulance."
I intimate that, because of time strictures, I will not take interventions, which is unusual for me. I do not think that the content of my speech is such that it would provoke interventions.
It goes without saying that the proposals in the review are quite unacceptable. Let me make it clear that I am not of the view that Glasgow's health services could remain preserved in aspic for perpetuity. I suspect that anyone who has had any input into the discussions and consultations that have taken place shares my view.
Of course there will have to be changes and we welcome the additional resources that are being put in, but that is hardly the issue. Let me be equally clear that the proposals create as many problems as they resolve, particularly in relation to services south of the river. To suggest that there could be that level of centralisation without a reduction in service is naive. In particular, to suggest that the only accident and emergency provision for the south side of Glasgow should be on the extremity of the hospital's catchment area is plain daft. The problem is that it is also potentially very dangerous.
It is clear that a reduction in emergency services, so that they are available on only two sites, is unacceptable and is causing considerable public alarm. I am particularly concerned about the lack of confidence in the basis of the decision making. The consultative process should have been transparent, but it was not. Some information that was provided has been found to be inaccurate and that is worrying.
There is alarm and bitterness about the way in which the consultation process has been run. It has been a sham. As Nicola Sturgeon said, in regard to the south side of the city, it is apparent that the Southern general option had been pencilled in in biro from the inception. The so-called consultation exercise was cosmetic. I have little doubt that those who were involved were determined to drive through that option. All through the process we have been bedevilled by lack of information and wrong information. We have received scant or wrong information on bed numbers, the availability of land for a possible new build at Cowglen, transport studies and costs. That is unacceptable.
The purpose of the SNP motion is to ensure that the review that is carried out is totally independent. Someone must consider the issue with a fresh mind and a clear eye. It is necessary to demonstrate that those decisions, which could affect the lives of people in Glasgow for the next 50 years, are taken on the basis of correct facts. There may be disagreement—it is inevitable—about the number of emergency units that there should be. Three would have to be regarded as an absolute minimum.
We must look into all the aspects more deeply and widely. Is the Cowglen option viable? Could a revamped Victoria hospital be built on the Queen's Park recreational ground site? Are ACADs a good idea where there is no emergency facility nearby to cope with the inevitable mishap that will occur from time to time? Are the figures for Stobhill and the royal infirmary accurate? Has the desirability of transferring the Stobhill patients to the royal been considered with the appropriate intensity? We need to know accurate bed requirements. As John Young will say, we must consider demographic changes.
It is the unanimous view of the Glasgow MSPs who have been involved in the issue that Greater Glasgow NHS Board's plans are wrong—wrongheaded to the point of being dangerous. It is disappointing that despite the considerable representations that have been made to him, the Minister for Health and Community Care feels unable to support the MSPs and the vast majority of the Glasgow public. He is even prepared to fly in the face of considerable medical opinion. That is a very dangerous thing to do. I pay tribute to
A failure to support the amendment calling for an independent review would be inexplicable. The proposals have the potential to be immensely damaging to the people of Glasgow. Any Glasgow member who fails to resist them would be complicit in causing that damage. The issue must be considered again in a detached manner if public confidence is to be restored. Even at this, the 11th hour, I ask the Minister for Health and Community Care, for the benefit of the people of Glasgow, to consider the review in more detail and allow an independent review to take place. [Applause.]
Order. I must ask members of the public in the visitors gallery to desist from applauding. This is not a public meeting, but a meeting of the Parliament. We want to proceed as smoothly as we can.
I am the first Glasgow member of the Executive parties to speak in the debate. I thank Nicola Sturgeon and the SNP for allowing its time to be used for this debate.
The future of hospital services in greater Glasgow has been the most difficult issue that I have had to face since I entered the Parliament in 1999. At that time, at my instigation, a number of MSPs formed a cross-party group to deal with the matter, in particular how it would affect Rutherglen and Cambuslang in the south-east of Glasgow. Since that time we have had scores of meetings of all kinds on the subject.
Matters have been clouded by a background of years of poor decisions and no decisions on Glasgow's deteriorating Victorian hospital estate. They have also been clouded by the strongly founded belief that the health board's consultation, although it devoured forests of paper and mega litres of hot air, was at heart a charade, designed to obtain a pre-ordained outcome. Other members have echoed that point.
The legacy of that is a significant democratic deficit in support for the administration and planning of our national health service and our hospitals. Campaign groups have done a signal service in articulating concerns and analysing the proposals. However, today's debate is essentially about whether to proceed with modernising Glasgow's hospitals, in greater collaboration with local communities, or whether to throw matters back into uncertainty.
I was attracted by the idea of an independent expert review. I suggested such a review at several stages of the process because it would be a way of having external appraisal not only of the procedures, but of the merits of those complex decisions. It would also help to tackle the democratic deficit that I mentioned.
At the end of the day, I am inclined to the view that the independent expert review would delay the process not by six months but by two years or more. There are no other worked-up proposals to hand and any significant changes would require renewed and extensive consultation and would be likely to produce a different balance of public forces against it. A major window of opportunity in funding terms would also be lost.
A review would harm and not help our shared objective of moving as rapidly as possible to a position where modern and attractive facilities are in place. I am not attracted by the suggestion of managed clinical networks as a way around the dilemma, as they would go against the grain of the comments that have been made repeatedly about the difficulties of split-site working and all that sort of thing.
In The Herald today, Dr Roger Hughes, chairman of the area medical committee, lays out the reasons for the concentration of in-patient services, which are increasing specialisation; major pressures on medical manpower because of the long-overdue working time directive requirements; and the increasing national shortage of doctors and nurses, about which we are all aware. It is for those reasons that all parties accepted the need for a single south side hospital until, nine tenths of the way through the process, the consensus ultimately fell apart because of unhappiness over the chosen site.
I remain of the view that the choice of the Southern general hospital as the main south side centre was wrong. The hospital is located at the extreme tip of the south side and is subject to unpleasant smells from the Shieldhall sewage works. The location will be a building site for some years.
The nub of the matter is the fear over the loss of one of Glasgow's busiest accident and emergency departments at the Vicky. The Executive has gone some distance to meet those fears by promising a review of A and E in two years' time. I seek the minister's assurance that, building on what he has said to us already, no irrevocable decision will be taken before that time or before alternatives are in place so far as accident and emergency provision across Glasgow is concerned.
I have never been against the ACAD. I consider the view of the friends of the Victoria infirmary committee on that matter to be more realistic than
The current plans envisage that the board will not be able to afford the revenue consequences of these long-overdue plans for at least 10 years. That is not acceptable for a community that has long been proven to have the greatest health needs in the UK and which has an established historic underfunding on health in respect of the Arbuthnott formula. It is vital that the minister looks closely at the figures and considers the injection of say £100 million free capital to ensure that Glasgow hospitals can join the rest of the civilised world. He has to do that on a much quicker time scale—the present plans are leisurely, to say the least.
This is a serious debate, not an occasion for party point scoring. We must consider the issues realistically and urgently. As the minister pointed out, greater Glasgow cannot wait much longer. Although I am moving towards the Executive's position, I have not made up my mind which way to vote. I require significant assurances from the minister on the questions that I have raised, which I am sure will be followed by other questions from my colleagues.
I welcome aspects of the Executive's amendment. Of course the status quo is not an option, and we must make progress sooner rather than later. I welcome on-going auditing; the commitment to retain services; the review of accident and emergency provision; and of course the massive investment in my constituency. However—and it is a big however—I also agree with the motion that the present plan for acute services is unacceptable. I am particularly concerned about the proposed number and location of in-patient hospitals.
The present proposal is to establish a massive hospital on the site of the Southern general hospital. However, it is a mistake to focus all the south side of Glasgow's acute services in that one location. The experts tell us that the best solution for the south side of the city is to concentrate everything in one site. That might or might not be the case. Perhaps we want one hospital. Perhaps it would be better to retain the Southern general at
I do not have the time to elaborate the reasons for that. We could talk all day about transport; the complexity of creating such a hospital on top of an existing working hospital; the fact that we have really no experience of managing such a project on such a scale; the accident and emergency implications; and other problems. Although there is a host of such reasons, the bottom line is simple: the present proposal is not right. It would be better to pause for a comparatively short time and reconsider the issue in a fresh and impartial way. Obviously, I very much want the investment—after all, I am talking about my constituency—and we need to make progress. However, it would be better to take a little time to reflect on the matter and get it right.
I know that we have had a consultation process. Indeed, that is part of the problem. The people of the south side of Glasgow feel that that process has been a sham, and they are not far wrong about that. It is increasingly clear that the health trust and its predecessor have had a very definite agenda and have always intended to reach the conclusion that has been reached. Having examined the matter over the past three and a half year, I have found that there has been no openness of thinking.
The people of the south side want a genuine opportunity to make a very compelling and impressive case. They believe that if they were given such an opportunity, the proposals would be seen for the mistake they are. They might or might not be right that that would change minds, but at the very least there should be a willingness to carry out that review.
This is not about narrow parochialism or about trying to save a local facility. The Vicky itself is past its sell-by date. Instead, this is about the future long-term health care of the people whom I represent. I do not want us, 10 or 20 years down the line, to say that we made a mistake. It is better to pause now.
I reiterate the point made by Nicola Sturgeon about political point scoring, but not by the SNP.
We are talking about delivering the best possible
Much has been said about the consultation process. Greater Glasgow NHS Board spent hundreds of thousands of pounds on the so-called consultation process. It hired the Scottish Exhibition and Conference Centre, Hampden football ground and another football ground and it produced a video. What did we get from that process? We got the original proposals and a quotation from a document dated August 2000, which says:
"Our aim is to create two adult Accident and Emergency Departments/Trauma Centres—at the GRI and on the Southside."
Hundreds of thousands of pounds were involved as well as hundreds of members of the public. Doctors, clinicians and nurses gave of their time. People have said that the consultation was a sham and I agree with them: it was a deliberate sham to present proposals that were presented originally in 1999-2000. We have not advanced one iota.
Transport links have been mentioned today. Gordon Jackson said that the hospitals were difficult to get to. I refer to the west end and the north of the city. I presume that some members have tried to get through the Clyde tunnel and city centre at peak times or at weekends. Believe me, even at off-peak times, the roads are congested and the tunnel is often closed or only one lane is open. We cannot afford to deal with people's lives under such conditions.
Two accident and emergency hospitals for Glasgow are not sufficient. That is why I support the motion.
The Glasgow royal infirmary is already under great pressure, as we all know. During the consultation process, doubts were raised about whether the GRI could cope with the projected number of patients it would receive. The consultants and nurses told the health board that they did not think they could cope. A letter that I received from west Glasgow hospitals says:
"The Health Board and Trust have yet to provide any sensible reasons for this plan or indeed any evidence that it is workable. Despite the lack of evidence neither the Board nor the Trust have ever seriously considered a proper option appraisal between one or two sites for North Glasgow."
That says it all. Hundreds of people have given of their time, as I said before, for the consultation process. What about the ACADs? It is insufficient to have an ACAD that is not attached to a hospital. The public know that and we agree with them.
As I said, the SNP motion is not about political point scoring. The amendment, however,
"endorses a commitment to keep named services at Stobhill and Victoria over the next five years" and
"recognises the particular concern over the number of accident and emergency departments and supports a review of this in two years time".
There has been no political point scoring from this side, but there certainly has been from the minister's side. The amendment is a cop-out and would lead to the worst possible scenario, with Glasgow left in limbo for five years—and perhaps for a further five years after that. This is all about saving Lord Watson's skin and the Lib-Lab coalition in Glasgow. I am glad that I have said that. This is a cop-out. If any Glasgow MSP votes for the amendment, they will have to answer to the people of Glasgow.
I remind the minister that, if we close down hospitals in two years' time, and if we remove commitment, we will not get those hospitals back. Please, members, support the motion and get rid of the amendment.
Because of time constraints, I suspect that my senior colleague, Paul Martin, may not get to speak. Since my election, having the co-operation and solidarity of Paul Martin and other colleagues has been a help to me in serving my constituents.
I welcome the £700 million of much-needed investment in greater Glasgow's hospitals. I will say that figure again—£700 million. I acknowledge and welcome the £75 million on top of that for the Beatson clinic. Malcolm Chisholm knows that I take a particular interest in that.
The sum of money is colossal by any reckoning. It reflects the need for sustained rising investment in our NHS—including investment in our acute hospitals. Of that money, £60 million is destined for Stobhill. I repeat, £60 million. Paul Martin will not mind me saying that he has never seen £60 million spent on his constituency, never mind on the hospital. The same would go for my constituency. That monetary investment reflects our guarantee of a long-term future for Stobhill hospital.
I recently attended a meeting at Stobhill hospital to hear theatre and support staff reporting uncertainty and concern about their future. Those are the very people who make the hospital tick. I want the minister urgently to interrogate the measures that are being taken and that are to be taken to inform and to involve staff, patients and local communities about the future secured for them at that hospital.
I am sorry, but I do not have time. I agree with Alex Neil that a four-minute time limit is daft.
I want the minister to be specific about what is being done and what will be done to make early progress on the ACAD unit at Stobhill hospital, and I do not just mean ditching the daft abbreviations. Stobhill's ACAD unit is not the health board's baby. The proposals for an ACAD unit at Stobhill came from the medical and support staff at Stobhill. The ACAD unit enjoys near unanimous support across the north of the city. I know that a different position obtains in the south of Glasgow, and I am sure that people in the south of the city will make their case. However, I strongly urge the minister to ensure not only that we get a green light for our ACAD unit, but that we get a kick start for the works. Since I was elected, I have sat through many meetings where we seem to go round in circle after circle about the ACAD unit. Please let us get round to the hospital with the builders and let us do so as soon as is practicable.
We need to speed up investigations for patients, we need to cut waiting times and improve treatments, and we need to do as much as possible in one single attendance, continuing the move towards day care. Those are things that I hope we all agree on and want to see. Delay fuels uncertainty and stalls progress.
I hope that the Parliament will also consider the nine-month consultation that was undertaken by the board. There were lots of meetings and I attended nearly all of them, but I do not feel that there was true public participation. We need to ensure that NHS boards properly reflect the views of staff and patients. I welcome the independent monitoring and review guarantees that were conceded today by the minister. Paul Martin and I have been pushing hard to get oversight from outside the board over what we know will be a long haul. I take it that the amendment means that the Auditor General would report annually, publicly and to the Parliament.
I welcome the prospect of getting the ACAD unit on site with in-patient beds at Stobhill. I do not want to mislead the minister, so I shall be explicit. I will use the presence of the ACAD unit at Stobhill to continue to make the case for in-patient provision at Stobhill. As has been mentioned, we know the position in relation to rising emergency admissions and in relation to transfers into Stobhill from the royal infirmary. I also want assurances from the minister that he will insist on flexibility from the board on accident and emergency services. On the commitment to retention of services, local monitoring will be absolutely crucial, as Paul Martin said. It needs to be
We have a wide range of excellent services at Stobhill, including general surgery, general medicine, the day surgery unit and, I hope, the coming ACAD unit. There is a range of first-rate specialties at the hospital, and it is a highly attractive site for other specialties that are looking for a location. I shall be coming back to the minister on that point.
I am pleased to speak in a debate on an issue that has for many years caused great concern and frustration to many in the Greater Glasgow NHS Board area. I begin by paying tribute to my Conservative, Liberal and Labour colleagues in the unofficial cross-party group, which was formed in 1999 to address the provision of hospital services in south Glasgow, for their hard work and dedication to the issue over the past three years.
I thank Bill Aitken for that clarification.
Last Saturday, I attended the annual forum of Glasgow's community councils. Many of the 140 delegates were angry and frustrated that consultation is devalued by the frequent refusal of the council, the health board or even the Scottish Executive to take any notice of the views—often passionately held and well researched—of community groups, staff and members of the public. The acute services review is a prime example of that.
"The process has been discussed in Glasgow for 20 years and the proposals were based on extensive public consultation."
Does anybody really believe that? On 17 January 2001, in response to the debate on acute service provision in greater Glasgow, Malcolm Chisholm, then the Deputy Minister for Health and Community Care, said:
"The reviews offer an opportunity to assess strategically and objectively how the location of services balances local access with the scope and delivery of specialist services."—[Official Report, 17 January 2001; Vol 10, c 323.]
That has not happened. It is clear that Greater Glasgow NHS Board has paid not a blind bit of notice to the views of the public, community councils, health forums and the like. Certainly there has been no objectivity on the part of the health board.
Bar some minor tinkering around the edges, the proposals that have been submitted by the minister for approval are the same as those that were made a decade ago. As a result, confidence in the health board has been lost. On 13 August, the Glasgow health service forum south-east unanimously passed a vote of no confidence in a health board that it believes has treated the people of south-east Glasgow with contempt.
Unfortunately, the minister has swallowed the health board line and supported plans that Gordon Jackson MSP described at that meeting as "an absurdity". Although, on Tuesday, the minister appeared unwilling to reconsider, his amendment is more flexible—but what guarantees can he offer that, this time, the consultation will be genuine? Will people throughout Glasgow be given ownership of the process and be offered real choices, or will they be confronted with the take-it-or-leave-it attitude that has recently prevailed?
As we all know, the carrot of a new hospital at Cowglen was previously dangled by the health board—as, it now seems, a sop to those who were opposed to centralisation at the Southern general site, which was intended to kibosh the prospects of establishing a new Victoria infirmary. We now know that Cowglen was not a serious proposal, as the health board did not even get the basics right. It overestimated the site size by an incredible 36 acres and took more than two years to find that out. Specialisation is important, but why not have complementary services? Not all services have to be provided at one site: there can be complementary services at two locations. This time, we must get it right.
Nicola Sturgeon's motion recommends that an impartial review be carried out within six months. That is a sensible suggestion that we all can and should rally round. We must get it right, not just for this generation, but for future generations. A review would mean that correct decisions can be made sooner rather than later and that much-needed improvements to acute services can be made at an early date. The minister's amendment would prolong the agony; it is, regrettably, a fudge. I therefore urge all members to support the motion.
I acknowledge the strong feelings that exist on all sides in this matter. It is important to recognise that serious people on all sides have taken different views and come to different conclusions. There is no monopoly of concern for the health of the people of Glasgow, either here or elsewhere. It is therefore not helpful to imply that those who seek to modernise the national health service or the national health service board do so out of malevolence or a reluctance to recognise the problems that the motion suggests. We all take a serious position, having considered the issues. I do not believe that any member will vote out of cowardice; they will vote because they are convinced one way or another by the arguments.
We must also acknowledge the fact that the proposed investment is massive and that the potential impact of it, if it is properly directed, would be a huge difference in the lives of ordinary people. The question is how we spend that investment. Like many things in life, there is no black-and-white answer to that, only varying shades of grey. The conundrum in the south side is as follows.
It is agreed that the best medical care can be provided by having one centre of excellence in the south side. If someone is ill, the key factor in their survival is the immediate, effective attention of paramedics. The next priority is getting them to a centre of excellence as quickly as possible. Logically, there should be one centre of excellence in the south side to provide such care, but that centre is not in the centre of the south side—and nor is the Victoria infirmary. Furthermore, the development of a new hospital in the south side would eradicate the significant investment that has already been made in the south side. It would therefore be a waste of investment.
That hospital provision for Glasgwegians is probably as good as that for people anywhere else in Scotland weighs heavily with me; local access to a hospital in Glasgow is better than the access my relatives in Tiree have. Local access is, of course, relative.
Nevertheless, the health statistics for Glasgow remain shocking. We are the sickest, unhealthiest people in Britain. Sadly, the sickest and most ill Glaswegians will, in all likelihood, be living in the shadow of a local acute hospital. While geography, transport and access are all important, we recognise that Glasgow's health problems cannot be solved through bricks and mortar alone.
If this debate is about choices, my choice is for money to be used to change the poor diet of many of our children and to drive care and good health into our communities, where health workers can
The acute services review has generated serious debate. The key themes voiced by people who talk to me about the national health service are the time it takes to be seen, how they are treated by those with whom they come into contact and the extent to which they are kept informed about their health care. My recent involvement with the health service raised concerns not about the hospital supplying the treatment but about the ability of those providing the service to deal with us with any compassion. We have to invest in staff and systems as well as in buildings so that people are not frustrated or insulted by the treatment they receive and so that their health needs are met speedily and properly.
I support the Executive's position because it moves matters forward. I am encouraged to see that it has written reviews into the process at every stage. As the service's needs and the demands on it change, the systems must change too. For too long the health service has done things because that is how they have always been done and it has not addressed people's health needs in their communities. I seek an assurance from the minister that any commitment to moving forward to address health inequality in Glasgow will be matched by a capacity continually to reflect on and review what is actually being delivered locally.
Brian Fitzpatrick mentioned ambulatory care and diagnostic—ACAD—units. I remind him that the surgical sub-committee of the area medical committee for Glasgow was completely opposed to isolated ACAD units. It is worth bearing that in mind in any discussion on this subject.
I wish to quote from another sub-committee, which has made quite a telling statement. Accident and emergency consultants on the accident and emergency sub-committee of the area medical committee for Glasgow submitted evidence to Greater Glasgow NHS Board in June. They stated:
"A more recent concern about the two A&E model is that the city's acute medical receiving workload will not fit into two and a half medical units safely. All five of the receiving sites are struggling to accommodate medical admissions at present and failure to process these patients in a timely matter leads to A&E exit block or trolley waits. There has been consistent advice that planning three balanced A&E departments for the city represents the lowest risk strategy. Running a service from two very large departments is
I repeat that that statement comes from accident and emergency consultants.
Greater Glasgow NHS Board's proposal runs a high risk. A high risk for whom? The risk is faced not by the board but by the citizens of Glasgow who, as Johann Lamont has just described, live in the sickest, unhealthiest city in Britain. Although politicians cannot agree a strategy for replacing the Greater Glasgow NHS Board's proposal, we can agree that the current plan is unacceptable. What we are asking for is not some time-delayed idea that we can somehow fumble and fiddle until we come up with a plan that is accepted by everybody; we are looking for a six-month time-limited review.
The board has lost the confidence of the people of Glasgow. Let us be clear about that. It has failed to consult properly. It has failed to deal with the problem of transport to the south side accident and emergency hospital and with the worries about standalone ACAD units. It has failed to deal with the loss of in-patient services at Stobhill, which is an environment that the medical profession recognises is a model environment for recuperation. That is a failure of the board that will be compounded if the politicians are not prepared to recognise it.
It is rare—even unique—for me to applaud the likes of Bill Aitken and Gordon Jackson for speeches they have made in the chamber, but we have a rare situation. We have an opportunity for the members of Parliament for Glasgow to seize on an issue that means so much to the people of Glasgow. It is a cross-party issue. It is about ditching party priorities and putting Glasgow first. That is why the proposal cannot be accepted today. Let us have the six-month time-limited review and let us make sure that we do not subject the citizens of Glasgow to any more high risks.
On a point of order, Presiding Officer. We are deciding the future of Glasgow hospitals for the next 100 years. Many Glasgow and west coast MSPs have not managed to speak. Can I move that we extend the debate for another 20 minutes at least? We do not need our lunch as much as we need to debate this issue.
I am well aware that I am not a Glasgow MSP and I have a lot of sympathy with the point that Dorothy-Grace Elder has raised. I say that before I speak with a great lack of knowledge in comparison with many of my colleagues who have already spoken today.
We have had an important and very good debate this morning. The issue is complex, not only in terms of Glasgow's hospitals but in terms of the services available to people across the west of Scotland. It also echoes concerns raised by patients and others across Scotland, as well as those raised in my constituency when we lost our accident and emergency department at the Western general hospital under the Conservative Government in 1991.
One of the most important things that has been touched on today is the point made by Johann Lamont: that Glasgow's and Scotland's health problems are about much more than brick and mortar and hospital buildings. We can live in the shadow of the most wonderful hospital in the world, but if we do not address the fundamental health problems that come from poor diet, smoking and poverty, we will not gain any ground on dealing with Glasgow's and Scotland's health problems.
The balancing of accessibility to health services against clinical specialisation has been at the heart of the debate. The clinicians will often say that what is required is a critical mass. I will mention Lothian in passing. Today, I am again being told that we cannot open our accident and emergency department because the colleges will not allow Lothian NHS Board to provide major accident and emergency cover because the training will not be accredited. Time and again, clinicians are backing the centralisation of services.
I have a certain amount of sympathy with both sides of the argument. Clinical standards boards, guidelines and key shortages of personnel are all pushing us towards centralisation of services, but when we centralise services we have to ensure that patients' needs are taken into account. If patients and paramedics will be caught in traffic jams and therefore unable to get to the unit in time, we have to take that on board.
The most important thing that the Minister for Health and Community Care agreed to today is a review of accident and emergency provision after two years. However—and the Health and
Mike Watson is the author of a book called "Rags to Riches". If he votes the wrong way later today, come 2003 his second volume could be entitled "Riches to Rags". I urge Mike Watson to bring honour into politics and to vote the way his thousands of electors want him to vote.
Malcolm Chisholm and his predecessor, Susan Deacon, faced considerable difficulties in meeting the representatives of Greater Glasgow NHS Board, who had a plan that they wished to implement: neither had intimate knowledge of the localities. We, our constituents and delegations made representations but, as others have said, were ignored. In my 39 years as a councillor and MSP, I have never known a consultation to be swept aside in that manner.
Neither Malcolm Chisholm nor Susan Deacon were told that no major new hospital had been built south of the River Clyde since 1890—112 years ago—when the Victoria infirmary was built. The health board started to sabotage the Victoria infirmary several years ago. In addition, prior to any decision being taken, building started at the Southern general hospital, which is in a packed, inaccessible location next to a sewage works, and the original structures of which were built in the 1880s. For the large population in south-east Glasgow and the large population from East Renfrewshire that is in the catchment area of the Victoria—
No, time does not allow me to do that.
As Nicola Sturgeon and others said, for people in the south-east of Glasgow, bus journeys to the Southern general could take up to two hours and require a change of buses. Nicola also mentioned the population of 350,000 people in that area.
For two years the health board conned us by
In April 2000, Greater Glasgow Health Board had five main aims. First, it sought modern facilities for a better patient experience, whatever that means. That was a joke. Secondly, it aimed to create large specialist teams of doctors for continuous availability. How? Thirdly—and this is the cardinal insult for many people in Glasgow, in particular those in the south-east—it aimed to maintain local area access for as many people as possible. Fourthly, it aimed to create a pattern of hospitals that made sense across Glasgow as a whole. That was a sick joke. The fifth aim was to lever in major capital investment in a way that was affordable.
In my opinion, 51 per cent of health board members should be elected by the electorate.
Before I finish, I will take an intervention, if the MSP is willing to take—
I am happy to deal with that question. John Young must not misrepresent the position in relation to the future of Stobhill hospital. It will remain open. The real argument, as anyone who knows anything about the issues knows, is about in-patient beds at Stobhill. John Young must not mislead people by saying that Stobhill is closing. A sum of £60 million does not represent a closed hospital. John Young is being ridiculous.
Like many, I am disappointed that the debate has not had as much time as many members would have liked. That was the result of the main Opposition
Anyone who speaks or purports to speak for the people of Glasgow has a responsibility to say not only what they disagree with, but what they agree with. The world is simple for any member who knows what they oppose but does not argue and fight for what they support. Many folk claim that they know what they support, but the debate has lacked clarity.
No, because I have five minutes to describe the key issues for the Executive in the acute services review.
No members who have spoken—particularly those of us who care passionately about the city of Glasgow and who live there and will continue to live there for the foreseeable future—want anything other than the best hospital services. It is insufficient to cry alarm or to say that any reconfiguration of acute services will result in some of the more alarming claims that have been made and which have been repeated by some members today.
In the past two or three years, many folk have said that we need to move to three in-patient sites. Unfortunately, some people seem to have argued for four or five, depending on the dance they wanted to do for the public. The issue is whether we want to address longer term in-patient development.
Members have identified issues that relate to the present locations of services. The ministerial health team has listened to them. We want to work on monitoring and bed planning with communities, which have been fractured by some of the consultation processes in the past couple of years. We must rebuild trust. Along with Malcolm Chisholm and Mary Mulligan, I give a commitment to work with communities.
The three points that I will stress are clear. Do we accept that we need three in-patient sites with more clinical support? I think that we do. Do we need to take people with us on that journey? Of course we do.
I welcome the commitment to local consultation, but will the minister describe one Greater Glasgow NHS Board proposal that has been affected by the views of residents? Has one change been made to the plan that was proposed two years ago because of the views of residents on the south side of Glasgow?
The health team has listened. Ken Macintosh asked what has changed. We gave a commitment this morning to hold a review in the next two years of the board's accident and emergency recommendation. Those who are—rightly—concerned about some of the implications of that recommendation have a responsibility to submit views to try to address those concerns. In addition, we have given a commitment to consider sustaining services in present hospital locations, depending on clinical observation and judgment.
The fundamental issue is that we will work with the health board and patients to address how such services are sustained in the next five years, which will deal with many of the concerns that have been raised.
Two facts have been missing from the debate. The capital investment figure is more than £700 million.
I am sorry, Mr Sheridan, but such a level of investment has not been delivered for
I would be happy to have a debate, but I am hearing a monologue instead.
The fundamental issue is how we move forward for the future of Glaswegians. We also have the issue of the £130 million investment differential between the single-site options for Cowglen and the Southern general. That substantial amount of money could deliver two more ACADs to the city of Glasgow. However, more important is the revenue implication, which no Opposition member identified. There would be £10 million a year, which would be a substantial investment for staffing. It would certainly result in 500 more nursing staff and 160 more consultants. We must consider those issues in our deliberations.
Every member who spoke in the debate welcomed the investment of which the minister speaks. I ask him to address the special role that Glasgow has always played and which has never been recognised: I mean the special service that Glasgow delivers well outwith its boundaries to health boards such as Argyll and Clyde NHS Board and Lanarkshire NHS Board. It is about time that the service that is delivered outside Glasgow's boundaries is recognised and reflected in funding.
Thank you, Presiding Officer.
We are in place to have developed a regional planning framework that will address many of the issues Pauline McNeill raises. The funds will follow the location to provide people with a regional or national service. That point identifies a key challenge facing the health board and anyone making decisions on future health provision: the Southern general already provides much of that regional and national provision. That was one of the calculations that were factored into the assessment by the Greater Glasgow NHS Board.
The important aspect to stress is that representations were made about accident and
Robert Brown addressed the issue of capital investment and revenue streams. We will be happy to have a dialogue with Robert Brown to address that issue. It is not just about whether there is capital over a shorter period, but whether capital can be drawn down for staff, for their support and for investment in the time for which we would ideally aim. We are certainly happy to discuss that issue.
The fact is that there will still be five sites in Glasgow that will meet much of the health need of communities there. That fact was not brought out in the debate by many Opposition members. The two ACADs will service 85 to 90 per cent of the service needs that are presently provided for those communities or needed by them. That is in partnership with the modernisation of primary care investment and the commitment to invest in the acute services. This is about trying to get a total package that addresses the long-term future health needs of the people of Glasgow.
No one said that that would be easy or that it would not require painful decisions, but any suggestion that a delay of six months will make decisions easier is only trying to prevent inevitable decisions. We believe that we need to crack on. We also need to address many of the sensible concerns that were raised by members who did rise to the debate, Mr Sheridan. We are happy to address those points.
The debate has been interesting. Every MSP who spoke welcomed, as does the motion, the £700 million investment in Glasgow's health services. Every MSP who spoke asked pertinent questions about whether the Greater Glasgow NHS Board review meets the needs and aspirations of the people of Glasgow. Did we get any answers? Well, Frank McAveety summed it up when he almost refused to take interventions from his back benchers. The Executive has not listened to MSPs and does not appear to listen to its ministers. The Executive has also refused to listen to the 43,000 people who signed the "save Stobhill" petition. It is about time that that ended. The Executive must listen.
I would like to pick up on one of Mr McAveety's opening comments. If the Executive is serious about listening, perhaps it will give time to the debate during its time in Parliament. I am sorry that so many of the members with local and constituency interests in the issue were unable to get into the debate. I am especially sorry that Paul Martin, a doughty fighter for Stobhill, was unable
As every member is aware, the SNP has three hours for debate each month while Labour controls every other hour. Paul Martin is a member of the Labour party, which has accepted the review. The matter should have been debated in Executive time.
"a commitment to keep named services at Stobhill and Victoria over the next five years".
I was going to ask the minister to name those services but he told us that the services have already been named by Greater Glasgow NHS Board in its health improvement plans. If there is no change there, what is the point of mentioning it in the amendment?
For the minister's benefit, I will name the services that Stobhill has already lost and which it will not be able to hang onto for five years: in-patient orthopaedics, in-patient renal medicine, vascular surgery, respiratory function services and laboratory services for bacteriology and pathology. Three weeks ago, we learned that Stobhill is to lose medical illustration. What is going to be left at the end of the five-year period?
This is a piece of masterly spin but it will not be believed by anybody in the greater Glasgow area. I hope that Glasgow's Labour MSPs will not accept that spin and, when they come to vote later today, will listen to their constituents rather than accept the whip. While all this spinning is going on, staff morale at Stobhill is plummeting. Stobhill is finding it difficult to attract junior consultants. The minister has offered a five-year moratorium, but what is a five-year career path for a junior consultant? Nurses are leaving Stobhill and others are not applying for vacant posts in the hospital.
Robert Brown mentioned managed clinical networks, which are important in relation to Stobhill. Managed clinical networks can work, as has been clinically proven, and Stobhill makes them work. The hospital should get the chance to keep showing that they work.
On the issue of the end of the accident and emergency review in two years' time, in reply to Bill Butler the minister said that he has an open mind on whether there should be three accident and emergency sites rather than two. If the minister has an open mind now and will have an open mind in two years' time, why has he accepted Greater Glasgow NHS Board's proposal to have only two accident and emergency sites?
Fiona McLeod mentioned the whips. As a total of 250,000 Glaswegians and people from the west of Scotland have opposed the plans—including the 43,000 who oppose the Stobhill plan—does Fiona McLeod agree that some members are more frightened of their whips than they are of the will of the Glasgow people and that they are putting themselves in a difficult position?
I have already said that I believe that, today, we should be voting for our constituents and I hope that every MSP will do so.
The minister has already heard that my constituents from Milngavie and Bearsden are going to get stuck in the Clyde tunnel. When a constituent of mine who can go into anaphylactic shock if she cannot get to a hospital gets stuck in the Clyde tunnel, will the minister tell her that that is all right because it does not happen often? How will the minister tell my constituents from Kirkintilloch and Bishopbriggs that, on the way to Glasgow royal infirmary, they will be stuck in a traffic jam and that, upon arrival, they will be unable to park, thereby adding another hour to their journey to accident and emergency? Will the minister make freely accessible the transport study that we have been told has been done for the Southern general hospital?
This is all fantasy, like the standalone ACAD, which is a fantasy and a fig leaf. The minister talks about building an ACAD at Stobhill and at the Victoria infirmary. There are no standalone ACADs in the United Kingdom, so where is the long-term future for hospitals in having standalone ACADs?
Brian Fitzpatrick said that he wants the ACAD at Stobhill to be built soon. I alert all members to the fact that, to build the ACAD at Stobhill as currently configured, we would have to start demolishing wards 2a, 2b, 3a, 3b, 4a and 4b. That would be the beginning of the end of Stobhill hospital. That is not acceptable.
The minister should stop kidding around. He should start listening. He should listen to MSPs and to the people of Glasgow. I also say to all Glasgow and West of Scotland MSPs that we should stop kidding around and ensure that we vote for what our constituents have clearly told us they want—the SNP motion.
On a point of order, Presiding Officer. Yesterday, a number of members from the other political parties said that the SNP should have chosen to use its time today to debate Iraq. This morning, they said that we should have chosen to use all the time for the debate on the economy and then they said that we should have devoted it all to the acute services review. Given the overwhelming view of the other political parties that the SNP should have more time to debate the