Hospital Closures (Coldstream and Jedburgh)

– in the Scottish Parliament at 5:00 pm on 23rd March 2006.

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Photo of Murray Tosh Murray Tosh Conservative 5:00 pm, 23rd March 2006

The final item of business today is a members' business debate on motion S2M-3921, in the name of Euan Robson, on the proposed closure of Coldstream and Jedburgh hospitals. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes the contents of NHS Borders' consultation document, Getting Fit for the Future; believes that the preferred options for the closure of Coldstream and Jedburgh cottage hospitals manifestly do not command the confidence of the respective local communities; further believes that NHS Borders must take advantage of opportunities to redevelop both hospitals in conjunction with other statutory bodies, private providers and voluntary organisations in the spirit of Professor Kerr's report, Building a Health Service Fit for the Future, and the Scottish Executive's response to the report; congratulates the local action groups on their constructive approach to these issues, and believes that the Executive should reject closure and require redesign of the proposals to redevelop these locally delivered NHS services.

Photo of Euan Robson Euan Robson Liberal Democrat 5:07 pm, 23rd March 2006

I am grateful for the opportunity to place on the record my constituents' views on "Getting Fit For The Future - Modernising Health Services in the Borders", which is a consultation document that has been published by NHS Borders. It is the subject of controversy in my constituency. Some of the proposals that it contains would have a far-reaching effect on the two towns that are mentioned in my motion—Coldstream and Jedburgh.

The consultation document covers the future of the community hospitals in Coldstream and Jedburgh. However, it also covers other issues, some of which I will mention to set my later remarks in context. My colleague Jeremy Purvis will expand on certain points later in the debate if he catches the Presiding Officer's eye.

In our response to the consultation document, I and my Liberal Democrat parliamentary colleagues in the Borders stressed our broad agreement with the general statement of objectives that NHS Borders has set out. Who could argue against

"more flexible community-based services", or

"a modernised network of health centres, increasingly bringing together a wider range of services provided by more organisations"?

That is indeed what we want. We welcome the extensive investment of some £15 million in health centres and community hospitals in a number of places in my constituency—Hawick, Duns, Kelso and Newcastleton. We accept the case for

"a Borders Emergency Care Centre ... integrating Accident and Emergency, primary care out-of-hours services and a ward for emergency admissions into one purpose-built unit at the Borders General Hospital".

Yes, we want

"improved and more appropriate services for people with a learning disability" and

"improved and more appropriate rehabilitation services for people with the most severe and enduring mental illnesses".

We agree with the concept of

"organisations, services and voluntary groups working together in localities".

Our concern lies in the way in which that has all been put together.

From the very start, I stressed to NHS Borders that local communities must have confidence in their NHS services. It is manifestly the case that the people of Jedburgh and Coldstream do not have confidence in the proposed closure of the community hospitals in their towns. There have been hundreds of letters to NHS Borders from both communities. On two Saturdays, hundreds of people turned out to march in both towns, registering their concern and calling on the board to change its mind. If the Kerr report is about anything, it is about listening to local people and providing services locally, and it is my submission that NHS Borders should go back to the drawing board at its meeting on 30 March and redesign those proposals.

How might that be done? The Borders emergency care centre is a project of considerable benefit to our area. The capital cost is £6.9 million, with an annual running cost of some £862,000, which, when aggregated with the debt charges, rises to around £1.3 million. A project of such cost in the acute sector sits uncomfortably among a series of proposals for primary and community care. That project is of not only local but regional significance, and should therefore be the subject of a separate discussion with, or bid to, the Scottish Executive. If that were to happen, NHS Borders could then rebalance its package. If the cuckoo were taken out of the nest, the other fledglings would prosper.

I turn now to the main substance of the motion, which is about Jedburgh and Coldstream cottage hospitals. Both facilities are highly regarded in their local communities. The quality of care is not in doubt in facilities that nearly all agree could benefit from modernisation. I pay tribute to the staff who deliver excellent care in those facilities.

Many people are emotionally attached to the two cottage hospitals, as generations have been born and have died in the buildings. Both towns have accepted, however, that much-loved buildings can outlive their purpose and that redevelopment is necessary and desirable. Indeed, placards carried on the marches said as much.

The towns have been represented by the two hospital action groups, led by John Craig in Coldstream and Len Wyse in Jedburgh, and those groups have made an immense contribution to presenting an alternative to the board's proposals, in which a commitment to redevelopment is stressed. An eloquent 39-page document has been produced by the Coldstream action group, which should be given detailed and fulsome consideration. In November 2002, local health professionals in Jedburgh, George Miller of the patient participation group and I submitted proposals to NHS Borders in a document entitled, "Looking to the Future", which stressed the need for redevelopment in Jedburgh, combining a new health centre and community hospital together with other allied agencies on one site in the town.

NHS Borders has gone some way towards meeting that objective by putting a health centre into its five-year capital programme. The board now says that it will locate two of the palliative care beds from the hospital in the town—but where? There is a shortage of nursing home provision in Jedburgh, and there, in my view, lies a major opportunity. Throughout Scotland, partnerships exist between nursing home providers and the national health service. There are examples in Saltcoats, Rutherglen and Hamilton, to name but three locations. There are partners who are prepared to talk to NHS Borders about co-located facilities, and there have to be advantages in sharing costs.

The board talks about the sustainability of its service in the future, and here is a way of delivering local needs and possibly introducing more services for local communities on an economic basis. At Coldstream, for example, outline permission apparently exists for a 60-bed nursing home directly opposite the cottage hospital. Provision could be made for a number of NHS beds, a day hospital, a dental suite and perhaps an input from social work services in the form of a day centre or variations thereof. All of that is achievable if there is a will to embark upon meaningful discussion and to find a local solution to meet local needs. Jeremy Purvis and I will offer to host a conference for the various parties this summer, to talk about the provision of community care services and to encourage joint co-operative working, as we believe that dialogue needs to improve.

I want to make two further points. NHS Borders' proposals are to move Coldstream and Jedburgh patients to other community hospitals in neighbouring towns, but I am not as confident as the board is about spare capacity in other community hospitals. Jedburgh medical practice tells me that, in recent weeks, there have been four or five alerts from Borders general hospital about extreme pressure on beds. On 41 days between April 2005 and January 2006, if only Kelso community hospital had been available to Coldstream and Kelso patients, there would have been more patients than available beds.

Travelling arrangements for relatives, friends and carers—particularly if they are elderly—from Jedburgh and Coldstream will be difficult as public transport timetables are not particularly convenient. For example, there is no link between Coldstream and Jedburgh except for the morning and afternoon school buses, and it will be extremely difficult for someone from Coldstream who does not have a car to visit a loved one in Duns community hospital.

NHS Borders has made financial provision for care in the community for some of the people who would otherwise have been in the two community hospitals. However, the provision of such care, together with the investment required for the changes in provision for those with learning disabilities and mental illness, will add up to a very large new commitment for Scottish Borders Council social work department. Jeremy Purvis will explain that, in our view, that commitment will be almost impossible to meet.

I could say much more about issues such as the flaws in the consultation process, which the Scottish health council is investigating, the divisions in opinion on the closures among medical professionals and the contradiction of the outcomes embodied in the Kerr report.

If the board does not relent next Thursday and the proposals come to Lewis Macdonald and Andy Kerr, I want them to remember eight words from this debate: keep care in Jedburgh; keep care in Coldstream.

Photo of Christine Grahame Christine Grahame Scottish National Party 5:16 pm, 23rd March 2006

I congratulate Euan Robson on securing the debate. As he knows, we both submitted motions in almost identical terms. There is cross-party consensus on the need to retain the cottage hospitals in Coldstream and Jedburgh. I thank members of all parties who signed both motions.

Recent marches through the towns were attended by more than 700 people in Coldstream and more than 700 people in Jedburgh. That indicates the strength of feeling and emotion about retaining the cottage hospitals. People want the hospitals to be retained not for sentimental reasons but for practical reasons.

The general practitioners, the community councils and the churches fully back both campaigns. Statements from the churches make it plain how much the hospitals are required. For example, a letter from the minister at Jedburgh Old & Edgerston parish church states:

"As a Parish minister let me say that the quality of life in Jedburgh is partly reflected in how we care for the elderly, the sick and the dying within our own community. The Cottage Hospital more than fulfils the community's expectations."

Similar letters from Coldstream state that its hospital is integral to care in the community and care for elderly people.

Euan Robson mentioned the pressure that might be put on Kelso community hospital. The pressure that might be put on Borders general hospital by the need for beds for the elderly is equally obvious. When I was at the hospital very recently, some elderly people could not be discharged because the support services provided by social work and so on that are necessary for care in the community were not in place. The elderly people were therefore parked in the hospital—yet the health board is looking at taking away facilities in their communities.

As Euan Robson said, transport is a huge issue. Many people do not have transport that enables them to visit their friends and relatives.

The Kerr report made it plain that the first priority was

"Maintaining high quality services locally".

The executive summary in the Kerr report states:

"ensure sustainable and safe local services; redesign where possible".

Jedburgh and Coldstream have both put forward thorough plans. They accept that the buildings may not be suitable, but another facility could be developed. In Jedburgh, the facilities could be developed to extend to other services such as social work and benefits. The services provided from the facilities in Coldstream could also be extended.

The Kerr report states:

"redesign where possible to meet local needs and expectations".

What could be clearer than the local needs and expectations of the 700 people who marched through Coldstream and the 700 people who marched through Jedburgh? They said, "This is what we want. We are showing you what your consultation means. This is our response to your consultation. Will somebody please listen?" A fairly recent newspaper headline stated:

"Reprieve for 100 cottage hospitals in ... U-turn".

The article states:

"In a significant reversal of the trend requiring patients and their relatives to travel long distances to larger district general hospitals ... the Health Secretary said she wanted more facilities to be provided in the community."

And it includes the following quotations:

"'a service fitted round the patient, not the patient fitted round the service'" and:

"community facilities should not be lost in response to 'short-term budgetary pressures'"

Those quotations come from Patricia Hewitt and Tony Blair. They have seen the value of retaining cottage and community hospitals in the community and representing local people.

I share with Euan Robson and others who will speak the hope that if Borders NHS Board says on 30 March that it wants to close the Coldstream and Jedburgh hospitals, the minister will simply reject that, consider the other proposals that are on the table, be imaginative and, in this instance, follow England's lead—because sometimes they get it right.

Photo of Derek Brownlee Derek Brownlee Conservative

I have never heard it before, but I congratulate her on that sentiment and on her sentiments on the cottage hospitals. I also congratulate Euan Robson on securing the debate and on his important and well-made comments about Borders general hospital.

Christine Grahame's points about Borders general hospital and bedblocking were well observed. Those of us who have seen family and friends in wards for the elderly in Borders general hospital have seen that bedblocking at first hand. Members have discussed bedblocking previously, but it must be addressed again. It is difficult to see intuitively how Borders NHS Board's proposals, as they stand, would not make the situation worse.

As Euan Robson and Christine Grahame said, we should pay tribute to the many people in the Coldstream and Jedburgh communities who have come together to work on detailed proposals to protect their local hospitals. As they also said, it is not a knee-jerk reaction against closure; it is actually a thoughtful, forward-looking approach to protect services in the local communities. We should all be keen to develop them.

I cannot remember the precise phrase that Euan Robson used to describe people's feelings about the consultation process, so I will not quote him, but I think it is fair to say that most people in the local communities have a strong suspicion—I suspect that that is understating it—that, although Borders NHS Board has yet to make a formal decision, the closure proposal is pretty much the predetermined outcome. There is a real concern that not only has the consultation process been flawed, but no one is listening, despite all the outrage and concern locally.

There is great suspicion that the hospitals will close, regardless of what anyone says or does. That is not helpful, because the two communities have had a careful look at what they need and they have come up with incredibly innovative proposals that we may consider extending Scotland-wide. I hope that Borders NHS Board will think long and hard before it comes to its decision next Thursday.

I do not doubt that members of the board will act in whatever way they think is in the best interests of the people, given the constraints that they are under, but I think that most people in the Coldstream and Jedburgh communities question whether the direction in which they seem to be heading is the one that is best for either community.

The broader point, which I will not dwell on too much, is how we make the NHS more accountable. How do we give local communities more influence over the way services are provided? They pay for services through tax and they have a right to have their views taken into account. There must be a better way of making local decision making in the NHS more accountable. It strikes me that the influence of the GPs, in coming out with both sets of proposals, is crucial. I wonder whether part of what we need to do is look much more closely at giving GPs more power over commissioning in rural areas.

The Kerr report is all good stuff, but it is meaningless if it is not delivered. In fact, it is almost worse than meaningless if it is not delivered, because it raised many hopes about truly local health care. It is all well and good for Borders NHS Board to say that local health care is at Borders general hospital, but it does not feel very local if someone is in Coldstream. There are even people down the road in many communities nearer to the hospital who would say that it does not feel very local.

I echo the calls for the minister to look carefully at the closure proposal, if it comes before him, and, indeed, to reject it. He should come and have a look at the proposals for how the services might be reconfigured. They are some of the most innovative proposals that have been tabled to date. The minister would not be doing the communities a service if he did not look closely at those proposals.

Photo of Chris Ballance Chris Ballance Green 5:24 pm, 23rd March 2006

I, too, congratulate Euan Robson on securing this timely debate. Indeed, the timing of the debate is perfect. I apologise to him for the fact that, for personal reasons, I need to leave before the end of the debate. I hope that that is all right, Presiding Officer.

Development, not closure, is the way ahead for Coldstream hospital. The Coldstream hospital action group has thrown down the gauntlet to Borders NHS Board by presenting it with an alternative document that, I suggest, does the work that Borders NHS Board would have done if it was engaged in a genuine consultation. "The Way Ahead" outlines why Coldstream cottage hospital should remain open and how service provision on the site could be extended. It states:

"The Way Ahead proposes an action plan for health in Coldstream that incorporates a true interagency approach to health care and fits well with local and national strategies. It provides modern health care, as near to the patient's home as possible and in full consultation with patients and carers. It integrates services, extends the skills of its workforce and is aware of and responsive to the needs of individual communities."

Twenty-five per cent of Coldstream's population is aged 65 years and over. It is predicted that by 2018 that figure will have risen to around a third, which will place increased demands on NHS services. That is a strong argument for reinvesting in services in Coldstream.

The development of Coldstream cottage hospital is the action group's preferred option and was unanimously endorsed by Coldstream residents. Of the five options that were discussed, it was the initial choice of the Borders NHS Board appraisal team. It seems that a financial appraisal alone turned the initial finding on its head. That is short-termism that will simply divert costs elsewhere. For example, the closure of the hospital would increase the amount of traffic on our roads and create a need for extra public transport. It would also increase social exclusion, because those with the least mobility and disposable finance would need to spend more time travelling to appointments and to visit relatives.

Other members have mentioned the consultation process, which was severely flawed. Across Scotland, the public is sick of one-way consultations that are not consultations. I call on Borders NHS Board to really consult: not just to talk, but to listen; not just to tell, but to hear; and not just to impose, but to involve local communities in decisions that affect them deeply. I thank Euan Robson for bringing this excellent debate to the Parliament.

Photo of Ms Rosemary Byrne Ms Rosemary Byrne SSP 5:28 pm, 23rd March 2006

I welcome today's debate and thank Euan Robson for securing it. I congratulate the campaign groups in both Jedburgh and Coldstream on the fantastic work that they have done to get so many people out on demonstrations and into public meetings. That is evidence of a significant move by communities to fight against proposals about which they feel strongly. They should be listened to.

The Executive white paper on Scotland's health recognises that there is an unacceptable gap between the richest and poorest communities in the area. Coldstream is the fifth most deprived area in the Borders, with the highest proportion of elderly, so why should we reduce health services to the elderly? Communities should be listened to. In an area with poor public transport links, the travel burden on families would be great. The proposal would create a problem for everyone and would place strain and stress on families all round. Elderly patients, as well as the young and the vulnerable, would have to travel to hospital. That is wrong in an area where public transport is so poor, as other members have said.

The white paper states:

"Looking at services from a patient's point of view underpins everything that we are seeking to do in the health service."

In this case, it seems that the patient's point of view is being ignored. I hope that the minister will take note of that today. The proposals clearly fly in the face of the white paper. Communities value their cottage hospitals. The Executive promotes access to community hospitals in other areas. We are developing such hospitals in some areas, yet we are closing them in others. There seems to be an imbalance between the Executive's views and what health boards in different areas are doing. We need to look at—it should be debated further.

I agree with Euan Robson that integrated services, including dentistry, could be provided. That is perhaps where we might differ, because I believe that those services should be part of the NHS.

The people of Coldstream and Jedburgh have shown their opposition through their community campaigns and they deserve to be listened to. I agree with Chris Ballance and others that the consultation process has been extremely flawed. I further agree with Chris Ballance that that seems to be the case throughout Scotland, because there are similar issues with the accident and emergency department in Ayr, which is also part of the south of Scotland. Campaigns seem to be rising up in several areas because of poor consultation and people feeling that decisions have been made before they are consulted. Whether that is just a perception or true makes no difference—if people perceive a problem, there is something fundamentally wrong with the process.

I believe that the closures have been proposed because of Borders NHS Board's need to save money. The minister needs to answer two questions. Why is there a shortage of money? What is the problem? The closures would provide savings of £1.6 million—and the sale of the land, buildings and so on would bring in more.

Borders NHS Board claims that the focus on modern health means that the buildings are not fit for purpose. Why are they not fit for purpose? Why are we not investing in making them fit for purpose in the 21st century and fit for the people of the communities involved?

Photo of Jeremy Purvis Jeremy Purvis Liberal Democrat 5:31 pm, 23rd March 2006

I commend all those who have spoken for their constructive speeches, but I pay particular tribute to Euan Robson for bringing the debate to the Parliament this evening. I also pay tribute to his work on behalf of his constituents. He has worked with the people of Jedburgh for over three and a half years to present their views not only to Borders NHS Board, but to the Parliament.

Although the debate rightly concentrates on the concerns about the community hospitals in Coldstream and Jedburgh, important Borders-wide aspects need to be addressed. Euan Robson mentioned the Borders emergency care centre plans, which form a large project in my constituency and involve the Borders general hospital. The project will consume a great deal of capital resource and revenue over many years to come. On the face of it, the project seems admirable, but we need to investigate the costs. The Executive should certainly consider it as a stand-alone project if it has the merit that Borders NHS Board officials believe it to have.

Euan Robson touched on matters relating to those who suffer from mental health problems and people with learning disabilities. I hope that that is not lost in the debate and that the board gives due consideration to it next week. In the submission that Michael Moore, Euan Robson and I made to Borders NHS Board, we made it clear in that although we accepted its approach to ensure that people are cared for in the community, it is not an inexpensive option. As we said to the board, we believe that some of its proposals are expensive and that the initial resources of £514,000 will be insufficient to achieve the objective.

Some of those who are leaving current residential units might require 24-hour care. Their numbers might be small, but they require intensive care, although much depends on personal circumstances. That option carries a genuine burden for health and social work services.

Euan Robson and I recently met the Borders voluntary community care forum. Representatives of Borders mental health voluntary bodies agreed with our views and concerns. I hope that the board takes that into consideration in its discussions.

As regards the closure of the community hospitals, further burdens will be placed on social work services, as Euan Robson described. Despite an increase in Scottish Borders Council's social work department budget for the next financial year, the department faces problems of equal pay with regard to single status and guaranteed hours before it even begins to take on those new burdens, and there are other areas of stress in that department's budget.

Just last Friday, I heard from a distraught parent of someone under the care of the social work department about the cut that will be made to her care package at the beginning of this coming financial year. It is not realistic to state, simply, the expectation that, in some areas, a service will be transferred from the NHS to the council. Borders NHS Board must be careful that it accurately costs such changes.

Euan Robson and I acknowledge the quality of care that is provided in the community hospitals and believe that there is great value in what might be termed slow-stream rehabilitation in such settings, particularly for older people. Before her death, my great auntie benefited from such care in Coldstream and my grandmother benefited from care at the BGH, then at a cottage hospital in Kelso and then, finally, at her home. Respite care, which forms part of that care package, is immensely important not only to those who have chronic conditions that might be marginally improved or stabilised, but to carers.

Some parts of Borders NHS Board's plan have merit and should be commended, but at next week's meeting it must throw out the plans for the Coldstream and Jedburgh hospitals, respond positively to Euan Robson's proposals, work with the local communities and keep care in Jedburgh and Coldstream.

Photo of Karen Gillon Karen Gillon Labour 5:36 pm, 23rd March 2006

I congratulate Euan Robson on securing the debate. As a Jethart lassie and a regular visitor to Jedburgh, where most of my family still live, I am well aware of the strength of feeling in the town and will focus my remarks on that aspect.

As Jedburgh is not known as a hotbed of radical political activity—after all, its people vote Liberal Democrat—getting 700 people on to the streets is a remarkable achievement and shows the strength of feeling about the cottage hospital. The town has a huge emotional attachment to the hospital. In my case, all my cousins were born there; my granny and family friends spent time there; and I had my fingers put back in there when I dislocated them in a basketball incident.

However, for most people, the emotional attachment is not to the building itself but to the care that they receive. Most, if not all, accept that the current building, which is at the top of a steep hill, is not fit for purpose. It is not served by public transport and folk face a long walk up to it, especially in winter. When the health centre was built, the plan was to put a second storey on top of it, move the hospital down the road and provide people with care in the town centre. However, we are a long way on from that and the plan now appears to revolve round the closure of the cottage hospital.

I should point out that, when the first plan was put in place, there was a nursing home in the town. However, that facility no longer exists and, if these proposals go ahead, the only provision in the town will be an already oversubscribed residential home at Millfield.

Jedburgh has a considerable—and growing—elderly population. It is the kind of place that people retire to at the end of their working life—indeed, I might well be one of them. However, where will those people go if they become ill? First, they will go to the BGH, which is just outside Galashiels and then, if the proposals go ahead, they will receive continuing care either in Hawick or in Kelso. However, Borders people like their own towns. As the Deputy Presiding Officer knows, a day in Hawick is a day wasted; Jethart folk are very proud of coming from Jedburgh. The Hawick cottage hospital is also a considerable distance outside the town centre; it is far from the public transport links on which many people in the Borders rely and elderly people, in particular, face a significant walk to get there.

My grandmother, who had never been out of Jedburgh in her life, eventually had to move to the Inch hospital in Kelso to receive long-term care. Because no one in her family or among her friends had cars, they could not visit as often as they would have if the hospital had been in Jedburgh and the woman became relatively isolated. That situation is not right.

I realise that, in weighing up all the issues, the minister faces a huge challenge. After all, we all go to him and plead for our constituencies. If the Kerr report and consultation are to mean anything, then local health delivery is vital. There is a good proposal for Jedburgh on the table that would combine the hospital, the health centre and, potentially, nursing home care with a range of other services. The Executive should support that kind of integrated approach. Although I appreciate that the minister's hands might be tied over what he can say, I hope that when the proposals come before him, he will bear in mind the strength of feeling across all the parties in the chamber—even those that are not directly represented in the Borders—about the need for local health care delivery in local situations. That is the right way for us to go.

Photo of Lewis Macdonald Lewis Macdonald Labour 5:40 pm, 23rd March 2006

I start by congratulating Euan Robson on securing the debate. I listened with interest to his remarks and to the other positive contributions about modernising and improving health services for the people of the Borders. Clearly, that is the right approach to take.

I know that Euan Robson has raised the issue previously with Andy Kerr, the minister who will be responsible for making the decision. Because of that, it would not be appropriate for any minister to comment in detail on the proposals that might be made as a result of the debate until such time as they have been finalised and made formally in the appropriate manner. It is also important that the local consultation and decision-making process should take its course before ministers give detailed consideration to what arises out of it.

The Kerr report and the Executive's response to it—"Delivering for Health"—have put in place a national framework for service change and we expect NHS boards to make any proposals for service change with an eye to that framework. "Delivering for Health" sets out a comprehensive strategy for health care in Scotland for the next 20 years and NHS boards must show that they have taken that into account.

Euan Robson and other members talked about possible alternative ways of delivering the same objectives. All I will say about that at the moment is that when NHS boards make their final proposals, they must show that they have considered all realistic options for the future delivery of services.

The strategy that is set out in "Delivering for Health" aims to bring services as close as possible to patients' homes. Consequent on that strategy is the requirement for the prioritisation of investment in local health services, including community health centres. It is also about developing practitioners with extended roles, and fully utilising the skills of all professionals through stronger teamwork in community health partnerships. We expect NHS boards to identify priorities for investment in a delivery plan that builds on our framework for health, including mental health services and services for people with learning difficulties.

Members have described the process of engagement by Borders NHS Board with staff, voluntary organisations and the public in reviewing services. That has been done over an extensive period of something in the region of 18 months.

As I said, I will not comment in detail on the proposals. However, the NHS board has set itself the test that its final proposals should be able to demonstrate improvement in health care and delivery of waiting times targets, and better co-ordinated care for those with a chronic illness. Those targets are in line with the recommendations of "Delivering for Health".

Although I recognise some of the points that have been made, it is important to be clear that the principles of "Delivering for Health" are not about saying that there should never be change; in fact, they envisage quite radical change. I hope that members will accept that. The direction that has been set will require reconfiguration of services in some cases. It is also in the document that NHS boards must engage in genuine dialogue with patients and communities to build a consensus, where possible, on how such change will be achieved locally in order to deliver the high-quality health care that we envisage.

Boards need to be transparent over decisions on what is to be delivered locally. We expect boards to ensure that patients' interests are put first in developing proposals for service redesign. When there would be an impact on patients and communities, that must be explained fully and carefully and the public must be engaged from the earliest possible stage. With proposals of the sort that we are discussing, the board must be able to demonstrate increased capacity in community services, increased support for people to stay in their homes for as long as possible, an emphasis on preventive and anticipatory care and encouragement for self-care.

It is important to say a word or two about the consultation exercise, which members have mentioned. The process is complete, apart from next week's board meeting, which has been referred to. In examining service redesign proposals, ministers must consider whether the consultation process has met the necessary standards. During the consultation, there have been more than 50 meetings of various kinds, including drop-in meetings, roadshows and meetings with specific groups in the community and groups of users and carers. However, the determination of whether a consultation has been adequate is not simply about adding up the number of meetings.

Euan Robson mentioned the interest of the Scottish health council in the matter. The council has been involved from an early stage in the process—the board invited its comment. We will consider the council's view on whether the process has been adequate. As has been said, the Coldstream and Jedburgh action groups have produced alternative proposals, which I expect to be given serious consideration. I understand that both action groups have worked closely with the board to ensure that that happens. The board must take into account those views and the interest in and enthusiasm for maintaining and developing local services.

Another issue that ministers will consider is transport, which several members have mentioned. The local authority and voluntary groups have been involved with the NHS board in discussions on the matter. A traffic impact assessment has been carried out and the local authority has been actively involved in discussions. However, we must wait for the final proposals before we consider the conclusion of those discussions. In deciding on the final recommendations from the board, Andy Kerr will have to consider whether he is satisfied that the board has examined all the views that local people and the action groups have given and all the issues about which concerns have been raised, including transport, access to services and alternative options for delivering services. I assure members that Andy Kerr will give the matter proper consideration, on the basis that I have described.

Meeting closed at 17:48.