Accident and Emergency Units (Ayr and Monklands Hospitals)

– in the Scottish Parliament at 2:34 pm on 6 June 2007.

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Photo of Alex Fergusson Alex Fergusson None 2:34, 6 June 2007

The next item of business is a statement by Nicola Sturgeon on the future of accident and emergency units at Ayr hospital and Monklands hospital. The minister will take questions at the end of the statement, so there should be no interventions.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party 2:35, 6 June 2007

I am delighted to have the opportunity to deliver my first statement to Parliament since my appointment as Cabinet Secretary for Health and Wellbeing. The people of Scotland and members should be assured that the Government is committed to serving the best interests of national health service patients. It is therefore fitting that my first statement should be on an issue that has galvanised patients, public opinion and elected representatives of all parties in Ayrshire and Lanarkshire: the previous Administration's decision to endorse the closure of the accident and emergency departments at Ayr hospital and Monklands hospital.

Let me be clear from the outset. The Government's view is that the decisions to close the A and E departments at Monklands hospital and Ayr hospital were wrong. Those decisions will now be reversed. [Applause.]

Photo of Alex Fergusson Alex Fergusson None

Order. Members and those in the gallery must not applaud or interject in any other way, please, although I know that doing so is tempting.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I will outline why I believe that the decisions to close the A and E departments at Monklands hospital and Ayr hospital were wrong, the action I have taken to reverse those decisions, and what will happen now in those health board areas. I will also make it clear what my decision will and will not mean for health service reform in Ayrshire, Lanarkshire and Scotland generally.

First, I turn to why the decisions to close the A and E units at Ayr and Monklands were wrong. We have been consistent in our view that NHS Ayrshire and Arran's review of services and NHS Lanarkshire's picture of health review failed to address sufficiently the very real concerns of a significant proportion of their local populations about the centralisation of accident and emergency services. Many of those concerns were based not on an emotional attachment to bricks and mortar, as some have rather dismissively suggested, but on a level-headed analysis of particular local circumstances and the needs of communities now and in the future. There were concerns that the boards' proposals would inhibit access to A and E services; concerns, particularly in Ayrshire, that insufficient consideration was given to geographical, local transport and ambulance infrastructure issues; and concerns, most notably in Lanarkshire, that the proposals would have meant diminished emergency care provision in some of the most deprived areas of Scotland, where people need it most.

Those concerns remained even after the consultation and public engagement work that the health boards carried out, because neither the boards nor ministers were able to make the case convincingly that the proposals to centralise A and E services would be to the benefit of local communities. They were unable to demonstrate that the changes would mean an improvement in the level of available services. The overwhelming feeling in both communities was that the boards' processes and their subsequent recommendations, which ministers endorsed, paid scant regard to their clearly expressed views.

I want to make it clear what I consider to be the place of public opinion in decisions about health care provision. Public opinion cannot, should not and will not, while I am the Cabinet Secretary for Health and Wellbeing, override genuine concerns about the safety of services. However, where choices are to be made about how services are redesigned to meet the challenges that health boards face—there will be options in most circumstances—public opinion cannot simply be ignored.

We must never forget that the NHS is a public service—a service that is used and paid for by the public. It is the duty of health boards and of responsible Government to take full account of particular local views and circumstances. It is my view and the Government's view that, given the circumstances that are involved in these cases—the geography and demographics, the high levels of deprivation and ill health, and the concerns about access and public transport—A and E services at Ayr and Monklands should be maintained.

I turn to the action that I have taken. The first meetings that I undertook as Cabinet Secretary for Health and Wellbeing were with the chairs and chief executives of NHS Lanarkshire and NHS Ayrshire and Arran. At those meetings, I told the boards that I do not accept the previous decisions to close the A and E departments at Monklands and Ayr. Today I have written to both boards confirming that decision. I have instructed them to look again at their original plans and to produce revised proposals that will enable A and E services to continue at all three sites in Lanarkshire and at both sites in Ayrshire. Let me be clear—the A and E departments at Ayr and Monklands will not close.

I recognise the challenges that both boards face and have made clear to them that the Government will work with them to ensure a safe, sustainable, high-quality network of modern, patient-centred health services. I have also made clear to them that there was much to be commended in their original proposals to develop, modernise and maximise access to primary care, and to develop community casualty facilities that can appropriately deal with a high proportion of unscheduled care at local level. The decision that I have taken today will have an impact on those other proposals, but I am clear that, as far as possible within the resources available to them, I want the boards to retain their primary care and community development programmes. I put on record my thanks to NHS Lanarkshire and NHS Ayrshire and Arran for the commitment that they have already shown to working constructively to meet those challenges. I have the utmost confidence in their ability to respond positively to the announcement that I am making today.

I turn to what will happen next. Local people and clinicians will rightly expect the revised proposals that come forward for consideration to be robust, evidence based, patient centred and consistent with clinical best practice and national policy. To ensure that that is the case, I have decided that the revised proposals will be subject to a process of independent scrutiny. I will make a further announcement soon about the form of independent scrutiny that will apply to all future significant service change proposals. However, in order to minimise uncertainty and the impact on service development in Ayrshire and Lanarkshire, I will today announce separate arrangements in those cases.

I intend to set up an independent panel, which will have access to expert clinical and financial advice and will take account of the views of local people, to scrutinise the boards' revised proposals and report back to me. I have made it clear to both boards that their revised proposals must enable A and E services to continue at all three sites in Lanarkshire and at both sites in Ayrshire. I will look to the independent panel to assess the safety, sustainability, evidence base and value for money of the revised proposals, and to be satisfied that due account has been taken of local views. I have agreed with the boards that their revised proposals, having been scrutinised and evaluated by the independent panel, should be with me for a final decision by the turn of the year. That is a demanding timescale, and members should be assured that both health boards will have the full commitment and support of the Government in taking forward this important work.

I turn to the implications of my decision for health service strategy as a whole. I say unequivocally that it is not our intention comprehensively to rewrite the established national service strategy for our national health service, but we will update that strategy to reflect new priorities and challenges. For example, we will consult soon on new waiting time guarantees for patients. However, in doing so, we will adhere to the principles that were laid down in the framework report, "Building a Health Service Fit for the Future", which was published in 2005. Indeed, seldom has this Parliament been more united than it was in its response to that report. There is a great deal in the report to commend, and I support its general direction.

The report addressed not only Scotland's long-term health needs and the shape of services required to meet our communities' needs, but changes and developments in clinical practice and training. We agree that it is important to shift, where possible, the balance of care into communities; to tackle inequalities by anticipating and preventing ill health; and to take account of demographic and workforce pressures in the planning of services.

We see the logic of separating where possible the delivery of planned and unscheduled care. Such a move helps to improve efficiency and minimise waiting times for patients. Moreover, we appreciate that in certain instances—for example, in specialist cancer care, neurosurgery or heart treatment—a concentration of skills on a specialist site really benefits patients. This Government will adhere to those important principles in its stewardship of the health service.

However, that does not mean that we will automatically endorse every decision that is taken in the name of the Kerr report. Service change proposals must always be critically assessed against the report's broad framework. Clinical issues, service quality, sustainability, local circumstances and affordability must be considered alongside the views and preferences of the public and of patients. We must have an NHS that now and in the future provides patient-centred, high-quality, efficient and effective services that take account of particular local circumstances.

I want to be clear that, in honouring our commitment to maintain A and E services at Ayr and Monklands, I am not signalling a general review of service changes that have been made in the NHS. I recognise that difficult decisions have had to be made, and that some of those decisions have been hard for local communities to accept. That said, I appreciate that uncertainty, instability, delay and costs would flow from any general review of decisions that in many cases were taken several years ago and which, unlike the situation at Ayr and Monklands, are now in advanced stages of implementation. However, I am determined to engage with communities that still have concerns to build confidence in the range of services that is provided locally.

Finally, I will comment on how I will approach future proposals for significant service change. As I said, difficult decisions about the NHS will have to be taken, and my job is to face up to those decisions. However, my job is also to ensure that the public have greater confidence in the process leading to those decisions and in the evidence underpinning them. I have made it clear that I will expect all proposals for service change to be subjected to rigorous independent scrutiny before full public consultation takes place. That will ensure that the information that is presented by health boards is factual and evidence based, and that the choice that is presented to the public is fair and genuine. In Ayrshire and Lanarkshire, the public were not even consulted on an option that would have retained all A and E departments. It is no wonder, then, that public confidence in the process was absent from the outset.

After independent scrutiny and public consultation, proposals will come to me for a decision. I will operate a presumption against centralisation. That is entirely consistent with the Kerr report, which clearly stated that before decisions are taken about centralising services

"on the grounds of resource or workforce constraints", it must first be demonstrated that no alternative service redesign can be achieved. I will apply that principle.

That does not mean that there will be no change in any circumstances. However, it means that any proposals must be robust; that all alternatives for service redesign must have been properly considered; and that the health board can demonstrate that due weight has been given to public opinion.

This Government is committed to working with all in this chamber, with all in the NHS and with communities across Scotland to deliver a health service that is truly fit for purpose; that is efficient and effective; that delivers a consistent, high-quality service to the Scottish people; that takes full account of—and is responsive to—the needs of patients and the public in the way it develops its services; and that is straightforward, open and honest about the challenges and pressures it faces in doing so.

We will retain the core strategic plan for the NHS, but we will also ensure that the NHS maximises the involvement of local people in the way that it delivers and develops services, and that those developments are subject to independent scrutiny. Let there be no doubt—when decisive action is necessary to safeguard the best interests of patients and communities, such as in the case of our decision to reverse the closure of the A and E departments at Ayr and Monklands, we will not shirk from taking that action. Those communities—and, indeed, all of Scotland—deserve no less.

Photo of Alex Fergusson Alex Fergusson None

The minister will take questions on the issues raised in her statement. I intend to allow around 30 minutes for questions, after which we will take the next item of business.

Photo of Andy Kerr Andy Kerr Labour

I thank the minister for the copy of her statement.

This is a con and a sell-out of gigantic proportions. We already knew that the Scottish National Party wanted to reverse the decisions in question, but it is simply not acceptable or credible for the minister to come to the chamber with no detail. She has reversed nothing and given no detail regarding the future of the two units. To simply instruct boards is an irresponsible and empty gesture, and it is unbecoming of a minister. She has abdicated her responsibility to take tough decisions and has passed the buck back to NHS boards.

Let me be specific. The British Association for Emergency Medicine recommends that a modern A and E department needs to have immediate access to intensive care, high-dependency services, anaesthetics, acute medicine, general surgery and orthopaedic surgery. Will the minister therefore guarantee that those services will be available on all sites 24 hours a day, seven days a week?

Why does the minister believe that Lanarkshire can support three A and E departments when the recently retired medical director of NHS Lanarkshire, John Browning, said:

"Lanarkshire cannot support three A&Es ... the service will deteriorate and collapse."

Will the minister give an absolute guarantee that all the proposals that are contained in the current plans for health services in Lanarkshire and Ayrshire—including those on the 13 community casualty units, the investments in the hospitals at Monklands, Wishaw, Hairmyres, Ayr and Crosshouse and the building of new hospitals and primary care facilities—will be delivered on time and as agreed by the previous Executive?

Does the minister's statement mean that the commitments that her party made during the election campaign to restore services at St John's hospital, Stobhill hospital and the Queen Margaret hospital have been reneged on? Has she not read, or has she simply failed to understand, the latest available evidence on the need for emergency care services—just like the other services to which she referred—to be specialised?

What would the minister say to the chairman of the British Medical Association, who said recently:

"This strategy is a package and to break it apart would be to return to the old problems that have dogged the NHS for too long"?

What would she say to the consultant orthopaedic surgeon Gavin Tait, who asked whether she would take the responsibility for the future crisis that would arise in emergency care and for the lives that would be damaged or lost in second-rate A and E departments for want of the best specialist care?

The minister had the audacity to mention David Kerr, who said that her decision was "sentimental, emotional, irrational". Does she share my view that her gesture guarantees nothing and that it will cause months of uncertainty, put services at risk, shatter the confidence of clinicians, cause a flight of specialist skills and, most notably—as the evidence demonstrates—put patients' lives at risk?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

It is interesting that the former health minister managed to criticise me for protecting some services and for allegedly failing to protect others. He should make up his mind what side of the debate he is on.

Mr Kerr was rather selective in his quotation of clinical opinion. I have the greatest of respect for the clinicians whom he quoted, who are absolutely entitled to their opinions. However, I will quote Dr Christine Rodger, a recently retired consultant at Monklands, who said:

"the decision was made on financial rather than clinical grounds ... alternative strategies were never seriously considered." [Interruption.]

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

How about Martin Watt, a consultant at Monklands, who said that A and E services in Lanarkshire would not survive with only two units? The medical staff association at Monklands said that the closure of A & E at Monklands would be a serious error of judgment. Perhaps Mr Kerr was prepared to make that error of judgment, but I am not prepared to do so.

The former minister's comments about lives being lost are utterly reprehensible and irresponsible. I remind him that, even under Labour's plans, Monklands hospital and Ayr hospital would have continued to provide accident and emergency services until 2010. To suggest, as he has done repeatedly in the past few days, that those services are somehow unsafe or substandard is wrong and insulting to the staff who deliver them—it represents scaremongering of the worst kind. Safety and sustainability will be the bottom line of any decision that I take.

Mr Kerr criticised me for giving no detail. I repeat that I have today reversed the closure of Ayr and Monklands accident and emergency units. I responsibly asked the health boards to go away and revise their proposals and, even more responsibly, said that the proposals will be subjected to rigorous, independent scrutiny to ensure that they will be safe and sustainable, and provide the best service for patients.

I understand that Andy Kerr, having taken the decision to close the A and E units, has no choice but to come here and criticise me for keeping them open. However, perhaps the key difference between him and me is that he is still not prepared to listen to public opinion. I will always listen to the opinion of the people who fund the national health service in Scotland.

Photo of John Scott John Scott Conservative

I welcome Nicola Sturgeon to her new position as Cabinet Secretary for Health and Wellbeing. I thank her for her very positive statement and for the advance copy of it.

I am delighted that Nicola Sturgeon has announced plans to keep the A and E unit open at Ayr hospital, thereby delivering on an SNP and Conservative manifesto commitment. I welcome her can-do attitude to making two A and E units in Ayrshire work. I also welcome to the public gallery—Nicola Sturgeon may have forgotten to do so—the local campaigners who supported Adam Ingram and me during the campaign.

Problems with staff recruitment and retention and the impact of new contractual arrangements were cited as factors in the drive to centralise A and E services. The pressures on workforce planning that arise from such arrangements are, of course, genuine, so it would be helpful if the minister could say what approach the Scottish Executive intends to take to easing problems in recruitment and retention.

I agree with the minister that there is much to be commended in NHS Ayrshire and Arran's original proposals to develop services generally and that the disagreement was essentially about the provision of A and E services. With that in mind and on the understanding that it is a matter for NHS Ayrshire and Arran to present revised proposals for consideration, will she confirm that the Executive remains supportive of plans for a new integrated cancer unit at Ayr hospital?

I share the minister's clearly expressed view that greater weight must be placed on the views of communities in consultations. In light of her concern that communities should be confident that their view will be given due weight in consultations on the reconfiguration of health services, does she intend to issue revised guidance to health boards about the conduct of such consultations?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I thank John Scott for his questions. I also pay tribute to him and Adam Ingram, who represented their constituents on this issue very well.

I recognise the challenges that health boards face—no health minister can wish or magic them away. Some of the issues are to do with the workforce and recruitment. I remind John Scott that many of the problems were exacerbated, if not caused, by the poor workforce planning decisions of the previous Administration. Andy Kerr might be interested in being reminded that, when he was Minister for Health and Community Care, he failed to deliver on, and then completely abandoned, his pledge to recruit 600 extra consultants, because in his view they were not needed in the NHS.

There are issues to do with staff shortages. There are also issues to do with appropriate case loads for consultants and skills mixes. However, I want us to face up to such challenges in a way that puts patients first and in a way that is innovative and looks to retain as many services as possible locally, while acknowledging that some services are best delivered on specialist sites.

I made it clear in my statement—I am happy to do so again—that I want the health boards to retain as far as possible the other proposals that were part of the package. As I said, much was commendable and I want as many proposals as possible to continue. I will look closely at that when the revised proposals come to me for a decision. Indeed, the additional resources that were made available to both boards as part of the package remain in the forward plan and remain available to boards as they take their plans forward.

On future consultation, I have announced specific arrangements for independent scrutiny in NHS Ayrshire and Arran and NHS Lanarkshire, which will take full account of the views of the public. I will shortly consult on the arrangements for building independent scrutiny into all proposals for service change. As we go forward in the health service, it is essential that the public should have confidence in the information and choices that are presented to them. Rigorous independent scrutiny will be a key component. I anticipate that new guidance to health boards will follow the consultation exercise.

Photo of Ross Finnie Ross Finnie Liberal Democrat

Like John Scott, I take the view that our proceedings should be conducted in a civilised way, irrespective of political differences, however profound. Therefore, I welcome the cabinet secretary in making her first statement to the Parliament and I thank her for providing an advance copy of her statement.

I have a general concern about how the cabinet secretary could make such a definitive decision and announcement before the respective health boards have had an opportunity even to draw up alternative proposals. I am even more curious as to what role an independent scrutiny body could have, given that the decision has definitively been taken.

I want to probe the cabinet secretary further on three areas. First, a presumption against centralisation might be all right in general terms but, as the cabinet secretary is well aware, Professor Kerr considered such a proposition specifically in relation to emergency services and concluded that the provision of core admitting services and sub-specialised services at every A and E unit was "not sustainable". However, the cabinet secretary clearly believes that the provision of core and specialised services at every A and E unit is sustainable. What is the evidential base that has led her to overturn the Kerr report's conclusion? What steps has she taken to overcome the difficulties in the provision of 24/7, 52-weeks-a-year, high-intensity emergency care services that were identified in the Kerr report?

Secondly, as the cabinet secretary is well aware, Kerr called not for the closure but for the redesign of A and E services. He suggested that wider community involvement be embraced, through the establishment of community A and E units. I regret that the cabinet secretary's announcement contained the clear inference that the Government regards the establishment of community A and E units—at Monklands hospital, Ayr hospital and elsewhere—as possibly inadequate. If the cabinet secretary has rejected the Kerr report's model for a two-tier redesign, what are her plans to provide more A and E services locally?

Finally, as the cabinet secretary admitted, the proposals of NHS Lanarkshire and NHS Ayrshire and Arran contained other plans for primary care and scheduled services. Given that her announcement will require the boards at the minimum to employ additional specialist clinicians and provide additional equipment and accommodation, which were not in their plans, it is not credible for the cabinet secretary to say that she believes that the revised approach can be contained in the current budgets. What impact on previously planned improvements to scheduled primary care and waiting times will she regard as acceptable?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I thank Ross Finnie for the nice words at the start of his questions.

I am slightly amused. At question time last week, Ross Finnie asked me—as he is entitled to do—to instruct another health board not to make changes, before any proposals were on the table and before any public consultation had taken place. Today, if I heard him right, he has almost accused me of making this announcement without due process. Like Andy Kerr, Ross Finnie should decide which side of the debate he is on. I know that he is new to the health brief, but perhaps he should ponder that question a little bit longer.

I have made this decision because, after long consideration both before and after I took up my post, I believe that the decisions to close Ayr and Monklands accident and emergency units were wrong. I have given the reasons why I believe that to be the case. As I said in my statement, the first meetings that I had in this post were with the chairs and chief executives of both health boards to advise them of my view, to give them advance notice of the decision and to ask them to revise their proposals in light of it. That is the reasonable and responsible way to proceed and I am sure that people throughout Lanarkshire and Ayrshire will agree.

Ross Finnie asked me about the presumption against centralisation. I think that I laid out my position reasonably in my statement. He quoted from the Kerr report, as I did in my statement. Kerr was talking about emergency services—among other services—but he was clear that centralisation on fewer sites because of workforce or resource constraints should take place only when there were no viable alternative service redesign proposals. That is what I consider to be a presumption against centralisation. It does not mean that there should be no change in any circumstances, but it means that there is a greater onus on health boards to convince me or any future health secretary that their proposals are robust, that they have considered all alternatives and that they have taken due account of public opinion. That is the responsible way to proceed.

I made it clear in my statement that I support the development of community casualty units. I support the shift from acute to community care and I think that there is a need to develop primary care, particularly in Lanarkshire, where it has been underdeveloped for a considerable time. However, I strongly believe that community casualty units should be supplementary to, rather than a replacement for, adequate A and E provision. Perhaps that is the key difference between me and some members in other parties.

I made it clear that I want as many as possible of the other proposed primary and community care developments to proceed. I made it clear that I am not trying to suggest that my decision has no impact on the health boards' other proposals. Ross Finnie is right that it would not have been credible for me to say that, which is why I did not. I want as many as possible of the other proposals to continue. I will look closely at that aspect when, following independent scrutiny, the proposals come back to me for a decision.

Photo of Alex Fergusson Alex Fergusson None

We move to open questions, which I hope will be kept concise. If the answers are also concise, we will fit in as many members as we can.

Photo of Alex Neil Alex Neil Scottish National Party

I welcome the statement by the cabinet secretary and tell her that the people of Lanarkshire and Ayrshire will be dancing in the streets with joy tonight. It is sad to see the party of Nye Bevan complaining because we refuse to close down essential services in the national health service.

I have two substantive points. First, does the health secretary agree that it is a myth that clinical opinion is unanimously in favour of the closure of these A and E units? Opinion among consultants is divided, but nurses and those in the ambulance services are almost unanimous in agreeing with us that the units have to be kept open.

Secondly, in the light of what has happened, particularly in Lanarkshire, will the health secretary review the consultation process? It was farcical that the decision was taken to reduce the number of A and Es in Lanarkshire from three to two without any consultation. It was also farcical that the decision was then taken that the choice would be between Hairmyres and Monklands. Is it not the case that a political decision was taken and that the A and E in Jack McConnell's constituency and the A and E in Andy Kerr's constituency were always going to be kept open?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I agree absolutely with Alex Neil. Clinical opinion is divided and I respect the clinical opinion that does not agree with me. I have read out some of the clinicians who take a different view from that of the former health minister: Christine Rodger; Martin Watt; and the majority of the medical staff association at Monklands. Even—if I read him correctly—Gavin Tait, who I accept supports the original decision in Ayr, suggests that the decision in Monklands was based more on financial and private finance initiative grounds than it was on clinical grounds.

Clinical opinion is divided but, with the possible exception of Andy Kerr and one or two others, political opinion is not divided. Eminent politicians such as John Reid have described the closure of Monklands as unacceptable. Mr Reid said that health care professionals were against the closure. Cathie Craigie has called Monklands A and E "the busiest in Lanarkshire", while Karen Whitefield has said that the case for retaining Monklands A and E is clear. Tom Clarke MP has said that there is no case to close any A and E facility in Lanarkshire and Michael McMahon has called the decision "fundamentally flawed". It is clear to me that political opinion is pretty united.

I have made my views about future consultation clear. I accept that there will be cases in which, although public opinion is against the change, there are grounds for making it. In those cases, I will not shirk from taking the tough decisions. However, in order to get there in a way that builds as much public confidence as possible, we must have consultation exercises in which the public have faith. That is why independent scrutiny is an essential component—it is so that the public know that the facts that they are being given are accurate, that the evidence is accurate and that they are being given a fair range of choices. Independent scrutiny will greatly enhance the consultation process in future.

Photo of Karen Whitefield Karen Whitefield Labour

I, too, congratulate the minister on her appointment.

I welcome any move to reverse the decision to downgrade Monklands accident and emergency. It is a matter of record that, from the outset, my colleagues Elaine Smith and Cathie Craigie and I believed that the decision to downgrade Monklands A and E was wrong and called on the Scottish Executive and NHS Lanarkshire to reverse it.

Having stated my support for the retention of full A and E services at Monklands, I would be keen to hear from the minister whether she intends to instruct NHS Lanarkshire that, in reversing its decision, it must retain a 24/7 intensive therapy unit; a 24/7 high-dependency unit; 24/7 anaesthetist general and emergency cover; 24/7 orthopaedic cover; and 24/7 acute medicine cover—all of which are currently provided and without which the closure of the accident and emergency service cannot be reversed. I know that she will understand that. We cannot and must not end up with a soap opera version of A and E—all props and dressing without the expertise to back it up. Does the minister agree that that would be unacceptable? Will she also give my constituents a cast-iron guarantee that the £100 million refurbishment of Monklands hospital, committed to by the previous Administration, will be delivered? That is vital for the long-term viability and future of the hospital.

Finally and importantly, will the minister give an assurance that the full business case for Airdrie health centre will be signed off in time to allow construction to go ahead in early 2008, and that there will be no backtracking and no doubt that Airdrie will have a fully operational new health centre by 2009, as promised by the previous Administration?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I recognise that Karen Whitefield has campaigned hard to keep A and E services at Monklands hospital. I am sorry that, when there was a Labour Government in office, her pleas fell on deaf ears, but I am glad to say that this Scottish National Party Government has acceded to her calls to protect that local hospital.

I fully understand the point that Karen Whitefield makes on other services. I have asked the board to bring forward proposals that will retain A and E services at all three hospital sites in Lanarkshire, but I have not set any other preconditions. The nature of services and how they will be sustained are matters for the boards to cover when they produce their proposals. Of course, the independent panel, which will have access to expert clinical and financial advice, will ensure that the services are provided correctly, safely and sustainably. I hope that that gives Karen Whitefield the assurance that she is looking for.

I will respond quickly to the two other issues that she raised. On Airdrie health centre, I say that the reason why I have set a tight and, some may say, challenging timescale for the final decision to be made is that I want to minimise the delay to and uncertainty around other developments. I have said that I want as many of those to continue as possible, and the timescale that I have set will minimise any delay and uncertainty. That is the right thing to do.

The simple answer to the question about the £100 million is yes.

Photo of Aileen Campbell Aileen Campbell Scottish National Party

Does the cabinet secretary agree that the people of Ayrshire will welcome the decision to maintain the accident and emergency unit at Ayr, given that they will no longer be fearful of having to make potentially risky and significantly longer journeys to receive vital treatment? Furthermore, does she believe that her decision to reverse the closures shows that the SNP Government listens to the people and local groups instead of ignoring their concerns? Will she confirm that that listening approach will be the hallmark of her department? Is she aware that the people of Ayrshire were sickened by what can only be described as a sham consultation process? More than 50,000 members of the public registered their opposition to the downgrading of services at Ayr in a petition, but every one of them was simply ignored.

I congratulate the cabinet secretary on today's strong commitment—

Photo of Alex Fergusson Alex Fergusson None

Would you be brief, please, Miss Campbell?

Photo of Aileen Campbell Aileen Campbell Scottish National Party

Yes, okay. I congratulate the cabinet secretary. I am sure that the people of Ayrshire will welcome the fact that they have a Cabinet Secretary for Health and Wellbeing who realises that the NHS is run for the people who use it instead of a health minister who rides roughshod over the people of Ayrshire, who made their feelings very clear.

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

Yes, I think that people in Ayrshire will welcome the decision. I come from Ayrshire and I know its geography well, which is one of the reasons why I believe that the decision to downgrade Ayr hospital was fundamentally wrong.

I have answered the points about public opinion before, so I will be brief. Clearly, public opinion cannot and should not override questions of safety, but it should be given greater weight in the process of change in the health service because that is the way to build confidence in changes that have to take place.

Photo of Cathy Jamieson Cathy Jamieson Labour

As someone who lives in Ayrshire and uses the health services there, I have a particular interest in the matter. I noted the minister's reference to a meeting with NHS Ayrshire and Arran. Will she, for the record, tell the Parliament exactly when that meeting took place, how long it lasted and whether she discussed at it the impact on community casualty units and other primary care services?

I, too, met the health board this week and, as a result, I have some specific questions for the minister. Referring to the impact that her decision will have on the other proposals on community casualty facilities and primary care, she said that she was clear that

"as far as possible within the resources available to them" boards should retain those programmes. That does not sound particularly clear to me, so will the minister give me a categorical assurance that the new community hospital that is planned for Girvan will go ahead with all the services and facilities that Andy Kerr promised and that the extension to the East Ayrshire community hospital—which he instructed should be the first of the new CCUs to proceed—will go ahead with all the facilities and services that he promised? Will she give me a date for when that work will be completed? Will she answer John Scott's question, to which he did not receive an answer, about whether the specialist cancer care unit that Andy Kerr promised for Ayr hospital will go ahead? Will she put all the funding in place to ensure that no other health services or programmes in Ayrshire, including the mental health review, are delayed or cut?

Photo of Nicola Sturgeon Nicola Sturgeon Scottish National Party

I will give specific answers to those specific questions. I met the chair and chief executive of the Ayrshire and Arran NHS Board on 21 May. I cannot tell the member to the precise minute how long the meeting lasted, but we had a lengthy and detailed discussion about my views on the board's proposals and about the next steps.

The chair and chief executive engaged extremely constructively with me on the challenges that lie ahead, and I assured them of the Government's support in ensuring that they are able to face up to those challenges.

I have already made my views clear on the other proposals. I would like as many of them as possible to go ahead. [Interruption.] If Cathy Jamieson waits, she might get the answer that she is looking for. The proposals for Girvan will go ahead—the health board has told me about that. On the issue of the £100 million for the development of Ayr hospital, I have already said that that remains in the forward plan. I expect that money to be invested in the development of Ayr hospital and services in Ayrshire and Arran. I think that that, as well as my wider announcements today, will be greatly welcomed by the people of Cathy Jamieson's constituency.

Photo of Alex Fergusson Alex Fergusson None

I apologise profusely, particularly to Margaret Mitchell but also to all other members who wished to ask questions, as we have run out of time. The truth of the matter is that the longer members take to ask their questions, the fewer questions we can fit in.

There will now be a brief interlude to allow members to change seats.

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

Order. I ask members who are having conversations to desist.

Photo of Robert Brown Robert Brown Liberal Democrat

On a point of order, Presiding Officer. It has come to my notice that, in the course of the questions that we have just had on an important subject that affects a lot of areas, no Liberal Democrat back-bench members were called. I appreciate that you were not in the chair, but would you look into the matter and ensure fairness across the board among all the parties that are represented in the chamber, particularly where there are constituency interests involved?

Photo of Alasdair Morgan Alasdair Morgan Scottish National Party

I understand the point that you have made. I am sure that the Presiding Officers always use their discretion in whom they pick to ask questions. To some extent, however, they are in the hands of members. As the Presiding Officer said, the longer those members who are called take to ask their questions, the less time there is for other members.