St John’s Hospital (Children’s Ward)

– in the Scottish Parliament on 1st October 2019.

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Photo of Angela Constance Angela Constance Scottish National Party

1. To ask the Scottish Government how it will support the paediatric programme board to ensure that the return to a 24/7 service at the children’s ward at St John’s hospital happens as quickly and safely as possible. (S5T-01814)

Photo of Jeane Freeman Jeane Freeman Scottish National Party

As I know the member will agree, the key factor in the full reinstatement of the service to 24/7 at the children’s ward at St John’s hospital is patient safety.

Since the Royal College of Paediatrics and Child Health review in 2016, NHS Lothian has recruited an additional 16 staff but, at the same time—as happens across our national health service—three staff have left to take up posts elsewhere, and a further three are on reduced hours or extended maternity leave. The current staffing means that 32 of the 40 out-of-hours shifts that are needed to reach 24/7 delivery can be covered, so more recruitment is needed. I remain committed to a full 24/7 service and continue to actively support the board’s efforts to achieve that.

Photo of Angela Constance Angela Constance Scottish National Party

West Lothian parents are deeply disappointed, not least because they face yet another winter travelling to Edinburgh with their wee ones at the weekend when they could and should be cared for locally, but they are determined to see the Scottish Government and NHS Lothian deliver on their commitments. Will the cabinet secretary commit to meet parents to say what is now different about the plan that she has outlined and when we can expect to have a 24/7 service at the children’s ward?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I am grateful to the member for that additional question. I absolutely understand the disappointment that is felt by parents in West Lothian. For families with a sick child, having to travel to Edinburgh is an additional worry and an additional burden when they had hoped that this would be the winter when they did not have to undertake that additional journey.

Of course I would be very happy to meet the families concerned, and I would be grateful to Ms Constance for any support that she can offer in arranging that.

Photo of Angela Constance Angela Constance Scottish National Party

I have asked repeatedly about support for and scrutiny of the paediatric programme board in delivering a 24/7 children’s ward service. In the light of the challenges that are faced in paediatric in-patient services across the Lothians, does the cabinet secretary agree that, given that we have a first-class children’s ward, providing more services in West Lothian could not only help to anchor a 24/7 service at St John’s but benefit the region as a whole?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I very much agree with what the member has just said. She has made the important point that, in St John’s, we have a first-class and undoubtedly much-loved children’s ward. I am well aware of the population growth in the area that St John’s serves and the nature of that growth—there are many families with young children. I fully expect NHS Lothian to consider the Lothian-wide delivery of paediatric services in hospital and in the community, and that means giving active consideration to the design and delivery of services. I have asked the chief medical officer to engage directly with NHS Lothian on that and to look across the entire estate at how, not just for this winter and the coming months but in the longer term, we can make sure that both areas of the estate are actively and properly resourced and used to meet the needs of the populations they serve.

Photo of Kenneth Macintosh Kenneth Macintosh Labour

A number of members have supplementaries.

Photo of Monica Lennon Monica Lennon Labour

Following the cabinet secretary’s promise in January that a 24/7 service would be reinstated in October, families will indeed be bitterly disappointed that they have been let down yet again. It has not been a good year for NHS Lothian.

Can the cabinet secretary guarantee that the paediatric service at St John’s will be fully reinstated by the end of 2019?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I am grateful to Ms Lennon for that question. For the record, I say that, when I made my statement in January, I made it very clear that it was not a promise but a commitment, because I am not personally in charge of staff recruitment. Of course, I have asked NHS Lothian to overrecruit to ensure that it can take account of things such as long-term sickness, all of which play a big part in the rota.

At this point, without further detailed discussion with NHS Lothian about other opportunities such as advanced nurse practitioner training, which Ms Lennon will recall is a significant part of what makes a sustainable rota, I know that NHS Lothian has recruited to what it describes as hybrid consultant posts—posts in which consultants work both in Edinburgh and at St John’s. There may be more to do there and there may be more to do in the use of existing staff who are prepared to take on additional hours—in a sustainable, long-term way, not in a short-term way—as well as in recruitment.

The chief nursing officer, the chief medical officer and I will look in considerable detail at NHS Lothian’s specific plans in addition to what we already know about what it intends to do, and we will then discuss what more we require it to do. On the basis of that, I will feel more confident about being able to indicate exactly when I think that NHS Lothian will be able to reach full 24/7 provision in the children’s ward at St John’s.

I restate that my commitment is absolute to getting to a 24/7 provision in the children’s ward at St John’s and—to take up Ms Constance’s point—to maximising the use of St John’s for paediatric services.

Photo of Jeremy Balfour Jeremy Balfour Conservative

When will the cabinet secretary be able to come back to the chamber and give members an update and, more important, give parents an update as to when the service will be available? Will she work with NHS Lothian and her colleagues in the Scottish Government to look at the transport issues that parents face when trying to get back to West Lothian, particularly on a Sunday night, when there is a limited number of public transport options? What provision can be made for parents so that they can visit their children and then be able to get back to their homes?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

On the question of transport, my understanding is that NHS Lothian offered additional support to families who had to travel into Edinburgh sick kids hospital and then return home. If that is not the case, I am happy to look at that again or to look at what more NHS Lothian might do and raise that issue directly with it.

On when I will be able to come back to the chamber and update members, that is a difficult question for me to respond to directly. However, I make a commitment to update members at the start of November on the progress that we have made in October.

Photo of Neil Findlay Neil Findlay Labour

I hope that the cabinet secretary can see this copy of the

West Lothian Courier

, from February 2012, with the headline, “Staff Crisis in Kids Ward”. This shambles has gone on for seven years and it is still not resolved. The cabinet secretary said that the paediatric board met at the end of August and made a decision then that it would not reopen on a 24/7 basis in October. Why has it taken from the end of August until the end of September—a month later—to make that decision public?

Is it just a coincidence that NHS Lothian had to reply to a letter that I sent it about this issue last week? Is that why a Government question was set up for Angela Constance so that the cabinet secretary could give the answer that was given? Is it any wonder that the public have little faith in NHS Lothian or in the cabinet secretary when we see a shambles at St John’s and an even greater shambles at the sick kids hospital?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I completely understand Mr Findlay’s anger about this matter. However, it is not the case that there was a sudden flurry of Government activity because he wrote a letter.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

The programme board made that decision at the end of August but we questioned that decision and looked at it further.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

Mr Findlay may be cynical and sceptical about that but it does not alter the facts of the matter.

Members would expect me to query—

Photo of Neil Findlay Neil Findlay Labour

It has been seven years.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

Members would expect me to query a board if it tells me that it cannot do something when I have made a commitment that I need it to do that. Of course I went back and queried that, otherwise I would be failing in my responsibilities as a cabinet secretary.

Photo of Neil Findlay Neil Findlay Labour

You are not meeting your responsibilities.

The Presiding Officer:

Mr Findlay, please.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I do not think, Presiding Officer, that it is overly helpful when I am trying to be clear in the chamber for a member to insist on continuing to shout at me. I am trying to make sure that members are kept up to date. I do not know how well Mr Findlay knows Ms Constance but trust me when I say that setting up Ms Constance to do anything is a very unlikely circumstance.

Photo of Neil Findlay Neil Findlay Labour

She asked a question for the Government.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

She asked a question, quite legitimately, as the constituency MSP, just as Mr Findlay has a legitimate locus in the matter. There is no conspiracy or attempt to keep matters from the Parliament—that is not my way and it has not been the case here. More important is that it is not my way to keep information from the families who are directly affected. That is why we have been clear on the issue and why I will take up Ms Constance’s offer to meet the families that I met previously to hear from them what they need me to do now.

Photo of Alison Johnstone Alison Johnstone Green

Given the well-publicised difficulties and challenges facing the sick kids hospital in Edinburgh, will the cabinet secretary outline what support has been given to nearby hospitals that are treating patients who have been diverted from St John’s? The cabinet secretary said that the issue of staff leaving their posts has contributed to the delay. What steps are being taken to ensure that staff wellbeing is prioritised at St John’s?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

As Ms Johnstone is aware, a number of steps are being taken at the existing sick kids hospital at Sciennes, as the staff and services are continuing there while we ensure that the new site is safe and fit for purpose. That includes additional support to staff as well as matters relating to the building and facilities and so on. In addition, as I said in answer to Ms Constance, we are looking at a Lothian-wide paediatric service that maximises the use of all the resources at the board’s disposal. Indeed, when I visited the staff at the sick kids hospital last Monday, I heard from one of the senior paediatric consultants, who wished to ensure that the capacity, resource and quality of service at St John’s are maximised.

The offer to staff at St John’s in relation to mental health and wellbeing is as I would expect NHS Lothian, and any other board, to provide. However, if Ms Johnstone wishes, I will make a specific inquiry as to whether any additional steps are being taken and advise her of that.

Photo of Sarah Boyack Sarah Boyack Labour

In January, the cabinet secretary said:

“I will ensure that, month by month, we make the progress that we need to make by October.”—[

Official Report

, 29 January 2019; c 11.]

What lessons have been learned from the experience, given that, as Neil Findlay outlined, we have had years and years of understaffing problems at St John’s that have not been successfully resolved? The cabinet secretary is not able to give a commitment on the timescale today. What will she do to ensure that the issues are fixed? In her answer to the first question, the cabinet secretary mentioned the number of staff moving on. That seems to me to be totally unsurprising—these days, surely we have to expect that and plan additional staff capacity to give the hospital the numbers that the hard-pressed staff who are there already and the patients urgently need.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

Ms Boyack is absolutely right that planning a sustainable rota involves fitting in questions that can be anticipated, such as staff leaving, holiday entitlement and sickness absence. However, it is not possible to plan for long-term sickness absence that does not begin that way or for long-term maternity leave that does not begin that way. It is not possible to plan for a situation in which staff have made commitments to a particular service and then decide that they wish to take up opportunities elsewhere.

That is entirely reasonable and they are entitled to do it—it may be for personal reasons or because of domestic circumstances.

That is why I have asked and continue to ask NHS Lothian not to recruit to the numbers that it thinks that it actually needs for a 24/7 service but to overrecruit, if sufficient numbers come forward in a recruitment exercise. That is the approach that we are taking. We track the situation month by month and we will continue to do so to meet the commitment that I have made.