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Eye On Health Services In Caithness |
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Scottish Parliament Debate Thursday 15 January 2004 Medical Services - (West Highlands) 17:07 Stewart Stevenson (Banff and Buchan) (SNP): Does
the member agree that the significance of the Belford and Lorn hospitals
extends far beyond the areas in which they are located? Indeed, I have
heard from people in Banff who are concerned about the situation because
they are hillwalkers who rely on the Belford hospital, and I know that
others who follow tourist and leisure pursuits rely equally on the Lorn
hospital. The issue is important for Scotland, not just for George Lyon's
area. Members might ask why the west Highlands are a special case. When we close down a service and move it elsewhere in Glasgow or Edinburgh, we are asking the population to travel a further 5 or 10 miles to the nearest hospital. If we close services in Oban and Fort William, we are asking the population to travel 100 miles to access the same service, and that journey might have serious or fatal consequences for those involved. It is like saying to the minister and his constituents that, if consultant-led services were closed down, they would have to travel to Aberdeen to access them. That is the scale that we are talking about and it should bring home to the minister why the west Highlands are a special case. Why do I believe that such moves would have fatal consequences for my constituents? Official police statistics show that, on the roads in the Lochaber and Oban areas in the past five years, there have been 70 deaths, 600 serious casualties and 1,400 slight casualties. The majority of those road accident victims will have received emergency treatment at the accident and emergency unit in Oban or in Fort William and will have been treated by senior consultants who are experienced in dealing with trauma injuries. If those services are removed, such accident victims will have to travel to Glasgow or Inverness, which could have life-threatening results for them. There is a real risk that, if the changes go through, those 600 serious casualties could end up in the fatally injured category. That is an unacceptable risk for the health boards to take, and that is why there are special arguments for the continuation of the services and why provision in the west Highlands is a special case. The community, doctors and consultants have suggested a number of ideas to ensure the continued provision of services in the west Highlands, which the health boards must explore. At the most recent public meetings that I attended, the Lochaber solution was proposed. I am sure that other members will go into more detail about what that is about, and I will leave it to them; I am sure that Maureen Macmillan and Fergus Ewing will contribute on that matter. One of the suggestions that has been made is the rotation of consultants two days a fortnight into central-belt hospitals to overcome the challenge of maintaining skills and keeping up accreditation. The opportunities that are provided by the new general practitioner contract—under which we will also have to make further provision to cover out-of-hours services in Oban and Fort William—will help to address the shortage of doctors to fill the junior doctor rotas, certainly in Oban's case. There is a desperate need to get away from training
specialist surgeons all the time. We must emphasise the need to train more
generalist surgeons, to deal with rural constituents and rural needs.
Indeed, as one of the doctors said at a public meeting, only 3 per cent of
patients need a specialist to deal with their problem; the other 97 per
cent can be dealt with by either a GP or a generalist surgeon. 17:14 I was privileged to be the local MSP in attendance on Tuesday 11 November 2003, when more than 2,500 people turned out on a dreich night to show that they would not put up with the loss of a consultant-led acute hospital at the Belford and to demonstrate their personal appreciation of all the staff at the Belford. I am sure that the same arguments will have been put and the same sentiments will have been expressed at the meeting in Argyll. There is a serious problem, in that, because of the process so far, there is a strong feeling in Lochaber that a decision has perhaps already been made. That was manifest in many of the contributions at the meeting. I commend Mr Richard Carey of Highland Acute Hospitals NHS Trust for the way in which he spoke at that meeting, which Mary Scanlon also attended and spoke at; he conducted himself in a dignified way. He is doing his job and we are doing ours. The problem is that the option that was put forward at that stage was for a GP-staffed community hospital model, which would be simply unacceptable. I hope that George Lyon would agree with that. I have spoken to various people in the Belford action group—TBAG—and the reason why that would not be acceptable is because the key point is that we should continue to have a consultant-led service. It would not be acceptable to a member from Edinburgh—I can see that at least one such member is here—if their constituents had to travel to Newcastle to have emergency treatment at an acute hospital but, if Fort William loses that service, in effect that is what my constituents will face. There are national issues that must be addressed. I
have suggested to Mr Chisholm that, unless certain national issues are
addressed, Highland NHS Board might find it difficult to come up with a
proposal that it can implement, because it is not responsible for key
elements of the Lochaber option. Those elements include recognising the
work of surgeons who operate as generalists in remote areas as a
specialism in itself. I think that that case is resisted by the medical
establishment, but it is not resisted by the people of Lochaber or Oban.
Some of the existing consultants have specialist interests in neurology,
colorectal surgery and breast surgery, so I think that that is the way
ahead. I understand that work has been done on that in Canada and the
United States of America. I hope that we can all unite behind the fundamental requirement, which is that services in the west Highlands—in Oban and Fort William—will continue to be consultant led. That is the commitment that I will seek from the minister when he makes his closing remarks. 17:19 The current country-wide reviews of acute services and
maternity provision have produced a real sense of crisis among the people
of north Argyll and Lochaber, not to mention those in Caithness, about
whom I am sure Jamie Stone will speak. I fully appreciate that that is
coupled with an expansion in primary care that will deliver more health
and medical services closer to communities, but the model of health
centres that are well equipped with e-medicine, diagnostic facilities and
equipment such as defibrillators, and which have GPs and paramedics with
enhanced skills and other professionals—all backed up by a huge specialist
hospital nearby—which might work very well in urban areas, cannot work in
the areas that are covered by the Lorn and Islands district general
hospital in Oban or the Belford hospital in Fort William. The hospitals provide, and must continue to provide,
consultant-led surgery and some specialisms to their populations. They
also provide an accident and emergency service 24 hours a day, seven days
a week. That does not mean that the two hospitals cannot collaborate, but
they must do so on equal terms. Nevertheless, the communities are determined to fight to keep services at the present level. Highland NHS Board is now—wrongly—seen as the enemy, because it is perceived as trying to find clinical solutions to those challenges without paying regard to the repercussions for communities. Alison Magee, who is Highland Council's convener, has resigned her place on Highland NHS Board in protest and Highlands and Islands Enterprise is pointing out the consequences for the economy of the west and north Highlands if crucial services are lost. If we are to achieve a solution, we need proper
engagement between the health board, local authorities, Highlands and
Islands Enterprise and local communities. The charge that involving local
communities will lead to a dead hand on progress is not true. In Lochaber,
the most innovative suggestions—which, of course, need to be tested—have
been made about increasing the number of patients by encouraging people
from the central belt to have routine operations at the Belford. The same
practice could happen in Oban. European working time directive compliance can be achieved if clinicians are prepared to be flexible. Rural medicine must be delivered differently. We must build on the work of the remote and rural areas resource initiative, which ends this year. As Fergus Ewing said, rural medicine and health care need to be treated as a proper specialism to which medical students have properly designed routes. We must recognise the negative effects on a community if services are relocated 100 miles away. If that distance had to be travelled in an emergency, it would put lives at risk. I remind members what happened at Stracathro hospital in Angus, which was under threat for years as the former Tayside Health Board planned in a vacuum and did not involve the community. The board used producer arguments such as the working time directive to transfer services to Dundee. Only when the health board made a commitment to seek the community's full participation and to engage with the local authority and other partners were decisions made that everybody could endorse and sign up to. The Stracathro campaigners have formed themselves into the Friends of Stracathro, as they were so pleased with the consultation's result. Can we in the Highlands not use a similar way of reaching solutions? I ask the health boards to have confidence in the communities and let them help to shape the future of rural health services. We must keep the consultant-led service. 17:24 It is sickening that, two years after a review, we in
Caithness are once again in a black hole of doubt and worry about what
will happen. A petition of probably 10,000 signatures has been delivered
to the Parliament and we have had mass demonstrations in Wick, which has
seen nothing like that before. Feelings are running high, to say the
least. I am fairly confident that the powers that be are getting the
message, which is about distance, as George Lyon said. There would be
journeys of more than 100 miles each way to Raigmore hospital in Inverness
if the Wick maternity service were downgraded from being consultant led.
The ambulance service has said that it fears that it would be
overstretched by having to undertake such a service. What if the weather and road blocks were so bad that the emergency helicopter could not fly? That also happens. I pray to God that, if that were to happen, there would be nobody in an ambulance on the road—that is a tragedy waiting to happen. NHS Highland has talked about risk assessment, which is taking place for the Caithness maternity service. A risk that involves the kind of scenario that I have described, with a person being caught in an ambulance in a snowdrift or the road being block and an emergency helicopter not being able to fly, is a particular and frightening risk, but there are many risks. There might be infection risks, for example, but a risk associated with a long road from Inverness to Raigmore and the inclement weather conditions that there might be is a short road to tragedy. Only the Almighty can change geography and weather. Politicians can do many things, but they cannot do that. Maureen Macmillan correctly said that no less a person than the convener of Highland Council, Alison Magee—who is a lady whom all of us would agree does not reach swift or unthought-out judgments—has tendered her resignation as a member of Highland NHS Board. That is indicative of how strongly feelings are running. I will put a slightly different argument to members. All members are signed up to the notion of economic regeneration and economic development in some of the remotest parts of Scotland, from Dumfriesshire to Caithness. There are already examples of would-be employers who might consider moving to Caithness, for example, but who would be put off if they thought that the medical services were not as good as they could be. That could cut against and fly in the face of the stated policy of the Executive and all political parties in Scotland. The issue involves more than health—it involves the
whole Scottish Executive. For that reason, I, too, encourage the
Parliament to do everything in its power to engage with Highlands and
Islands Enterprise—we have heard about its feelings—the local enterprise
companies and Highland Council, which is taking a principled and correct
stance towards having its own independent inquiry. 17:28 Long, hazardous and sometimes painful journeys to Paisley or Inverness should be undertaken only in exceptional cases. Consultants often speak of the golden hour in which lives may be saved by patient stabilisation. That provides a fundamental reason for having hospitals that can deal with life-threatening incidents in rural areas. It also provides a good reason for upgrading the transport infrastructure to a higher standard. The people of Fort William and Oban must stand together
on the issue and not be divided by self-interest, which might weaken the
determined resolution that I saw recently when I attended a packed meeting
in Oban. There, I heard Baroness Michie of Gallanach give a stirring
speech in which she defended the right to acute health services of people
in the Highlands and Islands who depend on the hospital in Oban. At the
time, I said to her that I hoped that her Liberal colleague George Lyon
would echo her sentiments in the Scottish Parliament, which he has done. I
hope that he will follow through her words and the words of his motion
rather than follow Scottish Executive health policy, which is—I
regret—about centralisation and has lately been detrimental to health care
in rural communities. The west Highlands health services report, which has sparked off the furore, may have a value in highlighting the ever-increasing problem of recruitment and retention of members of all health care disciplines in remote and rural areas. Solutions must be found to the problems identified in the recent report by Professor John Temple. He stresses the need for the retraining of medical staff to make their skills more relevant to the needs of rural practices and hospitals. There are far too many specialist consultants and not enough general ones. Those problems are exacerbated by compliance with the new deal for junior doctors, the new general medical services contract for consultants and the agenda for change—all of which appear to be undeliverable within the current financial allocations. Professor Temple concluded: It is vital that the services not only survive but
improve. Recently, I spoke with Bill Crerar of North British
Trust Hotels, whose generosity and effort made it possible for both Oban
and Fort William hospitals to receive computed tomography—CT—scanners. A
huge amount of effort and money was required to achieve that admirable
result. The downgrading of those hospitals would be an insult to that
achievement. I call on the Executive to realise the effects that such a
move would have in the long term if those pillars of health care are in
any way weakened. 17:32 I believe that we have reached a turning point in the
Highlands and Islands. This is the point at which local people have shown
by their mass attendance at local meetings that enough is enough. They
have listened to the detailed proposals of the west Highland project, they
have heard about the implications of the European working time directive
and the need for medical staff to specialise and they have soundly
rejected the idea that those things must inevitably mean the downgrading
of services. We have seen signs of progress with the formation of
the solutions group, which will go back and think again. However, we
should guard against complacency and remind ourselves that we live in a
democracy and that people power can reverse Government decisions. Examples
of that include the fuel protests, the recent English council tax
campaign, the flexibility shown yesterday by the European Union on
Scottish fishing restrictions and our local experience of the successful
defence of the Fort William sleeper service. A positive move that is on the horizon is the all-party
meetings that are scheduled to take place with Highland Council and Argyll
and Bute Council. Another positive move is the councils' recognition that
the proposals would lead to the west Highlands becoming a consultant-free
zone. Highland Council has said that they would result in a negative
socioeconomic impact that is "likely to be wide-reaching and lasting". The Deputy Presiding Officer: Because of the number of members who wish to speak in the debate, I am minded to accept a motion under rule 8.14.3 of standing orders that the debate be extended by up to 30 minutes. Motion moved, 17:36 The services are needed. If I lived on the west coast, I would like to think that there were general surgeons at the local hospitals. I would not like to think that I would have to go to Glasgow or any other place to the north or the south of where I lived. Our approach to the provision of better services for our communities should be to produce more generalists. I agree that we need more of them than we need specialists. People go to the west coast of Scotland as tourists. If one walks through Fort William in the summertime, one finds that it is crowded. If the plans are implemented, I would not like to go to the area as a tourist, never mind as a mountaineer—indeed, mountaineers go to the area not only in the summer, but year round. I would like to think that the wonderful services that have been provided until now would still be there. It is true to say that local services have saved lives. All the emergency services have proved that lives are saved if patients get to hospital in time. If patients had had to be taken to Glasgow, they would have died. People think that they can send everybody down to Glasgow—I do not mean members in the chamber, because I know that some of them do not want to go there, or to any other place for that matter. However, we should remember that Greater Glasgow Health Board is about to accelerate its acute services review. The board is not coping even at present. Last week, there were no male beds in the city and the only female beds were in gynaecology. Trolley waits are also increasing. On Monday, in my local hospital, 20 people crowded in all at once. The trolleys were full to capacity; there were no more trolleys and there were no more seats. Some of my constituents are patients in the system and
they have come to me because they are desperate to find a place in Belford
or elsewhere to have their hip replacement done—indeed, one chap said that
he would go anywhere in Scotland where his hip replacement could be done.
I telephoned the Belford, but I think that that is one operation that it
does not do. Some of those people had read the article in Scotland on
Sunday—they are aware of the excellent services that members who live on
the west coast have and would like to share those services, because they
are not getting them in Glasgow. 17:41 Health managers and service providers have suggested that the current provision of acute services at Fort William and Oban cannot be sustained. The GPs and clinicians in those areas insist that the sustainability of those services is vital to the communities that they serve. There is an urgent need for much more financial support to respond to that dilemma. Much of what has been proposed for Fort William and Oban is just a carbon copy of the situation that developed in my constituency at the MacKinnon memorial hospital in Broadford on Skye. We had an excellent facility with a surgeon and an anaesthetist, who were able to provide medical services for any situation. That set-up was slowly downgraded, resulting in patients having to transfer to Raigmore or Fort William, with a journey of some 150 miles. If Fort William is similarly downgraded, patients from Skye who attend the hospital in Oban will be expected to travel almost 200 miles. That is unacceptable and it must be resisted. Can members imagine the protests that would arise if patients from Edinburgh or Glasgow were asked to travel to Perth, which is just up the road, for treatment? That would never happen. If equity of provision is to prevail in rural Scotland, we must support fragile communities and ensure that they are given the resources and support that they expect and justly deserve—first-class medical provision in their localities, not at a distance of hundreds of miles from their homes and families. 17:44 Over the past four years, the Health Committee has dealt with many problems relating to the downgrading and potential loss of hospital services—Stracathro hospital, Queen Margaret hospital in Dunfermline, Perth royal infirmary, Montrose maternity services, Stobhill and various others. The difference between those campaigns and that of Fort William is that whereas they were generally led by local people, local newspapers and, quite often, by local politicians, in Lochaber the clinicians are leading the campaign—32 out of 36 local doctors are against the NHS Highland proposals. Local nurses, physiotherapists, consultants—the whole range of healthcare staff—are against the NHS Highland options. I say to the minister that if the local clinicians and staff are worried, it is hardly surprising that the local population is worried. Mr Stone: I am sure Mary Scanlon is aware that among those clinicians is David Sedgewick, who is a consultant gynaecologist. He pointed out to me on the telephone yesterday that he likes doing the general run-of-the-mill surgery work in addition to his consultancy work. I say to the minister that that is a model for the rest of Scotland. Mary Scanlon: I was highly impressed by the gentleman Mr Stone mentions. I hope that the minister will agree that although we get many complaints about the NHS, the passion and support of the people in Lochaber for their NHS is second to none. I want to look at the situation not simply in the context of acute care: we must take into account NHS 24, the new GP contract and the opting out of out-of-hours care by GPs without knowing what will be put in its place. The change to the GP contract is the biggest change to local health care since 1947. Let us not look at what is happening at the Belford and Lorne hospitals alone—let us look at the delivery of health care services in general in Lochaber. NHS Highland gained most in Scotland from the Arbuthnott funding formula, to address inequalities in access to health services. The options that were put forward by the NHS will not address inequalities; they will create inequalities in access to healthcare. As others have done, I highlight travel times. It can take up to two hours just to get to Fort William from Lochaber, so we should add that to the 66-mile onward journey to Inverness and to the journeys to Oban or Paisley. When the planners talk about clinical feasibility and risk assessments, do they take into account the effect on a patient of lengthy travel times, of poorly maintained roads, of single-track roads and of adverse weather conditions? I commend Stewart Maclean and the Belford action group on their positive and constructive approach to finding a workable solution to the problem. People talk about community hospitals, but the term can be misleading. Glencoe is a community hospital that provides geriatric care; the Balfour in Kirkwall is a community hospital that provides excellent acute care—and it has just got a brand new theatre. When we talk about community hospitals, we must be clear what we are looking for. I hope that the proposal—it was not previously an option—suggested by Andrew Sim of the Viking surgeons group at the Lochaber meeting will be taken into account. 17:49 NHS Scotland must take into account Scotland's dispersed geography. The problems are beyond the power of one health board to solve, which is why in the case of the west Highlands, the Argyll and Clyde NHS Board and Highland NHS Board were asked to work together. Frankly, that is not a good enough base to make decisions that will stick. I ask the minister to ensure that NHS Scotland begins to create the conditions through which Scotland's geography can be dealt with. We have had one case after another. For example, there is full cross-party support for dealing with maternity services in Caithness and the need to have consultants there. If the problem is that the NHS has difficulty getting consultants, we must train people who have the necessary skills and can work in the places where the work needs to be done, such as Oban, Fort William and Wick. If that is to be achieved, the consultant contract, which is being formulated, must be considered. Consultants are used to a system under which they work in one centre. We are told that, in some cases, patients have to travel hundreds of miles to get treatment. Is it not time we turned the situation round and ensured that consultants travel to the places where the work is? George Lyon: The consultant contract, the GP contract and the agreement on junior doctors' hours were negotiated at the UK level at the insistence of representative bodies of GPs and consultants. Is it not time the Parliament insisted that such negotiations take place at a Scotland level and that those representative bodies engage with us so that we can come up with a contract that reflects Scotland's needs? Rob Gibson: I would welcome that, because I believe that we would get a much more sensible contract that met our geographical conditions. In other countries, transport issues are dealt with in a way that ensures that services are spread around. Many countries do not rely on roads. Norwegian health boards held a major conference about remote and rural areas. It is obvious that there is massive funding in Norway not only for helicopters, but for fixed-wing aircraft. Norwegian health boards also ensure that consultants go where the work is. That element has not been considered in the debate. The one-size-fits-all approach to consultants' work will not fit Scotland's conditions. I am sorry that members of the other governing party, which represents so much of the central belt of Scotland, are not here to take part in the debate in the numbers that they might have been. Jean Turner has told us that, in some ways, the rural areas of Scotland might have to start helping out the cities. People should recognise that rural areas are not peripheral and that we have excellent health facilities and long experience of working with communities. It is not unreasonable to ask the Government to consider means whereby patients can be moved to, for example, the Belford hospital to be treated, but it is much more reasonable to ask that medical staff be taken on with a suitable contract and given transport to go to places where the jobs need to be done. It is my fervent hope that we will receive the Government's support in ensuring that consultants fit the needs of the geography of our country. I am glad to support the motion. 17:53 Everyone understands the legitimate wishes of
communities to have a full range of general medical and surgical services
in their locality. I fully support communities' right to that. In
particular, I support communities' feeling that they need to have
sufficient facilities to treat all medical, surgical and obstetric
emergencies. Communities would feel vulnerable without the knowledge that
such facilities are available if I worked in the NHS until May 2003 and I recognise the
reality of recruitment and retention in rural areas. The situation is not
helped by the European working time directive, but I do not think that the
directive is the root cause of any of the problems; there are many other
causes of staffing problems in the NHS. I believe that there is low morale in the NHS among doctors, nurses, professionals allied to medicine—absolutely everybody. There are lots of reasons for that, one of which is repeated reorganisation, which is notoriously bad for morale. It would be really nice if we could have an NHS that we were reasonably happy with and stick to it without any major upheavals for a few years until it had settled down and people felt that their jobs were safe because they were being managed by people who did not feel that they were going to have to re-apply for their jobs in the next six months, or whatever. Another thing that we must look at is the policy for recruiting medical students, which now emphasises the academic. I know that I would not get into the profession now. I cannot prove this, but I believe that such a policy makes it less likely that we will train generalists and GPs and more likely that we will train specialists who want to work in specialist centres. I cannot prove that, but I think it is likely. There has also been a wider change in society: it has become much more litigious. That has had severe knock-on effects on medicine. Various high-profile cases have shown up doctors and surgeons in quite a bad light. At the time of the Alder Hey hospital scandal, there was a nice cartoon in one of the medical journals. It depicted somebody reading a newspaper, one page of which said, "Get the Evil Pathologists" while the facing page said, "Acute Shortage of Paediatric Pathologists". We cannot recruit people when the professions to which we are trying to recruit have a bad image. Individual practitioners and the professional bodies have become increasingly defensive and the health service as a whole is becoming risk averse. Professional bodies are insisting on a lot of revalidation and continuing professional development. That is all very laudable, but if people can look up their surgeon on a website and see their success and failure rate without any regard to the fragility of the patients on whom they have operated, it is understandable that health professionals feel defensive. That militates against people wanting to train to be generalists. I want a consultant service to be retained in Oban and Fort William and I believe greatly in the value of generalists, but those people need to feel that they are supported by their professional body, their employers and the community. It is all very well for a community to say that it wants a service that is good enough, but when something goes wrong, people will turn round and say that they should have had the best possible service—and the best possible will always be a specialist, not a generalist. It is a challenge for the communities to have that kind of contract with the people who work with them. I am encouraged to hear from GPs in Lochaber that there have been fruitful discussions with the Royal College of Surgeons in Edinburgh, in particular, about the creation in Fort William of a trauma centre that could also be a teaching centre. Such a development would be really good. People have seen the downgrading of hospitals to GP units as the worst-case scenario; to me, the worst-case scenario is putting in place something in theory that cannot be delivered in practice—putting in place a consultant-led service where consultants cannot be produced. We must ensure that we grow and recruit consultants and that the community is right behind them. 17:58 I welcome the passionate and positive speeches that have been made in the debate. In particular, I welcome the emphasis on the importance of public involvement, the two NHS boards' willingness to work together to find potential solutions, and the recognition that the status quo is not an option. I appreciate the fact that Mr Lyon was practical enough to make that statement because, frankly, the status quo is not an option. Let me make a couple of things clear from the outset.
The two NHS boards have reached no decision about the future pattern of
services in the west Highlands, which are rightly matters for further
local discussion and, if appropriate, public consultation. Unless or until
the boards put forward firm proposals, it is not appropriate for me—or any
other minister, for that matter—to try to second-guess the outcome. That
would wholly compromise the local consultation and decision-making
process. However, I will set out some of the principles that underlie the
framework within which the boards will reach their decisions about future
patterns of care. Those principles apply equally in the unique
geographical circumstances of the west Highlands and include clinical
safety; meeting quality standards; sustainability; access to services;
and, most important, consultation. A number of factors drive the need for change. Clinical practice is constantly developing, with major advances in new treatments and technology. Clinical needs change as well. The incidence of some conditions is rising whereas that of others is lower than before. The birth rate is falling substantially, which has consequences for the safest ways of delivering maternity services. The NHS must respond to all those pressures. Working patterns also have a clear impact on the
quality and safety of services. NHS planners need to take account of
working time regulations, new contracts, training requirements and the
choices that people make about the balance between family and their
working lives. They need to consider the availability of staff and their
willingness to work in rural hospitals. It is in no one's interest to be
looked after by staff who are overtired, or who have insufficient
experience of treating particular conditions. Mr McCabe: There is considerable work going on in the NHS with regard to training, which I will deal with later. There is nothing to stop the importing of elective surgery at the moment. I am glad to hear that the boards are inviting key stakeholders to join a solutions group to map out a vision of the future service and provide a basis for consideration and consultation of local people. That does not indicate that anything is predetermined and it is unhelpful to suggest that it does. It would be entirely wrong if anything were predetermined and I am confident that the boards are well aware that if anything were predetermined, they would be taken to task. I have heard a lot about what the vision might include. I am sure that the boards and the management in Argyll and Clyde and Highland will be listening carefully to this debate and noting the points that members and I have made. There is a suggestion that GPs should have a bigger
role to play in supporting acute hospital services in places such as Oban
and Fort William. Some people have cast doubt on that suggestion this
evening. Last summer, I visited the Western Isles and saw an excellent
health service whose hospitals largely depended on the input of GPs. One
of the strengths of our NHS must be role expansion. For far too long,
committed and able people in our health service were held back and were
not allowed to play as full a part as they desired in the delivery of
services to patients. Those barriers are now being broken down, and it is
critically important that we do nothing to prevent that from happening.
For too long, too many people have been allowed to stay in their own silos
in the national health service. That must stop. Mr McCabe: I will do my best to do so. Mention has been made of the scope for more rotation of consultants between rural hospitals and larger centres. Managed clinical networks for specific services across traditional NHS boundaries, which the Executive is strongly encouraging, offer one way of increasing such interchange. There clearly need to be more ways of encouraging that. To return to a point that I made a few moments ago, if we are asking the people whom the service is there to serve to appreciate the need for change, we need equally to explain to the people who work for that service that they, too, need to accept that need for change. That applies to consultants and everybody else who works in the national health service. A suggestion that often comes up is that patients from the central belt should be referred to smaller hospitals. I made my views known to Mr Ewing after his intervention on that subject. As I said, there is nothing to prevent such referrals from happening, but they would of course be subject to agreement between the boards and to the willingness of clinicians to refer. They would also be subject to patient choice. We also have to bear in mind the fact that smaller hospitals have a more limited capacity, which is especially true in terms of theatre space. I have also heard about shifting the balance of doctors' training away from increased specialisation towards the more generalist skills that are needed for rural practice. The next Temple report, arising from the review of medical career structures, is due shortly. It will make recommendations about securing safe and sustainable medical services throughout Scotland, including in rural parts of the country. We have to be frank, however: it is unlikely that the report will come up with a one-size-fits-all approach. Local solutions will often be more appropriate to local circumstances. We will look long and hard at the Temple report when it is published and we will carefully set out our response to it in due course. George Lyon: On the point about local solutions to local problems, I hope that the minister has recognised tonight just how unique the situation in the west Highlands is. If the minister told his north Lanarkshire constituents that, as of the following week, they would need to travel to Aberdeen to access a consultant, I can imagine the reaction that would be felt there. I want the minister to recognise that the situation is a unique one, and that the distances involved are huge. It is not just the fact that the necessary trip will be 100 miles each way; the road structure means that, for most patients in my constituency and in constituencies that Fergus Ewing and others represent, that could be a six to seven-hour journey in an ambulance. That critical point needs to be taken on board at the highest level. Mr McCabe: As I mentioned near the start of my speech, we fully appreciate the unique geographical circumstances that apply in the Highlands. In response to Mr Lyon and Mr Stone, I would say that both the boards concerned need to factor those unique geographical considerations into their thinking on these matters. That will obviously be the case. I am well aware that the reason why we are debating this matter today is that the NHS boards' assessment is that the current level and configuration of acute services at either or both of the hospitals in the west Highlands are not sustainable. It is therefore incumbent on the boards to consider all clinically feasible options. It is crucial that they involve the local communities in that. I encourage and implore them to apply innovation and imagination when they take on that task. I look forward to learning the outcome of the further
work on the options for the west Highlands that the boards will now be
taking forward, under the direction of the solutions group. I look forward
to the contribution of local communities and their representatives to the
process. I assure members that if, after public consultation, the NHS
boards come to us with any firm recommendations for change, we will take
careful account of all the evidence provided and the views expressed. I
also offer members the assurance that we would not be prepared to endorse
any solution that did not guarantee a safe, high-quality and sustainable
service for the west Highlands. |