Official Report 685KB pdf
Rural Scotland (Healthcare Needs) (PE1845)
Agenda item 3 is consideration of three public petitions. The committee took evidence on the petitions from the Cabinet Secretary for Health and Social Care on 17 January, and I will go through them one by one. Members should let me know whether they wish to comment on any of them.
The first petition is PE1845, which calls for a health agency to advocate for the healthcare needs of rural Scotland. I believe that Emma Harper wants to come in first, after which I will go to other members.
I am well aware of this petition; I was at the Citizen Participation and Public Petitions Committee meeting at which it was presented by the petitioners, and I know that other members in the room were there, too. I know the history behind it, and I am keen that we do not lose sight of rural health and social care needs and that we hear people’s voices.
The example that I have before me is the experience of people in Stranraer. A key issue that the petitioner has been trying to raise for 20 years now relates to the fact that NHS Dumfries and Galloway is part of the south-east cancer network and that, as a result, patients in the south-west of Scotland—which isnae in the east of Scotland—end up having cancer treatment in Edinburgh instead of at the closest cancer centre for radiotherapy, which would be in Glasgow. It means that, instead of just going up the road to Glasgow, people who are undergoing radiotherapy or other cancer treatment have to travel a distance that is pretty hefty for them.
My understanding is that, for 20 years now, Dr Gordon Baird, who is a retired GP and former chief medical officer at the Galloway community hospital, has been trying to look at ways in which we can hear the voices of people who live in remote and rural parts of Scotland, particularly Dumfries and Galloway—although, as we can see from the other petitions, the issue goes wider than that to, for example, Caithness. The question is how we support what is best for patients; it is not about telling them, “You’ll get your treatment where we tell you,” but about giving them the best opportunity to get the best care where they choose and reducing the issue of travel.
Currently, the people in question are means tested for their travel, whereas those in other parts of Scotland are not and get their care without having to cough up from their own finances. That is a health inequality issue, too—means testing people for their care should not be happening.
There are other issues regarding maternity services. I know that a review of the midwifery-led service in Galloway is happening right now because no baby has been delivered in Stranraer for four years. That is similar to the issue at Dr Gray’s hospital, which has been raised in the chamber of Parliament on a number of occasions.
11:30My concern is that, for 20 years, little progress has been made to hear the voices of the people who live in remote and rural areas, whether that is in the area that NHS Dumfries and Galloway covers or more widely. If we in the committee do not keep the petition open and hear from witnesses, I am concerned that we might lose sight of what the real issues are for people in remote and rural areas.
I want to press you on the substance of the petition, which makes a targeted call for an agency. We need to decide whether to take evidence on the idea of having an agency. Are you talking about taking evidence on the wider aspects that surround the call for an agency?
I know that the Cabinet Secretary for Health and Sport said that he did not want to
“clutter a landscape”
that
“already has a fair bit of bureaucracy around it”—[Official Report, Health and Sport Committee, 17 January 2023; c 14.]
through the organisations, agencies and institutions that we already have. I am aware that the establishment of an agency is not the route that the cabinet secretary wants to take. I suppose that the big issue is how we ensure that rural voices are heard. We have raised the issue in debates and through questions in the chamber, but how do we get rural voices heard if we do not continue to pursue evidence taking?
I know that the petition calls for the establishment of an agency. I need to understand whether we need the petitioner to submit a new petition that addresses the specific issues with remote and rural healthcare rather than calling for an agency.
I will make a wider point to start with before focusing on the petition itself. The dedication of our staff who work in remote and rural areas is without exception. They are extremely dedicated and work very hard. However, despite their hard work, I feel that our patients who live in remote and rural areas get a far worse service than those who live in urban communities. There are a number of reasons for that, and Emma Harper has mentioned a few of them, including travel and there not being the required expertise. We also know that there is a lack of staff in remote and rural areas in comparison with urban areas. That applies to nurses, doctors and GPs. Retention is also important in those areas.
I have done a GP shift in Dumfries and Galloway, so I know that travel is one of the issues. When I drove to my shift, the road was flooded. At one point, I genuinely thought that I was going to drown. Admittedly, there was a storm. Patients face travel issues day in, day out in rural areas. What we offer is not good enough.
I would advocate our looking into rural healthcare generally and having an inquiry that would incorporate a lot of what we have spoken about and a lot of what the petitions highlight.
On PE1845, I am not sure that an agency is the way forward. However, I think that the issues that it raises need to be part of our potential work on rural healthcare.
As a former member of the Citizen Participation and Public Petitions Committee, I recall sitting in the session on 8 June 2022 with Gordon Baird and others in which we took evidence on four petitions covering rural healthcare. It quickly developed into a much more effective and quality discussion. It did not just home in on the idea of an agency but took in the broader issue of the agency of patients to advocate for themselves and for clinicians to advocate on their behalf. In particular, it focused on the power imbalance between health boards and other stakeholders in the system.
In that respect, the petition remains relevant, so there is scope for the committee to consider how we take those legitimate and sincere concerns forward. Although it is inevitable that inequalities will exist by virtue of geography in any healthcare system, because you cannot have a fully functioning neurosurgical department in a town of 100 people, we nonetheless need to look at ways in which we can mitigate those issues effectively.
Where changes to service provision are occurring, are we effectively ensuring that ambulance provision, travel allowances and protocols are in place to reduce the risks of, for example, going into labour in a way that means that someone is dangerously far from a maternity department? We should be cognisant of all those issues, which I do not think are necessarily being fed back into the healthcare decision-making system through health boards. Perhaps that is where this committee would have a locus in helping to further the petitioners’ concerns. That would be my suggestion.
With regard to the substance of the petition’s calls for an agency, are you of the view that Sandesh Gulhane has just expressed, which is that we could close the petition but look at the issues that brought the petitioners to lodge it?
When we had the discussion at the Citizen Participation and Public Petitions Committee, the petitioners were not committed hard and fast to the idea of an agency. They were happy to row back from that opening gambit. I do not know whether there are technical rules around this, but I would be content to keep the petition open with an understanding that we could look beyond the simple ask for an agency, because the issue is the concept of who has agency in the system.
The protocol is that the committee must decide either to take forward the petition, which means looking at an agency, or to close the petition and then make a decision about further scrutiny of the more general issue of rural healthcare that has been raised. We could absolutely do that—we can discuss that when we discuss our work programme.
I believe that NHS Dumfries and Galloway is one of the health boards that will come to the committee in due course as part of our general scrutiny of health boards. Therefore, a lot of the issues that Emma Harper has just raised—the issues that that health board area is facing and the decisions that have been made there—can be put directly to that health board.
With regard to petition protocols, we either take further evidence on the idea of an agency or close the petition. That would not preclude the petitioners from coming back with a new petition based on something that we find out as a result of any further work and scrutiny that we might do as part of an inquiry or whatever.
My view is that we are not bound to the petitioners’ specific ask, and an inquiry would give us a useful basis on which to roll the issues forward. We can still retreat from that. In my view, it is not a binary thing, in that we have to agree whether there should be an agency or not. We can certainly take on board—
Protocol-wise, either we keep the petition open or we close it. If we keep it open, we have to go forward on the basis of what the petition asks for. Closing it would not mean that we would forget everything that was in the petition. We can take the learning and evidence from the petition as part of a wider inquiry and roll it into that work, so we would not be dismissing it or the things that people have said about it.
I just want to make it clear that I would like to take evidence from Dr Baird, but as part of that wider work.
Yes—as part of a wider inquiry.
We take cognisance of and pay respect to the fact that the petition was lodged. As Paul Sweeney says, the petitioners were not really wedded to the idea of an agency but wanted the issues to be looked at, so they might be quite happy with that. That does not preclude them from deciding, “We have not changed our minds and we are going to bring back a new petition, exactly the same, and get this looked at again because, as a result of the work that the committee has done, we feel the same.”
If the impact of the petition is that the committee holds a related inquiry, it will have done its job in a way. In that sense, perhaps whether or not the petition is kept open is not such a big deal. I would be content to rest on that.
I know the work that Dr Gordon Baird and the Galloway community hospital action group have done to get the petition to the Parliament, and I know that local people feel powerless. I know that Professor Sir Lewis Ritchie is interested in how Australia’s National Rural Health Commissioner works—Australia is also a big rural country. I also know that a centre of excellence for remote and rural medicine is being created, but it does not have an advocacy role. That is what Professor Sir Lewis Ritchie said when he gave evidence.
The proposed agency is not about picking up individual casework. That is not what Dr Gordon Baird was after when he asked for an agency to be created. It is about advocating for and giving a voice to people who feel powerless and who do not know that, for example, they should be offered a choice of care that might be closer to home. That is one of the challenges.
NHS Dumfries and Galloway committed to addressing cancer care pathways and then Covid came along. Therefore, when the board comes in front of us, we will need to ask specific questions about where it is with altering cancer care pathways and what steps it has taken. This is not about addressing all the challenges overnight. I know that there are real challenges—everybody does; I was a healthcare clinician as well.
I am keen to ensure that, whatever pathway we take, Dr Gordon Baird is permitted or invited to give evidence about the challenges for remote and rural healthcare and advocacy for patients.
That is a really good point. As you say, there are a couple of reviews going on in the health board area.
Does Gillian Mackay want to come in on the petition?
My comment is not specifically on this petition; it is on the others.
To avoid confusion, before we move on to the next petition, we will take a decision on this one. There are too many letters and numbers, and we will all get confused otherwise.
On PE1845, which calls for an agency to advocate for the healthcare needs of rural Scotland, can I have a show of hands of members who want to close the petition with the proviso that we look into doing a wider review, which is something that seems worth while?
I see that a majority of members are in favour of closing PE1845 but with the proviso that we include the issues in a wider piece of work that we might do.
Rural Healthcare (Recruitment and Training) (PE1890)
PE1890 is on finding solutions to recruitment and training challenges for rural healthcare in Scotland. The theme is very similar. Gillian Mackay wants to comment.
We should consider the issue as part of a wider piece of potential work. The petition is broad and covers a number of areas.
In the evidence session that we had with the cabinet secretary, we explored why some of the challenges are not purely healthcare recruitment issues but issues to do with life in rural environments in the first place. If we were to incorporate the petition into a wider piece of work, it would be interesting to hear from other ministers about how their portfolios could support recruitment in rural areas and support people to consider working in rural and remote areas. At the moment, it is people who come from or have a connection with such communities who take up recruitment and training opportunities and then go back to the community, rather than our making working in those areas an easy choice.
I reiterate what I said about the previous petition. I think that we should also fold this petition into our potential look at rural healthcare.
I agree with what Gillian Mackay says about the other issues and about listening and talking to other ministers. As I said, when I was on my way down to Dumfries and Galloway, the roads were terrible. That would put people off going there and moving around. We should certainly ask the Minister for Transport about that.
Further, it is not possible for people to obtain housing in rural and island areas because it costs so much or it is just not available. Those are all factors when it comes to recruitment and retention.
11:45
Yes. The petition is on finding solutions to recruitment and training challenges for rural healthcare in Scotland, so it is almost asking for an inquiry.
I did not think that I would be talking about roads in Dumfries and Galloway—the A75 and the A77—at a meeting of the Health, Social Care and Sport Committee, but the issue is relevant to the many challenges with recruitment and retention.
We must remember that we have the Scottish graduate entry medicine programme. It would be really good to hear how that is working. What is the retention level? Where is that programme doing well? That is part of it. There are also programmes for trained general nurses to become midwives and vice versa, although that is not happening in my part of the South Scotland region because Dumfries and Galloway was not selected for the dual training approach.
Work is being taken forward, but it will not be an overnight fix. I support doing whatever we need to do to look at rural health and social care.
Your point about ScotGEM is timely. The first cohort has just graduated, so now is a good time to follow that up and consider what we might do in that regard.
Are there any other comments on the petition, or is everyone more or less in agreement with the points that have been made? Do we agree that we should again bundle the petition into a wider piece of work about rural healthcare, given that all the issues will come up?
Let us take the decision. I ask for a show of hands of members who are in favour of closing the petition but with a view to doing a wider inquiry.
I see that we agree unanimously to do that.
Women’s Health Services (Caithness and Sutherland) (PE1924)
The final petition that we are considering today is PE1924, which calls for the completion of an emergency in-depth review of women’s health services in Caithness and Sutherland. I know that Tess White and Gillian Mackay want to comment on the petition.
I note that the petition uses the word “urgently” and that it is dated 20 December 2021. These are systemic issues and I think that we all agree that they need to be looked at. It is important to make sure that the women feel listened to and that services are not just centred around the central belt. For example, there are two mother and baby units in Scotland and they are both in the central belt. One was supposedly planned for Grampian, but it was kicked into the long grass—
That was a perinatal unit. That came up in the inquiry that we did.
I think that it is very important for us as a committee to progress something specifically on women’s health in rural areas.
You are calling for us to do something specifically on women’s health and not just something as part of work on rural healthcare. I am not sure that the committee has the scope or the capacity to do two separate pieces of work on rural healthcare. I think that it will have to be one larger piece of work that encompasses women’s health.
I will make two points. First, we now have the women’s health champion, which is a major step forward. That was not factored in when the petition was lodged. It would be interesting to find out what the women’s health champion’s thoughts are on the petition.
Secondly, as you say, there is a piece of work to be done on wider rural healthcare issues, but we need to make sure that we do not water down the points that are made in the petition.
I totally agree.
On the back of what Tess White has just said, I think that a wider inquiry into rural healthcare services is really important, but I propose that we defer a decision on the petition because of the current work that is being done. The best start north review is based on maternity services in particular, and the minister, Maree Todd, has other pieces of work that are looking at wider issues, including abortion care and other women’s health needs. The other pieces of work that are being done could be lost in a wider inquiry. If those things develop, we might want to take evidence on them, and other issues could arise.
Given that those other pieces of work are still on-going, particularly the best start north review, I propose that we defer a decision on the petition so that we can pick it up again if there are other things going on.
That is a good point. Someone has only just been appointed to the women’s health post, so the committee would want her to come before us anyway. Keeping the petition open is therefore an option, with a view to seeing what comes back from the best start north review and other work.
Do members wish to raise any other points?
The petition is focused on one particular area, but we know that there is an issue at Dr Gray’s hospital and that plenty of other rural areas have the same issue. Paul Sweeney said that we cannot always have an expert in a small village. However, experts could travel to different areas where they are needed, which would make it easier for people to get the help that they need. I would like expand our wider inquiry into rural health so that we could have an evidence session on maternal health in rural areas.
Okay. Paul, do you want to come in, or are we ready to move on?
I have nothing to add.
Those were all really good points. Gillian Mackay has proposed that we keep the petition open. Are we agreed?
Members indicated agreement.
We agree that we will defer our decision on the petition until we have found out more about on-going work. We will therefore keep PE1924 open.