Plenary, 01 Jul 2004

Meeting date: Thursday, July 1, 2004

Official Report 691KB pdf

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Argyll and Clyde Clinical Review

The final item of business is a members' business debate on motion S2M-1530, in the name of Frances Curran, on the Argyll and Clyde clinical review. The debate will be concluded without any question being put.

Motion debated,

That the Parliament rejects NHS Argyll and Clyde's consultation on its clinical review; believes that this consultation is flawed from the outset as it neither consults the people who live in Argyll and Clyde, nor those who use the NHS, about what kind of services they need; notes that the consultation announces a raft of severe cuts and then has the audacity to attempt to consult people on which services they would like to see cut; considers that the proposals for cuts in this consultation should be rejected outright and, furthermore, that NHS Argyll and Clyde should withdraw this consultation and begin a new consultation with the people they serve on what kind of NHS is needed for the 21st century; believes that the experiences of Argyll and Clyde reflect a Scotland-wide crisis in the NHS, and further believes that a national conference of campaign groups, trade unions, NHS professionals, professional organisations and community representatives should be convened to develop a strategy to protect and improve the NHS in the absence of adequate action by the Scottish Executive.

The first point to make is that there is absolutely no confidence in the public consultations of Argyll and Clyde NHS Board. During the previous consultation, 84 per cent of women respondents said that they wanted to keep consultant-led services at the Rankin maternity unit in Greenock. Despite that view being widespread in the community, the health board decided to downgrade the maternity service anyway.

The current so-called consultation document is not a consultation. It is not so much a document for dialogue between the health board and the people of Inverclyde as a statement. It announces the effective closure of six hospitals: the Vale of Leven hospital in Dumbarton, the Inverclyde royal hospital in Greenock; the Ravenscraig hospital in Greenock; the Dumbarton joint hospital; the Victoria infirmary in Helensburgh; and the Argyll and Bute hospital in Lochgilphead.

The health board's strategy is not to consult about local services but simply to provide an opportunity to let people sound off and sign petitions. Every local paper has had a half-page advert asking for people's views and explaining how they can get in contact and attend the consultative meetings that will be held. However, the board intends to carry out the cuts anyway. There can be no confidence in what is just a sounding board. The health board's approach is completely cynical.

According to the local branch of the Royal College of Nursing, the consultation document was not developed and produced through partnership agreements or with staff involvement. Many staff believe that the consultation is not a genuine attempt to gauge local views and many potential options have been ruled out already. The RCN is absolutely right in its summing up of the document.

In today's debate, I call on the Minister for Health and Community Care to instruct the health board to withdraw the consultation document. The proposals are a disaster waiting to happen. The health board area includes Greenock, Dumbarton and the surrounding areas, which have some of the worst deprivation and poverty statistics in Scotland. The health board needs to take into account the rural nature of much of the wide geography that it must cover.

The consultation document proposes the closure of Inverclyde royal hospital and Vale of Leven hospital as general hospitals. Last year, 21,000 people were admitted to those hospitals. Where are those 21,000 people supposed to go if those hospitals close? The answer, apparently, is that they will go to the Royal Alexandra hospital in Paisley. However, members will search the document in vain to find out what the alternative proposals are, where the spending will come from or what measures will be taken to provide those extra beds. That is without taking into account the issue of transport or the pressures on the ambulance service.

As it is Wimbledon week, I shall paraphrase John McEnroe: they cannot be serious. More than 500 beds are due to close in the other four hospitals, including elderly care beds, dementia beds and psychiatry beds. I want to ask the health board where the 500 people who are currently occupying those beds are supposed to go. The answer given in the document is care in the community. That is fine, but where? There is no detail on housing in Helensburgh, but there is a big question mark there because the hospital is being closed. There is no detail on care packages or on who is to pay for care. If I had a relative in one of those beds now, I would be very worried indeed about where on earth they are supposed to move to.

There are no proposals in the consultation document, but we are supposed to agree to the document and the cuts and trust the health board to come up with an answer. The health board says that people are spending less time in hospital, and that is true. It says that technology allows more out-patient diagnostic services and more day surgery, and that is fine. If people spend less time in hospital, that is great. If more can be done with day surgery, that is brilliant, but let us develop the practices now. Let us shift the balance in the health service now and let the health board prove that there will not be the same need for those beds, as its strategy suggests.

To downgrade two major hospitals and offer a diagnostic and day care service in their place is a major experiment that involves people's lives. The hospitals are to close within two years—that is what the strategy says—yet the alternative services will take between two and 15 years to develop. That does not add up in my book.

We need today's debate in Parliament because the health board is the messenger. It carries the policy and the message from the Labour Minister for Health and Community Care. Members of the health board are appointed by the minister and they are responsible to the minister and to the Executive, not to the people of Argyll and Clyde, whom they are supposed to serve.

The minister has the power to stop the proposals. He can stop the consultation in its tracks and go back to the drawing board. There are things that we need to discuss, such as the working time directive, the role of consultants and whether the balance is right in the move towards specialisation. Does the minister acknowledge that a significant number of the doctors whom we train in Scotland do not stay in Scotland when they graduate because there are not enough jobs? Let us discuss that. He and his colleagues in the Labour-Liberal Executive hold the purse strings. In my opinion, what the debate is really about—although it is covered up by clinical words—is money. The health board itself has stated:

"From a financial perspective alone, NHS Argyll & Clyde simply cannot afford to continue as it is. We currently spend around £40 million each year more than we receive from the Scottish Executive."

The matter is in the minister's hands, and he must not fail the people of Argyll and Clyde.

I have a long list of members who wish to speak, so I would be grateful if members could restrict their comments to four minutes. I was going to say that I would prioritise local members, but since virtually all those who wish to speak are local members, that will not be much of a concession.

I welcome the opportunity that the motion affords us to debate the clinical strategy. Although the motion is about Argyll and Clyde as a whole, I will not surprise anybody here by focusing my remarks on Inverclyde royal hospital. In doing so, I declare an interest. Inverclyde royal hospital is my hospital. It is not just in my constituency; it is in my community. It is where my mother went when she recently broke her hip and where my wife went when she broke her shoulder. Indeed, as a result of the maternity contingency plans, it is my grandchild who is likely to be born in Paisley and not in the Rankin unit this autumn. When the stress of fighting the continued plans from the health board to centralise the services finally gives me a heart attack, Inverclyde royal is where I want to go.

In the last ever parliamentary debate in this chamber before we hand it back to our theological friends, I suppose that it is appropriate to ask, "Why are we here?" How did we arrive at a situation where, on one hand, the Government—or, to be more precise, the taxpayer—is putting more cash than ever into the national health service and, on the other, our services seem to be disappearing?

The root of the problem, as I have long argued, is NHS work-force planning. I have spoken countless times in the chamber about the impact that that is having on services. I take some comfort from the fact that the British Medical Association and Sir John Temple now publicly acknowledge the importance of the issue. The Health Committee is set to question the health industry's key players as part of its major work-force planning inquiry.

The issue is not just about money—I wish that it was, but if it was that simple, we would have solved it. If politicians are good at anything, it is giving more money to the national health service.

If the problem of centralisation is the same throughout Scotland, the proposed solutions are not. Other areas are responding better by, for example, sharing services between hospitals. However, Argyll and Clyde NHS Board's plans are almost all one-way traffic. It seeks to cram most of those in need of emergency or in-patient services into a hospital that is already struggling to cope with its current numbers—Paisley Royal Alexandra hospital is full to bursting. We all agree that the strategy has weaknesses, but if we are to expose them, we need to muster support, knowledge and expertise.

Our local newspaper, the Greenock Telegraph, has to be congratulated on leaving the health board in no doubt about the strength of local feeling. Such support is essential, but on its own it is not enough. We must also back up our passion with precision. In other words, we must engage the health bosses on their own terms and challenge their arguments and the assumptions on which they rely with cold, hard facts. In order to frame our arguments, I have been speaking to academics, clinicians, trade unions and the many others who deliver our health services locally.

Tomorrow, I will make the case for Inverclyde royal to Dr Andrew Walker, the top academic who is charged with independently evaluating the plan. Although I would not seek to pre-empt his expert analysis, I am convinced, after examining the strategy in some detail, that it is seriously flawed and that a better way forward can be found.

A number of clinicians are ready to stand up and be counted. Leading Inverclyde general practitioner and chair of the local health care co-operative, Dr Mustafa Kapasi, and senior consultant surgeon and clinical director of surgery at the Inverclyde royal hospital, Mr Ian Morrice, have both assured me that they are prepared to challenge the plans and play their part in drawing up credible alternatives. I now hope that others will come on board, because there is a big job to do.

The health board's proposals are the product of many officials working over many months—those are two luxuries that we will have to do without when we draft our alternatives. I therefore look forward to the Minister for Health and Community Care outlining how our efforts will be supported in terms of time, resources and expertise. I would also welcome an undertaking that the minister will ensure that equal weight is given to any alternative plan and to the health board plan.

Finally, we need a guarantee that the consultation process will be worthy of the name. I agree that the process is a complex one, but my bottom line is that closure is not an option. There shall be an Inverclyde royal hospital.

I thank Frances Curran for securing this important debate. It is the last parliamentary debate in this chamber and it is a crucial one; it is certainly one of the most important debates in the Parliament this week and for many weeks.

The health service is a crucial safeguard for all of us in our time of need—from our most elderly relatives to our youngest relatives. The health service is a safety net for us all, which is why so many members feel so desperate about the situation—not only in the west of Scotland and in Argyll and Clyde but throughout Scotland.

I pay tribute to all the MSPs from every party, party activists, community activists, doctors, nurses, other medical and health staff, the local press and members of the public who have been involved in the campaign north and south of the river—whether it be in the areas of Inverclyde that Duncan McNeil mentioned or right up into the areas of Argyll that are also affected by the changes. NHS Argyll and Clyde covers a massive area—from Barrhead to Oban, and Tyree to Dumbarton, and it includes Paisley and Inverclyde. That is an enormous geographical area, which is why the centralisation of services will not work.

Before there was any loss of service and before the cutbacks started, the travelling time to Vale of Leven for many people was enormous. If someone came from Campbeltown or Oban, the travelling time was ridiculous to start with. The situation now, particularly for those from parts of Argyll, after cutbacks, rationalisation or centralisation—whatever one calls it—is much worse. We have already seen the loss of accident and emergency services and maternity services, to name but two, but now there are proposals to remove even more services, including elderly care, care for the mentally ill and even chiropody services. Frances Curran mentioned a number of others. Many services seem to be going from the NHS Argyll and Clyde area.

Health board managers have to explain their proposals properly. In their documents that they have produced, they seem to be saying that they are taking things away, but what will be in their place? People are worried about their services. If elderly units are to be closed and chiropody services are to be taken away, managers must explain what the alternatives are. I do not see the detail on the alternatives in the documents.

Inverclyde and the Vale of Leven have been offered either an ambulatory care and diagnostic unit or an intermediate hospital. I attended a public meeting not so long ago at which a letter was read out from local doctors who said that even they did not know what an intermediate hospital was. If they do not know what it is, how on earth are the rest of us supposed to understand what it is? I understand what an ACAD is, because I have seen the fights over them in Glasgow, in particular on the south side of Glasgow, where the Victoria infirmary is to be replaced by an ACAD. ACADs are hospitals with no in-patient services and no accident and emergency. Frankly, I do not think that they offer the hospital services that are needed north or south of the Clyde.

The Royal College of Nursing made important comments about the consultation process. I was concerned by some of the things that it said and two of the comments in particular struck me. The RCN stated:

"the document was developed and produced without staff involvement or through partnership arrangements".

That is a disgrace. If the managers are not involving the staff in the process, what on earth are they doing? The RCN also stated that there was a

"lack of clarity in the consultation document about how current services will be provided in the future and … that it seems likely fewer services will be provided locally than at present."

That is the point that I was trying to make about the document: all we can see are cutbacks. We cannot see the clear vision. The reason why we have health board managers is to provide that vision. If the managers cannot provide it in the documents, frankly, I do not know whether they are doing their job properly.

If the services go, many people will have to travel to either Glasgow or Paisley. For people on the north of the Clyde, there is a superficially attractive solution in the transport corridor north of the river. I can see why it might be attractive, but more distance will be added to the journeys for people from the more distant parts of Argyll. Given that Greater Glasgow NHS Board is cutting back and centralising its services, it will be no solution for Argyll and Clyde to say that people can go to Glasgow.

The process that is going on in Argyll and Clyde—but also in every part of Scotland—is of great concern to people all over Scotland. The people of Argyll and Clyde deserve no less than that we find an answer that saves their services.

I, too, commend Frances Curran and congratulate her on the passion of her speech, because she is striking a chord that resonates within every person in the chamber and in the areas that are affected.

Hospital provision is now a vital issue, not just for Argyll and Clyde but for a wider part of Scotland. Those of us who attended the meeting of the save Stobhill campaign on Monday evening will be aware of how intense passions are in respect of Greater Glasgow NHS Board's proposals. That situation is echoed throughout Scotland. The minister must be sensitive to that and be willing to show a listening ear, because the themes that are emerging on this broad base are common to all areas.

Health care for local communities is disappearing or is in threat of disappearing and local communities feel more and more distant, not just from the care but from having a say in the kind of care that they need. There is increased centralisation. Questions arise, such as what the role of the health boards is, what the role of Government is, and what the role of clinicians is. There is a feeling that patients have too little say and Government has too much control. For that reason, my party supports foundation hospitals. We believe in trying to offer greater choice and giving patients the opportunity to have a greater say on the provision of care. It is important that we understand the general backdrop against which the debate takes place. It is easy to be critical of Argyll and Clyde NHS Board—I share many of the criticisms that Frances Curran articulated—but the board is purely a bureaucratic deliverer of what it is told to provide within a fixed package of resource. That goes right to the heart of who the provider is—it must be Government.

I have read the summary of the consultation document and it seems to me that the proposals are a threat to six hospitals, which will affect hundreds of thousands of people in an area with difficult geography. We should not forget that the geography of the Argyll and Clyde NHS Board area is particularly challenging, which gives rise to problems for communities in accessing the care that they need. A three-month period for a consultation on such proposals is simply unacceptable.

I turn to the specific proposals for Inverclyde royal hospital and the Vale of Leven hospital. We cannot deny those areas the hospital care to which they are entitled. The consultation presents the proposals as an option, but I share Frances Curran's concern about what people are being consulted on. People are being told, "Here it is—take it or leave it." That is not good enough. There are legitimate arguments about the kind of care that the population mass in Inverclyde and in the Vale of Leven are entitled to expect. The proposals place a question mark over the current provision from those hospitals, with a view to concentrating everything in the Royal Alexandra hospital in Paisley. In my opinion, that would be impossible because the location of that hospital is difficult, development is constrained by the site and access is problematic—it is one of the most difficult hospitals to get to.

The review is not shaping the future; for the area concerned, it is hospital provision meltdown. The proposals are not safe or accessible and they are not acceptable. The consultation should be extended to at least six months. Ideally, the minister should intervene to revisit what the health board is talking about before the consultation process continues. What is at stake is far too important and enduring for the future of the area concerned to leave to something as unacceptable and inadequate as the current proposals.

I, too, congratulate Frances Curran on bringing the subject before Parliament. The issue is of deep concern to all members who represent patients and other constituents in the Argyll and Clyde NHS Board area. My constituents are asking me why on earth they are being asked to accept a reduction in local health services and greater centralisation of services at a time when the Executive is pouring record amounts of public money into the NHS. They are concerned, if not horrified, to learn that, according to evidence that has been presented to the Parliament's Audit Committee, one of the main reasons for that is the substantial cost of funding new pay modernisation contracts for consultants, GPs and junior doctors. Along with rising prescribing costs, the new contracts are swallowing up the vast bulk of the £2 billion of extra funding that will be spent on health services in Scotland through to 2006.

The problem is particular to Scotland. Executive figures show that the NHS in Scotland has nearly 30 per cent more doctors and nurses per capita than the NHS south of the border, which means that the costs of pay modernisation have a disproportionate impact on health board budgets. Those are the issues that drive the agenda behind Argyll and Clyde NHS Board's clinical strategy review—it is not driven by the needs of patients in the health board area. Certainly in my constituency, patients want the best possible care delivered as locally as possible, but they are being offered further centralisation of health services and poorer local services. The review is driven by the need to meet the terms of consultants' and doctors' contracts, aided and abetted by the demands of the Royal College of Physicians for specialisation by consultants.

When the people of Scotland agreed to pay more taxes for their NHS, they expected in return more operations, shorter waiting times and better patient care. I do not believe that they expected their hard-earned cash to be swallowed up in modernisation costs and in payments to consultants and doctors. In many cases, those payments have represented considerable rises in people's salaries, with little left over for service improvements. That appears to be the reality today.

I have grave concerns about the proposals in the strategy—in particular, the proposal to close the Argyll and Bute hospital, a hospital that is held in high regard throughout Argyll for its provision of mental health services. It is essential that those services continue. We are also deeply concerned about the loss of consultant-led services at Inverclyde royal hospital. Many of my constituents are wholly reliant on the services provided there.

I do not have time to go into the detail of the proposals, but I leave the minister with one final thought. When Beveridge set up the NHS in 1948, it was said that he had to stuff the doctors' and consultants' mouths with gold to achieve his vision. Cynics might suggest that history is repeating itself.

Like others, I start by congratulating Frances Curran on securing what I consider to be an extremely important debate. There is no doubt in my mind that there is considerable anger and dismay at the proposals emanating from Argyll and Clyde NHS Board in its clinical strategy review. I share that anger. Many people have found the attitude of Argyll and Clyde NHS Board to be breathtakingly arrogant. Let me explain why. In so doing, I will acknowledge that, yes, if one was drawing boundaries for health boards from scratch, one would not choose to create the present Argyll and Clyde boundary. There are relatively few economic, social or transport links between the communities that make up the Argyll and Clyde NHS Board area. I accept that the geography is extremely challenging. However, those points must not be used as excuses for a lack of imagination and a lack of responsiveness to people's needs.

Argyll and Clyde NHS Board's proposals are, I believe, an insult to the intelligence of the people in my local community and the communities of many other members. We will leave no stone unturned in opposing the proposals. We will do so in partnership with many local organisations, such as the Vale of Leven hospital services forum, community councils, Save Our Services, local authorities and the local press.

I will deal first with the proposed closures of Dumbarton joint hospital and Helensburgh Victoria infirmary, especially in relation to provision for the care of the elderly. No discussions took place with either local authority in advance and no discussions took place with any of the relatives, who found out about the proposals through the local press officer. Some 18 months ago, elderly people were all reassessed and a number of them were relocated in the community. It would therefore appear that some elderly people with medical needs remain in those facilities. Surely they are not candidates for community care. In any case, what a way to treat elderly people!

What about the range of out-patient services that are currently delivered from Dumbarton joint hospital and Helensburgh Victoria infirmary? The strategy is silent on what will happen to them. That runs entirely contrary to the minister's response at question time today, which was about providing local services. Is he aware that substantial capital funds have been invested in the services of both those hospitals? That perhaps suggests that Argyll and Clyde NHS Board is incapable of forward planning.

Let me now deal with the proposals for acute medicine. We have been given options. Did members know that? Well, they should not kid themselves, because the options are not options at all. Under the first option, we are offered an intermediate hospital at the Vale of Leven, with major services provided at the RAH in Paisley. Stewart Maxwell is right to ask what on earth an intermediate hospital is. Health professionals struggle to come up with a consistent definition. Most say that such a hospital is GP led. Is the minister aware that a third of GPs in the area are set to retire in the next five years? The net effect of that will be to remove more services from the local area—not specialist services, but basic services. Again, that runs contrary to the minister's expressed view.

I will deal briefly with the Glasgow option. I am talking not about Gartnavel, which is 20 minutes down the road, but about the Southern general hospital or Glasgow royal infirmary—as will be discovered, the option of Gartnavel is tucked away as a footnote. That is reason enough to withdraw the consultation document, of which it was famously said by a health board official in response to criticism:

"It's not flawed; it's just not absolutely clear."

It is absolutely clear that 88 per cent of health professionals and local people who were surveyed by me and John McFall want a north-of-the-river solution. I will be clear about that solution. The starting point is maximising the services that are delivered from the Vale of Leven hospital and giving us access to Gartnavel hospital or the Golden Jubilee national hospital for services that cannot be delivered at the Vale of Leven. That is not simply a superficial option; it is a real option. The issue is quite simple: it is about providing a service that is 20 minutes down the road or one that is two and a half hours away in Paisley. There is no contest. Paisley is a tolled bridge too far.

I, too, commend Frances Curran for securing the debate and pay tribute to George Lyon's reasoned and powerful argument on behalf of his constituents. Duncan McNeil's comments about Inverclyde royal hospital allowed me to recall the fact that that hospital saved my father's life, which I do not think it would have been able to do if it had not been on his doorstep.

I am not keen to repeat the words and sentiments of other members, especially as I agree with almost everything that has been said, perhaps excepting what was said in support of foundation hospitals. Instead, I will progress the argument to slightly different territory.

I accept that the demographic trends throughout Scotland are not the only trigger for the proposals, but I am sure that the centralisation plans will—sadly—exacerbate the population trends in the longer term. In essence, there will be a double hit on Inverclyde and the Vale of Leven, which will affect west central Scotland and Argyll in particular. I do not think that we are talking about a consultation—it looks as if two unacceptable options have been tabled in the hope that people will be fobbed off with the least objectionable one. In conscience, that cannot be allowed to work, especially as the effect of the moves will be materially to increase distances and travel times for many patients and visitors.

I accept that the proposals are out for consultation between 14 June and 17 September and urge everyone to involve themselves in the process and expose what is being planned, bearing in mind the critique that I have just given and the absence of Government involvement. There is a case for being indignant about a situation in which wider policy failure provides the excuse for change and in which Argyll and Clyde NHS Board uses as justification the projections that there will be fewer children and young people and more older people and that the overall population will reduce by 5 per cent over 15 years.

Surely a Scottish Government should have targets and should take steps to tackle, halt and turn around those so-called inevitabilities and surely Argyll and Clyde NHS Board must know that older people do not travel as well as young people. I am sure that my father would not have survived if he had had to travel in the crisis that he went through. Surely the board knows that clinical excellence is eroded and nullified if patients face long journeys and are likely to have fewer visitors. From my perspective, we are beginning to see a pattern in operation in the NHS Argyll and Clyde area.

The whole focus for acute care is moving not even centrally within Argyll and Clyde, but as far to the east of the board's area as it is possible to get. Obviously, I worry about that. I have always believed that the accepted priority was to provide quality services as close as possible to the patient. If health care services are perceived to be below par, Scotland—and rural Scotland in particular—has much less chance of attracting the economically active people that it needs to bring about regeneration. The aim must be to reverse the demographic and population trends so that our services can be boosted.

I worry when I see the direct threat to clinical services and the resultant damage to the economy that will come from that threat, especially when that is happening at the same time as the Westminster Government is committing itself to building more houses in the south-east and is paying higher salaries to NHS and other public service personnel who work there. That begins to make our diminution and centralisation of services look as though it could go even further. We need to put down a marker and propose a system that will reverse those trends, hold on to the services that we have and accept no diminution and centralisation.

Before I call the next speaker, I advise members that an additional member with a constituency interest has been added to the list of speakers. I am therefore minded—and the minister has agreed—to accept a motion without notice to extend the debate. I think that it may have to be extended for about 10 minutes.

Motion moved,

That, under Rule 8.14.3, the debate be extended by 10 minutes.—[Jackie Baillie.]

Motion agreed to.

I, too, congratulate Frances Curran and, indeed, Duncan McNeil, who made excellent speeches, rightly defending the interests of the local people who use our hospitals and those NHS employees who work in our local hospitals and clinics.

Like everyone else, I want to ensure that we have excellent hospital and local services that are readily and easily accessible to their surrounding communities. That should be, and is, our goal and aim, but we must acknowledge that some changes have been forced on us—for example, the falling population and the welcome and sensible reduction in the hours worked by junior doctors, although that has caused other problems. In addition, the Inverclyde royal hospital has, for a considerable time, had difficulties with unfilled vacancies for consultants and other staff. There are problems that need to be addressed realistically and comprehensively.

As other members have said, the board has presented its views on how things can be changed by way of a document that it has called a clinical strategy, which is out for consultation during the summer holidays. In a press release on the strategy, a spokesman for NHS Argyll and Clyde stated:

"The overall aim of the consultation plan is to enable the greatest possible number of people with an interest in the future shape of Clinical Services in Argyll and Clyde to learn about, debate and contribute their comments and suggestions on the proposals."

That leaves me with some unease. Many interested people and groups will want to do much more than debate and offer their contributions and suggestions on the proposals; those who use the services and those who provide the medical and other skills will rightly and properly want to help to shape the strategy and the kind of NHS that it will create. Annabel Goldie is right that three months is not long enough. I agree with her that the consultation period should be at least six months.

The strategy is called a clinical strategy, but I believe that it is not that: it is a managerial strategy, in that it considers how to organise the services with an eye to the finance. The patients—the users of services—and their communities must play a huge role in shaping local NHS provision. Our constituents want ready and local access to primary care services and hospitals.

I strongly challenge the board's seeming commitment to the centralisation of services. Board members appear to believe, along with other boards in Scotland, that centralising services is the only answer to the problems of the NHS. A fair and genuine consultation will allow that approach to be analysed and other prescriptions to be tabled for serious consideration. Regional and local hospitals can be adapted, along with expanded primary care and GP-led services, to accommodate about 96 per cent of the treatments that local communities require. Centralisation is only one option.

I have no doubt that Duncan McNeil has driven from Greenock to the Royal Alexandra hospital. I have driven from Port Glasgow to it and I know that you, Presiding Officer, have done the same, although you had some difficulty because it was not signposted and you lost your way—it is not an easy journey. However, one of the seven principles that are at the heart of the strategy is access. How accessible is the RAH for someone who lives even 20 miles from Paisley?

I also have grave concerns about the RAH's ability to cope with the additional numbers. I do not have the pleasant experience of no complaints from patients from the RAH. Waiting lists are long in some disciplines, there are problems with access and every service seems to be stretched, so how will it cope with extra patients? I have a duty to defend those in the RAH area whom I represent from an influx of new patients that will cause even greater delays in accessing services.

Another concern is the small number of comments on those patients with mental illnesses who will always require to be treated locally in a hospital. Care in the community, if it is planned and administered carefully and sympathetically, is fine for some, but it is not fine for all. The clinical strategy document contains four lines on that subject.

I have every intention of submitting my response to the so-called clinical strategy. Like Duncan McNeil, I am already listening carefully to constituents' views and concerns about their NHS. Accessibility is, and always will be, at the heart of my approach. There must be local accessibility to both hospital and primary care in an NHS that responds actively, sympathetically and honestly to the needs and aspirations of our local communities.

The review is disastrous. It is a draconian solution that is based on concern about financial budgets rather than on concerns for the health care of the people of Argyll and Clyde.

It is obvious that the desire to retrieve the £35 million overspend has resulted in a totally blinkered approach that shows no awareness of the real geographical and logistical problems that patients and their families face. Why should people face continual downgrading of acute services? Nothing else is being talked about. Given that millions of pounds have been spent on the NHS, we should be talking about upgrades.

The truth is that the review is all about mismanagement of money rather than about good management of proper health services for the people of Argyll and Clyde. If the review is carried out, it will have the effect of closing all acute services except those in Oban. Although closure there has been put on hold for the time being, people are extremely worried about the future of services. All emergency and out-of-hours services will be transferred to Paisley, but how will Paisley cope if that happens? In a supplementary to a question that I asked about Argyll and Bute health services, Duncan McNeil pointed out that the Royal Alexandra hospital in Paisley was already overstretched without its having to cope with a greater influx of patients.

Surely it cannot be acceptable to the people of the west of Scotland, from Tiree to the outskirts of Glasgow, that all their health services are being downgraded. Even if the population diminishes, the situation will obviously not be enhanced by removal or relocation of adequate health facilities. People in Helensburgh, Dunoon, Campbeltown, Lochgilphead and Oban should be able to look forward to improvements in the facilities that they already have. Health should be more, not less, accessible and the standard of the services that are provided should be higher, not poorer.

In spite of the overspend in Argyll and Clyde, there has been no significant upgrading of the existing facilities, which must be a cause of concern. Perhaps there was always a secret plan to centralise services: if so, people should be told. The health board has said that it needs to make tough decisions and the decisions that it has made are indeed tough for the patients and the professionals in the hospitals. The review also says that decisions should be flexible enough to adapt to changing needs and new opportunities. Why cannot the NHS in Argyll and Clyde understand that, by removing local facilities, it is reducing the possibility of new opportunities, because the thrust of development is already limited?

Mr Neil Campbell has told Oban hospital that it will not lose its acute services as long as it stays within its devolved budget, but why is the NHS Argyll and Bute hospital in Lochgilphead being threatened with closure? That hospital has provided vital psychiatric services for many years and has always worked within budget. What will happen to the people who require such services? Will they be sent to Dykebar hospital, which has a history of problems? That would be no solution.

What will happen to the people of Helensburgh if the Vale of Leven hospital closes? They do not even have proper public transport to get to Paisley. The people of Dunoon are worried about what will happen if Inverclyde royal hospital is downgraded; their excellent maternity services at Dunoon hospital have already been downgraded. The unfortunate truth of the matter appears to be that, under the present Government, the only concerns of this aggressive health board are budgetary. The Government wants central control.

There are 100,000 people in Inverclyde, 60,000 in the Vale of Leven and another 60,000 in Argyll. That adds up to 220,000 people, all of whom may have their services downgraded. For once, I agree with John McFall MP and Jackie Baillie MSP, who have been vocal in campaigning to defeat the health board's plans.

People are losing trust in NHS Argyll and Clyde. Only last January, the medical acute assessment unit was opened at the Vale of Leven hospital. NHS Argyll and Clyde promised that it would be a model of care for the future and that it would be sustainable in the long term. Only six months later, the people in charge have changed their minds. How are people expected to trust the health board after that? In spite of the best efforts of the staff of the Royal Alexandra hospital, it is bursting at the seams.

Devolution was meant to deliver a better standard of living for Scottish people, but the prospect of an acute-services-free zone between Inverness and Paisley after five years of Labour-Liberal Government will hardly achieve that end.

Thank you, Presiding Officer, for recognising my local interest. I thank Frances Curran for the opportunity to express that interest and I thank the Minister for Health and Community Care for letting me express it. I have received representations on the consultation process that we are discussing tonight and I have concerns about it. Like many members, particularly Jackie Baillie, I am concerned about ensuring that it addresses what we might call, for the purposes of this debate, cross-border issues.

I represent and live in Cunninghame North, which is of course in Ayrshire, but like Duncan McNeil, my two sons were born in Argyll and Clyde—in Paisley maternity unit, to be precise. I was a regular attender in casualty departments when I played football and, by and large, it was the Royal Alexandra hospital that put me back together again. Despite the fact that they live in Ayrshire, many of my constituents use services in Inverclyde as well as the local primary care services that are provided so well by Ayrshire and Arran NHS Board. The clinicians who were mentioned by Duncan McNeil provide and use services in Inverclyde although they live in Largs, Skelmorlie and Cumbrae—which is known to you, Presiding Officer.

My point is that the issues require consultation between boards as well as within boards. For all the reasons that have been mentioned by everyone else, the matter requires strategic consideration rather than a piecemeal approach to the decision-making process within boards. If clinicians argue, as some do, that there should be no district general provision west of Paisley for my constituents, I submit that that proposal should be subjected to wider scrutiny than is proposed in the west of Scotland. I know that the minister will want to ensure that that is indeed what happens.

Thank you, Presiding Officer. The speeches so far have demonstrated the seriousness of the issues, so I hope that the minister will take all the remarks on board, that we will achieve a halt to the terms of the consultation and that there will be a serious consultation about the needs of the population in the area, taking into account cross-border issues and the impacts on neighbouring health boards. Once again regional planning, which is supposed to be the Executive's policy, is completely absent.

I will make a comparison. Argyll and Clyde NHS Board has a £40 million per year deficit, which it proposes to address with 1,000 beds' being cut; 1,000 beds for £40 million. I cannot help but draw a comparison with the Healthcare International hospital, which was purchased by the Executive for £37.5 million in 2003 and which had already received £29 million of public money—a total of £66.5 million for running 60 beds, which is the equivalent of £1,108,000 per bed, not including running costs. It seems that the cost of an NHS bed in Argyll and Clyde is £39,643. The figures do not add up. Wayne Rooney was valued at £80 million the other week. One thousand beds in Argyll and Clyde are equivalent to one of Wayne Rooney's legs—surely we cannot defend that situation.

A question arises. When hospitals, departments, wards and services are being cut and centralised at a rate of knots throughout the country, how can the bail out of the Abu Dhabi Investment Company in 2002 be justified as value for money? The proposal to increase the number of beds at the HCI hospital beyond 60 is ironic—at best, it is questionable—when local hospitals and services are being razed to the ground. We should kick out the privateers, although I suggest that they got quite a good deal.

I am seriously frightened for the future of the NHS. The failure to implement effective, proactive and resourced work force planning has led to the convergence of measures such as the GP contract, the consultant contract, the new deal for junior doctors and so on. Individually, those measures would be challenging, but together they put unacceptable pressure on the NHS. The number of junior-doctor hours that have been lost through the working time directive is 470,000. That is enough of a managerial problem in itself.

That all takes place when health inequality has increased and when inadequate measures are being taken to reverse health inequality. In Lanarkshire, 5 to 10 per cent budget cuts have been announced and the closure of Coathill house is planned for 31 July. As that closure is taking place without public consultation, it raises another recurring theme. I suggest that health boards are panicking and cutting short the already inadequate consultation process to rush such measures through and save money.

The Executive's statistics show that although 60 per cent of Lanarkshire's population is in deprivation categories 6 to 9, it has the lowest numbers of practice nurses per head of population and, in effect, no additional funding of primary medical services to take account of that deprivation.

There are many issues and not enough time. That is why I have attempted at Parliamentary Bureau meetings to persuade the Executive to have a full parliamentary debate on securing the NHS's future with services that are provided in a way that communities support and which makes visible inroads into poverty-related ill health. That surely needs to be the first debate in the new Parliament building.

I ask the minister to do all that he can in the summer recess to prevent some of the disasters that might befall us. Health professionals, trade unions and all the people to whom I speak are terrified of a bad winter and the impact that that would have on top of all the changes and convergence. I ask the Executive please to schedule a full parliamentary debate, because the NHS's security, future and preservation are at stake. We need to acknowledge the seriousness of the situation.

I congratulate Frances Curran on securing this important debate and I welcome the opportunity to participate. I recognise the passionate speeches that have been made and endorse the emphasis on the importance of meaningful public involvement. All views—not just comments on the proposals in the consultation document—can and should be expressed as part of that involvement.

Members will be fully aware that the Executive has strict guidelines on how consultations should be undertaken. In formulating final proposals on any major service provision, we expect NHS boards to listen to and take account of the views that all stakeholders express. I welcome the news that NHS Argyll and Clyde has commissioned Dr Andrew Walker from the University of Glasgow to undertake an independent review of how those views have been taken into account.

Members will know that the time for me to express a view is when any proposals come to me following consultation. I will consider carefully the supporting evidence and the report of the independent review, as well as all representations that I receive on the matter.

As I have said repeatedly, I will not simply rubber-stamp NHS boards' proposals. I will want to be assured that all views have been taken into account in drafting the proposals and that the consultation process has been fully consistent with Executive guidance. I also guarantee that I will not be prepared to endorse any solution that does not ensure high-quality, safe and sustainable services for Argyll and Clyde.

Members will remember that a few months ago I did not rubber-stamp the maternity service proposals from Argyll and Clyde. I said that I was unconvinced by the planning assumptions about the number of women who would choose to have their babies in Paisley rather than Glasgow, and I asked Argyll and Clyde and Glasgow to undertake more detailed work on the pattern of patient choice between the two services. As a result, women are now being given genuine choice between consultant-led delivery in Paisley or Glasgow with local antenatal care.

I cannot comment in detail on Argyll and Clyde's proposals at this stage, but I can mention some of the key drivers for change to which boards throughout Scotland must respond. They include—crucially—clinical safety, meeting quality standards, sustainability, work-force regulations and training requirements. More generally, we should be mindful of the geographic and population density issues that make the organisation of services in Scotland significantly different from that in England.

"Partnership for Care: Scotland's Health White Paper" emphasised the importance of providing services as close as possible to people's homes. The NHS is making progress in bringing many services closer to local communities. For example, it is becoming standard practice for services such as chemotherapy and haemodialysis to be provided locally. More chronic disease is being managed in primary care.

However, we cannot ensure high-quality, clinically safe local services in every case. In 2002, the Temple report recognised that. More recently, the British Medical Association has spoken about the need to consider seriously the risks that are sometimes associated with providing local services and the alternatives that might be available. As John Garner, the chair of BMA Scotland, said this week, as politicians we must be careful not to rush to defend buildings and services that may be out of date when the real issues are quality of service and patient safety. Likewise, those issues of safety and quality, rather than the desire to cut costs, must be the drivers of any changes that health boards propose. In particular, I expect every NHS board to demonstrate a two-way flow in service change. Some specialisms may best be provided from one more central location. At the same time, other services must go local wherever possible.

The minister will be aware of the Auditor General's report on day surgery, which demonstrates that Argyll and Clyde NHS Board has the poorest record of any health board in Scotland on meeting the 98 targets that were set by the United Kingdom Government. One of the biggest challenges before the board is to up its game in that area.

That is certainly one of many challenges that the board faces. I recognise that in Argyll and Clyde there is a background of many years of mismanagement, especially of finances, which makes life more difficult for Argyll and Clyde than for other NHS boards.

I will give a good example from Argyll and Clyde of new local services: the new mid-Argyll project. This innovative new service model, redesigned from a patient's point of view, is an entirely appropriate response to local needs and will secure high-quality, sustainable health and social care services for the local community for the next 30 years and beyond. I am very much looking forward to travelling to Lochgilphead later this month to cut the sod for the new mid-Argyll hospital, which will be at the centre of the new development.

Frances Curran went beyond the situation in Argyll and Clyde and talked about a crisis and a lack of action in the health service more generally. However, no serious commentator would dispute the fact either that record investment is being made in our health service or that that has produced many improvements. The question is how to spend this record amount of money to best effect and to accelerate the dissemination of good practice that is undoubtedly to be found in abundance. That means making world-class specialist facilities available to all, alongside community facilities at local level. There should be extra bed capacity, when it is needed, but there should also be recognition that modern medicine will see an increasing amount of community and day treatment.

My question relates to the specific point of specialisation versus generalisation. Does the minister think that at the moment the balance between specialisation and generalisation is right, or does he agree with us that there needs to be a greater emphasis on generalisation, especially to meet the needs of rural communities?

In general terms, I do not think that the balance is right. Certain services must move to more specialist centres because of the overriding need to ensure clinical safety and quality of care, but many services should be moving in the opposite direction. This is a dynamic process. As I said at question time, we must ensure that we get the balance right. The objective must be a patient-centred NHS that improves the experience of patients, takes account of modern clinical practice and puts clinical safety and the quality of care first. There should be local access wherever that is consistent with those objectives. More generally, the approach means having complex solutions for complex situations, in which the objective is always better outcomes for patients.

I welcome the news about the new community hospital in Lochgilphead, but where will the psychiatric patients from the Argyll and Bute hospital in Lochgilphead go?

I am deliberately avoiding commenting on the details of Argyll and Clyde NHS Board's proposals, because they must come to me at the end of the day. However, it is a fact that there are far more in-patient mental health beds in Argyll and Clyde than elsewhere in Scotland. Some of the thinking behind the proposals relates to developing care in the community, as has happened in other parts of Scotland. I cannot comment more finally than that.

The extent of the change required in Argyll and Clyde and elsewhere has highlighted the need for further work to provide a national policy context for the detailed planning and service redesign efforts at local and regional level. That is why I have responded by developing work on a national framework for service change, which will explore and advise on strategies to secure a sustainable configuration of health services in Scotland and it will recommend how sustainability might be supported and enhanced through improved integration of care.

The national framework for service change will identify those services that need to be delivered at national, regional and local levels in a way that will help ensure that patients get the treatment they require when and where they need it, delivered to nationally agreed standards in an equitable and cost-effective manner throughout Scotland.

Although my time has more than passed, I assure members that no health issue is more important to me than the reconfiguration and redesign of services, which I recognise as the most controversial of all health issues in Scotland at present. I make it clear at the very end of my speech that that does not mean that every decision that is taken by every NHS board in Scotland will be the right one. Ministers will listen to clinicians, to other staff, to communities and to politicians to determine the right outcome.

As a West of Scotland member, I would have wished to speak in the debate, but I do get to speak the last words in this chamber, which are that I now close this meeting of Parliament.

Meeting closed at 17:51.