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The next item of business is a statement by Neil Gray on the Princess Alexandra eye pavilion. The cabinet secretary will take questions at the end of his statement, so there should be no interventions or interruptions.
14:25
I am grateful for the opportunity to provide an update to members on the Princess Alexandra eye pavilion in Edinburgh.
Last week, NHS Lothian announced that, from late October, the eye pavilion will be vacated for a period of around six months. That is to allow for critical maintenance to be carried out and for subsequent recommissioning of the site.
It is clear that the closure will cause disruption to patients and to staff, and I understand that both groups are concerned about the impact on arrangements for providing care and on waiting times. I am sorry for the worry that it will cause for many, so I will start by being clear that my priorities, and those of NHS Lothian, are to ensure safety and, to the fullest extent possible, to minimise disruption.
In my statement today, I will provide further information on the critical maintenance that will be carried out at the eye pavilion, and on the planning for the patient appointments that need to be rearranged as a consequence. I hope that that will provide assurance to all concerned that the matter is being addressed with due care and speed. I will also speak to the future and to the need for service and financial sustainability, as well as reform. We know that change is needed and we must do things differently.
First, I will briefly explain the issue that has led to the temporary closure of the eye pavilion. Two copper waste pipe stacks require to be replaced, and it is critical that that is done quickly to prevent damage that would require more significant remedial works and cause greater disruption. That is why the hospital is being vacated at pace, and NHS Lothian plans to hand the building over to contractors on 25 October.
The current estimate from NHS Lothian of the expected duration of the closure is six months. That is an estimate, and the timeframe and programme of works are being developed. That will be kept under review ahead of and during the works and recommissioning.
With regard to what will happen during the period of closure and why it takes time, the site requires to be decanted before remedial works can be undertaken, and recommissioning is required before reopening. Decanting the site is a complex process and includes the moving of equipment as well as the relocation of clinics.
Unfortunately, during surveys to assess the required work, it has been identified that one of the waste pipes is located within a cavity that contains asbestos. That adds to the complexity and the timeline of the remedial works. Safe removal of the asbestos material is essential ahead of the pipework replacement, for the safety of those who are carrying out the work and those who use the site. Once the remedial works are complete, a process of recommissioning is required to provide assurance that the site is fully operational and to ensure safety ahead of reopening.
During the coming weeks and months, my officials and I will stay in close contact with NHS Lothian to seek the necessary assurances around progress. As I have said, patient safety is paramount and, following my visit to the eye pavilion this morning, along with Miles Briggs, Sarah Boyack and Daniel Johnson, I am assured that the board is doing everything possible to minimise disruption and potential harm to patients.
NHS Lothian is looking at all possible options across its estate to maximise capacity for ophthalmology patients. After hearing directly from patients at a previous meeting on the issue, I have also sought assurance that there will be minimal travel for patients with the most profound needs. That is a critical issue that patients have raised with me.
The vast majority of patients whose appointments are scheduled before Friday 25 October will be unaffected, and the small number of patients who are affected will be contacted by NHS Lothian at least two weeks prior to their appointment. Patients who are booked for appointments from Monday 28 October will be contacted with changes to their appointments, and new patients will be given an alternative location in their booking letter.
While NHS Lothian is still finalising all of the details of its plans, I have heard from the board that communication with patients, MSPs, local partners and Government is and will be on-going. I know that NHS Lothian also has a planned meeting on 4 October with all Lothian MSPs, when it will share more detail following the conclusion of its final plan. The board is also working closely with staff and unions in relation to those staff who will be displaced, in order to manage their concerns.
I now turn to the future of eye care services. It is important to recognise that replacement of the eye pavilion was included as part of the national treatment centre programme, which was intended to provide capacity for all of Scotland. As we look ahead, we must continue to plan on the basis of need and available resources across the whole of Scotland. The landscape has changed significantly since the national treatment centre programme started, not least as a result of Covid, Brexit and soaring construction costs. As we have repeatedly made clear, the financial climate is extremely challenging across both the revenue and capital budgets.
We have also made clear that health service reform is essential for operational and financial sustainability. Our actions must enable NHS Scotland to maximise capacity, build greater resilience and deliver reductions in the number of patients who have waited too long for treatment. In that context, all spending—even that previously committed—must be carefully considered so that it is directed where it will have the greatest impact.
We know that the national health service estate is ageing and that it is not affordable to replace everything as quickly as we might like to—a position that is not unique to Scotland. We must make better use of our existing resources to support reform and improvement and we must consider where strategic investment across our existing estate will provide better value than replacement. We must also consider how we can improve through service redesign to ensure that we have a resilient service for the future.
We are working with all health boards, including NHS Lothian, to develop a whole-system infrastructure plan. That will consider health infrastructure needs for the whole of Scotland, to support continued safe operation of existing facilities and to inform longer-term investment priorities. As I have made clear, a key part of our consideration must be how existing resources can be better utilised to provide the required capacity.
We must also retain focus on preventing the need for hospital treatment in the first place. That means both investing in our existing estate and reducing pressure on that estate by delivering services in a different way. For eye care services, that includes consideration of how we better utilise capacity at existing treatment centres. A key part of that is ensuring that more people are treated in a community setting, where that is clinically appropriate. We know that treatment closer to home is of benefit to patients, with the potential to improve patient experience and overall health outcomes, and making better use of community services frees up acute capacity for more complex cases.
The community optometry sector already provides a first-port-of-call service to patients with eye problems. That is enabled by Scotland being the only nation in the United Kingdom to provide free universal NHS eye examinations—a policy that the Government is committed to maintaining. That approach has been really successful in supporting many patients to be managed within the community, closer to home, instead of needing to be referred to hospital or to be seen by a general practitioner.
However, the community optometry sector has the capacity and capability to do much more. An example is the new community glaucoma service, which moves lower-risk patients who would traditionally be seen in a hospital setting to available capacity in the community optometry sector, thereby freeing up hospital capacity for patients with the most sight-threatening conditions. The service is being rolled out nationally and will deliver the capacity and technology for an estimated 20,000 patients to receive their care closer to home.
We are also investing in our future optometry workforce through Scotland’s new UK-leading masters optometry undergraduate degree. That will, among other things, enable students to graduate as independent prescribing optometrists, and it will help to build additional capacity to support managing more patients in the community instead of their being referred to hospital.
The course has just launched at Glasgow Caledonian University, and the Minister for Public Health and Women’s Health and the Minister for Higher and Further Education; and Minister for Veterans visited the university on Tuesday to meet the new students and teaching staff. The Government looks forward to the University of the Highlands and Islands launching a similar course next year.
I understand that members and their constituents are extremely concerned by the announcement that the eye pavilion will close for a period of time. I share that concern, so let me reaffirm that my priority, and NHS Lothian’s priority, is to limit disruption and avoid harm, as well as to ensure that eye care appointments that would have taken place at the eye pavilion go ahead despite the temporary closure.
I also know that many are concerned about the future of the eye pavilion and will be disappointed that I have not been able to confirm its replacement in my statement today. I give my commitment that we will continue to look ahead to how eye care services can be delivered most effectively, with a clear focus on improved services and reduced waiting times.
We must be open to all possibilities on how that can be achieved, including how we make better use of existing services.
The cabinet secretary will now take questions on the issues that were raised in his statement. I intend to allow about 20 minutes for questions, after which we will move on to the next item of business. Members who wish to ask a question should press their request-to-speak button now if they have not already done so.
I thank the cabinet secretary for the advance sight of his statement and for the time that he gave to staff, patients and elected members on a visit to the eye pavilion this morning.
As the cabinet secretary heard directly from clinicians then, the closure of the hospital and the significant disruption to the service have the potential to cause harm to patients in Lothian. We are at this point because of a failure to deliver a new eye hospital for Lothian over the past decade. There has been a failure of leadership by Scottish National Party ministers to plan for and deliver the growing health services that we need in Lothian.
The cabinet secretary will be aware that there is real concern among patients and staff that this might be just the start of a much longer period of closure of the hospital. We will not know that until work starts to be undertaken. It is now critical, therefore, that we see a commitment from SNP ministers to fast-track the funding and construction of a new replacement eye hospital.
I have two questions for the cabinet secretary. First, will he give a commitment that the Scottish Government will help to cover the significant costs that NHS Lothian will face when the services are redistributed across the NHS estate? Secondly, after today’s visit, does he fully accept that we need a new eye hospital to be built in Lothian?
I thank Miles Briggs for his on-going interest in the issue and the representation that he and others in the chamber are providing on it to their constituents, who I was able to hear directly from at a previous meeting in the Parliament, as well as this morning at the eye pavilion.
At the outset, I stress that everything that NHS Lothian is doing with regard to providing the contingency arrangements during the temporary closure is about ensuring that there is the least disruption possible to patients and reducing the risk of harm. We heard that this morning.
I recognise the increased financial pressure that the closure puts on NHS Lothian, and discussions that directly reference the question of how we can support NHS Lothian are on-going.
With regard to the building of a new eye pavilion, Miles Briggs is well aware of the capital programme pause that is under way in Government and the fact that an infrastructure review is on-going. That will be determined based on the outcomes of both the UK budget at the end of October and the infrastructure review that is under way across the Scottish Government. I cannot give any greater commitment than that at this stage.
I, too, thank the cabinet secretary for the advance sight of his statement, and for the ability to meet senior staff and colleagues and members of keep Edinburgh eye pavilion—KEEP—at the eye pavilion this morning.
Let us be clear that, although the eye pavilion has been deemed not fit for purpose for a decade, this week’s announcement will still have been a huge shock to patients and deeply worrying to staff.
Can the cabinet secretary give us a guarantee today that the eye pavilion will reopen in six months and that its closure will be an interim measure, so that people do not have to worry about access to the vital services that will protect and save their sight when they need it? Will he also commit to updating Parliament in the coming months and in six months’ time, so that we are kept informed and can keep our constituents informed?
Will he also agree in principle on the importance of the need for a new eye pavilion? Notwithstanding the challenges that he has identified and the importance of the work on prevention, on which I totally agree, patients and staff urgently need and deserve a new facility that is safe and modern and meets everyone’s needs, whether it is—
Cabinet secretary.
If the cabinet secretary could answer those questions, I would be grateful.
I thank Sarah Boyack for her interaction on and long-standing interest in the issue. On her question around the closure being a temporary measure, it is absolutely NHS Lothian’s intention to see the eye pavilion reopened and for that to be done within the six-month timeframe. This morning, we heard about some of the risks to that timing because of the uncertainty around some of the works, but I intend to keep a close eye on that.
That links to Sarah Boyack’s second question, which is about keeping MSPs and their constituents informed. There is a meeting of all Lothian MSPs with NHS Lothian on 4 October. It is my intention to keep close to the issue and to provide updates from the Government perspective. I commit to keeping colleagues updated as soon as I hear anything further.
I have already set out to Miles Briggs as much as I can on the future for the eye pavilion, but I accept and agree with the point about the importance of prevention. The future of the eye pavilion will be determined in part by the outcome of the UK budget and in part by the infrastructure review that is going on across the Scottish Government.
There is, understandably, considerable interest in asking questions. I intend to allow everybody who has requested a question to pose their question, but I will need co-operation in terms of the brevity of those questions and, indeed, the responses.
Having an eye hospital close to people, especially in emergencies, is a huge part of the issue, especially given the significant population growth in the Lothians. The cabinet secretary has sought assurance and, thankfully, has been assured that there will be minimal travel for those patients with the most needs who will be affected. What support will the Scottish Government provide to patients in NHS Lothian who will have to travel further for medical appointments?
I thank Ben Macpherson for his interest in the issue, for his questions and for his engagement on a cross-party basis. As I have set out, and as we heard this morning, it is NHS Lothian’s intention for patients—in particular, the emergency patients to whom Ben Macpherson referred—to be kept as close as possible to existing services. Ben Macpherson and other Lothians colleagues will hear an update on that at the meeting with the board on 4 October.
It is NHS Lothian’s aim to see and treat as many patients as possible close to the city and the surrounding Lothian hospitals. If patients need to travel to a hospital outside NHS Lothian for treatment, and if they meet the assessment criteria, they are entitled to reimbursement of travel expenses or ambulance transport to help them to attend an appointment. However, having heard, at the meeting at which Mr Macpherson was present, the importance that is placed on minimising travel for patients with a significant eye condition, I have stressed to NHS Lothian the importance of keeping treatment as local as possible.
I declare an interest as a practising NHS GP.
This is a minimum six-month halt on activity at the Edinburgh eye pavilion. I fear that the cost of remediation will spiral, and it is clear that there is no plan for where to undertake procedures that require laminar flow. On average, over the past five years, 1,629 cataract procedures and 120 emergency eye procedures were carried out at the pavilion every six months. Where exactly will all those operations be carried out during closure? Will the cabinet secretary guarantee to maintain the number of procedures during the closure period and that patient eye health will not be threatened?
Sandesh Gulhane is right to reference the risk to the capacity that has been provided by the eye pavilion. I cannot give a guarantee that capacity will not be undermined because of the temporary closure of the eye pavilion. However, NHS Lothian is doing everything possible to maximise capacity not just in the Lothians but further afield to ensure that people can get access to the treatment that they need.
Sandesh Gulhane referenced the high level of sanitation that is required at theatre level for some procedures, which we heard about this morning. NHS Lothian is exploring all options to ensure that that is possible within the Lothians.
Asbestos is well recognised as one of the most dangerous substances still to be found in buildings up and down the country, including in the Princess Alexandra eye pavilion. Does the cabinet secretary agree that closure is the best course of action to ensure patient safety while plumbing system remediation work is carried out urgently to remove the risk of asbestos in the hospital?
I do not underestimate the anxiety that will be felt by Gordon MacDonald’s constituents or those of other Lothians representatives around the chamber. That is why it is important for NHS Lothian to move quickly and, on Sandesh Gulhane’s question, to provide reassurances on maximising capacity. I agree that closure is the correct course of action, and I support NHS Lothian’s plans to provide services elsewhere while rectification works are undertaken, exactly because of the points that Gordon MacDonald raises.
I thank the cabinet secretary for acknowledging the points that were made this morning about the fact that the need to travel and the loss of co-location of acute and emergency treatment would cause harm, which would result in preventable loss of sight. How will that be monitored and measured? Secondly, if there is such a risk with the interim arrangements, surely that makes the case for the need for a replacement for the eye pavilion, so that co-location of those facilities continues into the future.
Daniel Johnson makes a fair point, which underpins the decisions that have previously been taken in relation to looking at a replacement for the eye pavilion. I am not questioning that. What I am saying is that the future infrastructure plans for the health service are dependent on the wider Government infrastructure review and the capital that will become available off the back of the UK budget, the implications of which Daniel Johnson will understand.
On the question about how the impact of the loss of co-location will be monitored, clinicians have an important role to play in that regard, as does NHS Lothian, and I expect to be kept updated on that.
Given that we have an increasingly ageing population and that we expect that more ophthalmic procedures will need to be carried out in the future, including at the Princess Alexandra eye pavilion, will the cabinet secretary say more about the action that is being taken to ensure future resilience in the provision of specialist ophthalmic staff, including at the site, through the recruitment of ophthalmology nurse specialists and consultants?
It is critically important that we ensure that we look after the interests of staff as well as patients in the process; that was one of the areas that we discussed this morning.
A recent workforce review that was conducted by the national eye care workstream identified that an adequate number of ophthalmology consultants are in post to support patient care in NHS Lothian. Future proofing the service by upskilling additional non-medical staff and through the use of ophthalmic imaging equipment will enable more patients to be reviewed in a sustainable manner. There are a range of areas of intervention on which I can write to Emma Harper with more information to confirm our support in that endeavour.
I am grateful to the cabinet secretary for coming to the chamber to give us an update. It is clearly a frustrating situation for the board, for medics and for patients to be working in a building that has been unfit for purpose for 10 years. Keeping that building going will get more costly and will lead to more disruption.
The cabinet secretary has not set out a vision for the future of the eye pavilion. He has said that the Scottish Government will review the building as part of a whole infrastructure plan for the NHS. Will he please tell us when we will see that infrastructure plan, so that we can understand what the future of eye services in Lothian is?
The frustrations that Lorna Slater has outlined, which are felt by patients, by staff and by others, are shared by me. The outcome of the infrastructure review will come after the budget process.
The closure of the eye pavilion will come as a bitter blow to campaigners, especially the keep Edinburgh eye pavilion campaign group and the Corstorphine connect sight loss group, which operate out of my constituency, but it represents vindication that the hospital has not been fit for purpose for some time.
I am concerned by the discovery of asbestos. We know that, where it is found in one part of a building, it is usually found in other parts, too. Is the health board aware of the full extent of the use of asbestos in the building? If not, is it looking to ascertain where else it might be? If it finds more asbestos, will that lead to a longer closure?
The period of closure has some contingency built into it, based on what might be found when works begin. However, as I set out in my statement, there will have to be some flexibility. I hope that the eye pavilion will reopen before the six-month period elapses, but, depending on what happens as the works get under way, there will need to be some flexibility in relation to the term of the closure.
As a result of the identification of asbestos, there are obviously safety parameters that need to be explored, and that has been built into the current trajectories for the length of time that the process will take.
I understand that, in order to provide as much certainty as possible in relation to the Scottish Government’s investment plans, we are awaiting confirmation of the capital allocations from the new Labour UK Government. What conversations have been held with the UK Government to that end, and what solutions have been offered?
The First Minister and the Cabinet Secretary for Finance and Local Government have met the Chancellor of the Exchequer on a number of occasions, and they have highlighted that the expected real-terms cuts to our capital funding, which are worth about £1.3 billion, are significantly impacting our ability to fund vital infrastructure projects, deliver on our priorities and provide the certainty that Mr Coffey referred to in his question, including in relation to investment in maintaining high-quality public services. We are keen to work with the UK Government to ensure that the budget on 30 October provides us with the capital budget that we need to achieve net zero, maintain high-quality public infrastructure and see economic benefits as a result.
Earlier this week, MSPs were told in a briefing that eye pavilion services would be accommodated in facilities across NHS Lothian. The eye pavilion sees around 1,500 patients a week, with an average of 152 out-patient clinics a week, using 40 consultation rooms every day. Patients and clinicians will now be scattered across the city and I can only imagine the chaos and confusion that that will cause, all of which comes before we take into account the devastating impact on clinical care.
For months, I have been asking NHS Lothian for a back-up plan. Will the cabinet secretary finally give patients and staff the assurance that alternative and purposeful options are being arranged outside the existing NHS Lothian estate, whether that be in central office space, additional capacity in private opticians, or in hospitals and clinics?
NHS Lothian is looking to ensure that the disruption and co-location issues that have been identified by members across the chamber are minimised as far as possible. The board will set out finalised plans to Lothian MSPs at a meeting on 4 October, when Sue Webber will be able to hear more detail about plans to ensure that that takes place.
I recognise that the Scottish Government gave our front-line health boards a real-terms increase that has seen the budget for NHS Lothian increase by £80.2 million this year. Will the cabinet secretary explain how he will look to protect and increase NHS funding where possible, despite an almost 10 per cent real-terms cut in the Scottish Government’s capital funding between now and 2027-28 as a result of financial mismanagement in Westminster?
As Collette Stevenson said, a real-terms uplift for the health portfolio was prioritised for the 2024-25 Scottish budget. I recognise that pressures continue even with that real-terms increase for health boards—including Lothian—and that those pressures are driven by demand.
In contrast to our position, documents published as part of the UK spring budget set out a real-terms 0.2 per cent resource reduction for the Department of Health and Social Care and the UK capital budget is expected to reduce in real terms over the medium term. As members are well aware, those spending decisions affect funding here in Scotland. Ahead of the UK budget next month, I urge the UK Government to reflect on Lord Darzi’s findings and to deliver on previous calls from this Government and from organisations such as the International Monetary Fund to prioritise investment in infrastructure and public services.
A constituent who had an appointment for November told me that that appointment was cancelled in August, with an explanation that a new booking system would be operated at the eye pavilion. Is it just a coincidence that that coincides with the closure?
Without knowing the details of the case that Martin Whitfield raises, I can say with some confidence that that is a coincidence, because the closure has been announced relatively recently. If he would like to write to me with the details, I would be more than happy to follow that up with NHS Lothian.
Following on from that question, will the cabinet secretary tell us when NHS Lothian made its decision and when the board informed him of that decision?
I will write to Jeremy Balfour to give him the exact date and time when I was informed, but it was around the same time as the public: I was given, I think, an additional day’s notice. I would be happy to provide Jeremy Balfour with that information in writing.
This news is deeply disappointing. We have known for years that the eye pavilion was not fit for purpose but patients will now face uncertainty, with rearranged appointments in unfamiliar places. The eye pavilion provides specialist care. If a patient experiences an emergency with their eye condition, the accident and emergency department at Edinburgh royal infirmary may not be able to meet their needs. Will the cabinet secretary say where patients will now be sent for urgent care?
I recognise the concern that Foysol Choudhury highlights, as it was discussed this morning at the meeting at the eye pavilion that his colleagues attended. NHS Lothian is also acutely concerned about ensuring that travel and disruption are minimised for patients who are in need of urgent care in particular, as he sets out. The final details of where people will receive those services will be set out at the meeting on 4 October with NHS Lothian and Lothian MSPs.
That concludes this item of business. There will be a brief pause before we move to the next item of business to allow the front benches to change.
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