Cabinet Secretary for Health and Wellbeing
Nicola Sturgeon
Scottish Parliament
June 6, 2007
I am delighted to have the opportunity today to deliver my first statement to parliament since my appointment as Cabinet Secretary for Health & Wellbeing.
The people of Scotland - and this chamber - should be assured that this government is committed to serving the best interests of NHS patients.
It is therefore fitting that my first statement is on an issue that galvanised patients, public opinion and elected representatives of all parties in Ayrshire and Lanarkshire; namely - the previous administration's decision to endorse the closure of the Accident & Emergency departments at both Ayr and Monklands hospitals.
Let me be clear from the outset: it is this government's view that the decisions to close A&E at Monklands and Ayr were wrong and they will now be reversed.
In my statement today I will outline why I believe the decisions were wrong; the action I have taken to reverse them; and what will happen now in both of these health board areas.
I will also make clear what my decision means - and what it does not mean - for health service reform in Ayrshire & Lanarkshire and in Scotland generally.
Let me turn firstly to why I believe the decisions to close A&E units at Ayr and Monklands were wrong.
We have been consistent in our view that both NHS Ayrshire & Arran's Review of Services and NHS Lanarkshire's Picture of Health review failed to sufficiently address the very real concerns of a significant proportion of their local populations about the centralisation of A&E services.
Many of these concerns were not based on an emotional attachment to bricks and mortar - as some have rather dismissively suggested, but on a level-headed analysis of particular local circumstances and the needs of local communities now and in the future.
Concerns that the Boards' proposals would inhibit access to A&E services; concerns particularly in Ayrshire that insufficient consideration was given to issues around geography, local transport and the ambulance infrastructure; and concerns most notably in Lanarkshire that the proposals would have meant diminished emergency care provision in some of the most deprived areas of Scotland where people need it most.
These real concerns remained even after the consultation and public engagement work carried out by both health boards.
That was because neither the boards nor ministers were able to make the case convincingly that the proposals to centralise A&E services would be to the benefit of local communities.
They were unable to demonstrate that these changes would mean an improvement in the level of services available.
And the overwhelming feeling in both local communities was that the boards' processes and their subsequent recommendations - endorsed by Ministers - paid scant regard to their clearly expressed views.
Presiding officer, let me make clear at this stage what I consider to be the place of public opinion in decisions about healthcare provision. Public opinion cannot and should not override genuine concerns about the safety of services. But where there are choices to be made about how services are redesigned to meet the challenges faced by health boards - and in most circumstances there will be options - then in my view public opinion cannot simply be ignored.
We must never forget that the NHS is a public service. It is a service used by the public and it is a service paid for by the public.
It is the duty of health boards - and of responsible government - to take full account of particular local views and circumstances.
It is my view, and it is this government's view, that given the particular local circumstances involved in these cases - the geography and demographics; the high levels of deprivation and ill health; the real concerns about access and public transport - that A&E services at Ayr and Monklands should be maintained.
So let me turn now to the action I have taken.
The first meetings I undertook as Health Secretary were with the Chairs and Chief Executives of NHS Lanarkshire and NHS Ayrshire & Arran.
At these meetings, I told the Boards that I do not accept the previous decisions to close the A&E departments at Monklands and Ayr.
I have today written to both boards confirming that decision. I have instructed them to look again at their original plans and produce revised proposals that will enable A&E services to continue at all three sites in Lanarkshire and at both sites in Ayrshire.
Presiding Officer, let me be clear: the A&E departments at Ayr and Monklands will not close.
I do, of course, recognise the challenges both boards face and I have made it clear to them that the government will work with them to ensure a safe, sustainable, high quality network of modern, patient centred health services.
I have also made it clear to them that there was much to be commended in their original proposals to develop, modernise and maximise access to primary care; and to develop community casualty facilities that can appropriately deal with a high proportion of unscheduled care at local level.
The decision I have taken today will of course have an impact on these other proposals.
But I am clear that as far as possible within the resources available to them, I want the boards to retain their primary care and community development programmes.
I want at this stage to put on record my thanks to NHS Lanarkshire and to NHS Ayrshire & Arran for the commitment they have already shown to working constructively to meet those challenges and I have the utmost confidence in their ability to respond positively to the announcement I am making today.
Let me turn now to what will happen next.
Local people and clinicians will rightly expect the revised proposals that come forward for consideration to be robust, evidence-based, patient-centred and consistent with clinical best practice and national policy.
To ensure that this is the case, I have decided that the revised proposals will be subject to a process of independent scrutiny.
I will make a further announcement soon about the form of independent scrutiny that will apply to all future significant service change proposals.
But in order to minimise uncertainty and the impact on service development in Ayrshire and Lanarkshire, I will today announce separate arrangements in these cases.
It is my intention to set up an independent panel - which will have access to expert clinical and financial advice and which will take account of the views of local people - to scrutinise the boards' revised proposals and report back to me.
I have already made it clear to both boards that their revised proposals must enable A&E services to continue at all three sites in Lanarkshire and at both sites in Ayr.
I will look to the independent panel to assess the safety, sustainability, evidence-base and value for money of the revised proposals; and to be satisfied that due account has been taken of local views.
I have agreed with the local boards that their revised proposals - having been scrutinised and evaluated by the independent panel - should be with me for a final decision by the turn of the year.
This is a demanding timescale and members should be assured that both health boards will have the full commitment and full support of the government in taking this work forward.
I now want to turn to the implications of my decision today for health service strategy as a whole.
Let me say unequivocally that it is not our intention to comprehensively rewrite the established national service strategy for our NHS.
We will certainly update that strategy to reflect new priorities and new challenges. For example, we will consult soon on new waiting time guarantees for patients.
But in doing so we will adhere to the principles laid down in Building a Health Service Fit for the Future, the Framework report published in 2005.
Indeed, seldom has this Parliament been more united than it was in its response to that report. There is a great deal in the report to commend and I support its general direction.
The report addressed Scotland's long term health needs and the shape of services required to meet the needs of our communities. It addressed changes and developments in clinical practice and training.
We agree that it is important to shift the balance of care into communities where possible; to tackle inequalities by anticipating and preventing ill health; and to take account of demographic and workforce pressures in the planning of services.
We also see the logic of separating where possible the delivery of planned and unscheduled care. This helps to improve efficiency and minimise waiting times for patients.
And we appreciate that there are instances - such as specialist cancer care or neurosurgery or heart treatment - where a concentration of skills on a specialist site really benefits patients.
So this government will adhere to these important principles in our stewardship of the health service.
But that does not mean automatically endorsing every decision that is taken in the name of the Kerr report.
Service change proposals must always be critically assessed against the broad framework set out in that report. Clinical issues, service quality, sustainability, local circumstances and affordability must be considered alongside the views and preferences of the public and of the patients.
We must have an NHS that provides now and in the future patient-centred, high quality, efficient and effective services that do take account of particular local circumstances.
I also want to be clear today that in honouring our commitment to maintain A&E services at Ayr and Monklands, I am not signalling a general review of service changes that have been made in the NHS.
I recognise that difficult decisions have have had to be made and that some of these have been hard for local communities to accept.
But I also appreciate the uncertainty, instability, delay and cost that would flow from any general review of decisions that in many cases were taken several years ago and unlike Ayrshire and Lanarkshire are now in very advanced stages of implementation.
However, I am determined to engage with communities where concerns remain to build confidence in the range of services provided locally.
Presiding Officer, let me comment finally on how I will approach future proposals for significant service change.
As I have said already, it is the case that difficult decisions about the NHS will have to be taken. It is my job to face up to these.
But it also my job to ensure that the public has greater confidence in the process leading to these decisions and in the evidence underpinning them.
I have already made it clear that I will expect all proposals for service change to be subjected to rigorous independent scrutiny before full public consultation.
This will ensure that the information being presented by health boards is factual and evidence based, and that the choice presented to the public is a fair and genuine one.
It is worth noticing that in neither Ayrshire nor Lanarkshire were the public even consulted on an option that would have retained all A&Es.
It is no wonder then that public confidence in the process was absent from the outset.
Following independent scrutiny and public consultation proposals will come to me for decision. I will operate a presumption against centralisation - such a presumption is entirely consistent with the Kerr report.
That report stated clearly that before decisions are taken about centralisation of services on the grounds of resource or workforce constraints, it must first be demonstrated that no alternative service redesign can be achieved. That is a principle I will apply.
It does not mean no change in any circumstances.
But it does mean that any proposals must be robust, that all alternatives for service redesign must have been properly considered, and that the health board can demonstrate that due weight has been given to public opinion.
This government is committed to working with all in this chamber; with all in the NHS and with communities right across Scotland to deliver a health service that is truly fit for purpose; that is efficient and effective; that delivers a consistent, servichigh quality e to the Scottish people; that takes full account of - and is responsive to - the needs of patients and the public in the way it develops its services; and a health service that is straightforward, open and honest about the challenges and pressures it faces in doing so.
We will retain the core strategic plan for the NHS but we will also ensure that the NHS maximises the involvement of local people in the way it delivers and develops services, and we will ensure that these developments are subject to independent scrutiny.
And let there be no doubt, where decisive action is necessary to safeguard the best interests of patients and local communities - such as in our decision to reverse the closure of the A&E departments at Ayr and Monklands - we will not shirk from taking that action.
These communities - and indeed all of Scotland - deserve no less.