The Scottish Government

Letter on NHS Lanarkshire proposals for the future

Letter from Deputy Health Minister Lewis Macdonald to Ken Corsar, Chairman, NHS Lanarkshire, date August 21, 2006

Dear Ken

Thank you for your letter of 29 June asking for my approval of NHS Lanarkshire's proposals for the future direction of health services in Lanarkshire, following consideration by the Board on 27 June 2006.

I have been giving this matter very careful consideration since receiving the Board's proposals.

In reaching a decision I had to be satisfied that NHS Lanarkshire's proposals were consistent with the principles set out by Professor David Kerr in The National Framework for Service Change in Scotland and in Delivering for Health, the Executive's implementation plan.

I also had to be satisfied that NHS Lanarkshire had adhered to Executive guidance on engaging, involving and consulting key stakeholders on major service change proposals. In reaching a decision I gave very careful consideration to the Board's review under A Picture of Health and the Board's recommendation.

I have taken time since receiving the Board's recommendations to consider the considerable volume of information available to me. I have also met with and heard representations from local elected representatives and local people. I also visited all three hospital sites and Airdrie Health Centre on 22 June to see for myself how hospital and primary care services are delivered in Lanarkshire. As well as having the opportunity to see how services are delivered, I also had the opportunity to meet with and hear the views of frontline staff.

I also chaired the NHS Lanarkshire Annual Review on 1 August when I probed the NHS Board on wider health service issues in Lanarkshire. On the same day I also met with the Area Clinical Forum, the Area Partnership Forum and a group of patients.

I have concluded that I am satisfied that NHS Lanarkshire's proposals for health improvement, strengthening primary care, supporting and enhancing local services, upgrading mental health services and modernising acute hospital services are consistent with and will deliver the aims set out in The National Framework for Service Change in Scotland and in Delivering for Health.

Delivering for Health requires NHS Boards to develop services which will have the effect of reducing the health gap, enabling people with long term conditions to live healthy lives; streamlining emergency hospital care; separating planned from unscheduled care and speeding up access to diagnostic services.

I am also satisfied by the Scottish Health Council's report that NHS Lanarkshire took sufficient steps to involve patients, the public and staff in relation to significant service change proposals and that the consultation process used was in accordance with existing Executive guidance. The Council has also confirmed that it is satisfied with the procedures adopted by NHS Lanarkshire in arriving at options for consultation.

I have therefore concluded that the proposals provide a sound basis for the future provision of comprehensive, high quality, safe and sustainable health care services for the people of Lanarkshire. At the same time I acknowledge the specific concerns in relation to Monklands Hospital that have been raised during the consultation and in subsequent representations to me.

I consider that these concerns must be responded to and this letter sets out my requirements of NHS Lanarkshire.

I expect these to be delivered as the Board moves forward to develop the detailed proposals in the Outline Business Case phase and further into the implementation phase.

Firstly, in recognition of the current poor condition of primary care premises in the Monklands area, you have agreed that the Board will take forward the development of the Airdrie Resource Centre and the Main Street Coatbridge Primary Care Centre as immediate priorities.

I want to see the early development of the Business Cases to bring forward the completion of these schemes by the Spring of 2009. I also want you to accelerate the introduction of the remaining primary care developments across Lanarkshire and I will bring forward capital funding into 2007-08 to facilitate the earliest possible provision of the Cumbernauld Community Casualty Unit in particular.

You have also given commitments to take action now to further improve the provision of community based care in the Airdrie and Coatbridge areas. I note and welcome that implementation is already underway through the introduction of more flexible ways of working for primary care professionals, the recruitment of 17 additional community nurses and the recruitment of a specialist nurse for Long Term Conditions.

In this context the Prevention 2010 initiative covering Coatbridge, Airdrie and Wishaw, due to commence this Autumn, is very important indeed. Lanarkshire is at the forefront of the NHS in Scotland with this project which is supported by £2m of Executive funding.

Prevention 2010 will bring resources to bear on improving the health of our most disadvantaged people in North Lanarkshire with the prospect of significant change over time.

By making primary care and other healthcare staff more easily accessible through informal clinics and evening and weekend sessions, health problems can be anticipated before they cause acute illness, and people helped to access primary care at the right time.

The Prevention 2010 project will also help people to access the right care, making sure their chronic diseases are detected, monitored and managed more effectively and enabling them to avoid unplanned visits to Accident and Emergency services. The Board should link closely Prevention 2010 to its long term conditions strategy and track the impact of the project, and other measures to improve primary care, on A & E attendances.

I also want the project to include among its objectives reducing avoidable A & E presentations. I expect the Board to drive this initiative forward to maximise benefits to patients and ensure excellent primary care services in areas of most need.

I acknowledge the level of concern I have heard about transport issues and in particular about the difficulties for relatives and other visitors in travelling from the Monklands area to Wishaw and Hairmyres.

In response to these concerns, I required and you gave me the assurance that a shuttle bus service will operate between Monklands and the other two hospital sites. The service will be available for the use of patients, relatives and staff and will be in place by the time Accident and Emergency provision changes at Monklands Hospital. Usage of the service should be kept under review.

The Scottish Ambulance Service has been closely involved in NHS Lanarkshire's plans for modernising hospital services through A Picture of Health. Clearly, emergency ambulance services form an important part of high quality, safe and responsive services.

Indeed, highly-trained ambulance paramedics, who are usually the first NHS personnel to reach a patient in an emergency, are now able to undertake a wider range of emergency procedures than ever before and will stabilise the patient at the scene of the emergency before transporting them to the nearest appropriate hospital. It is important that the people of Lanarkshire can continue to rely on a swift and effective response when they call an emergency ambulance, and also that ambulance services keep up with the improvements that the Board is proposing.

I have therefore agreed with the Scottish Ambulance Service that they will deploy in Lanarkshire, by the end of this year, an additional 43 paramedic and ambulance technician staff together with a number of new emergency ambulance vehicles.

These additional staff will provide rapid response and full accident and emergency ambulance services to ensure a first class service for Lanarkshire residents. In addition, I expect NHS Lanarkshire and the Scottish Ambulance Service to ensure that, before the proposed changes in Accident and Emergency services at Monklands Hospital take place, additional ambulance staff will be deployed in Lanarkshire to handle both emergency and patient transport work.

I am confident that as a result of this further investment, ambulance services will be able to respond fully effectively to these changes while securing continuous improvement to the quality and responsiveness of the services it provides. I acknowledge that NHS Lanarkshire have agreed to meet the costs of this second group of additional ambulance staff.

On the question of public transport more generally, the development of the 3 Regional Transport for Health sub-groups across Scotland will bring together NHS Boards and their transport planning partners including the Scottish Ambulance Service, local authorities and community transport providers to allow them to develop innovative, integrated transport solutions that will enable access to healthcare facilities for patients, carers, visitors and staff.

I expect NHS Lanarkshire to play a full part in the Partnership. I can confirm that the Executive will be making available ring-fenced funding in the region of £150,000, over 2 years, to enable the infrastructure to be established.

I now turn to capacity issues. The key criticism I have heard is of an alleged lack of capacity in Wishaw General Hospital to deal with urgent GP referrals. I have made clear I expect the necessary additional emergency care capacity at Hairmyres and Wishaw to be in place before the proposed changes are implemented to acute hospital provision at Monklands.

I welcome the assurances you have given me that this will be the case, subject of course to any issues of clinical safety. I now want the Board to ensure that those assurances are delivered and that expanded Accident and Emergency Services and Acute Medical and Acute Surgical receiving services will be in place before the planned changes at Monklands.

I understand that this will be secured through a combination of planned moves of specialties among the sites together with new construction and I want the public and other stakeholders to be kept informed and involved as the Board develops its proposals.

I welcome your assurances that the Community Casualty Unit at Monklands Hospital will be an integrated Community Casualty and GP out of hours service, operating 24 hours a day, 7 days a week. The unit will be staffed for the full duration by emergency practitioner nurses with the GP input still to be finalised.

I also welcome confirmation that the expanded community units at Cumbernauld and Lanark will have extended opening hours during the evenings and over weekends. The two major Accident and Emergency Units and the five Community Casualty Units will provide the people of Lanarkshire with a comprehensive network of emergency services.

I have also heard arguments against the separation of planned and unscheduled care on separate sites. I note from your proposals that you intend to deliver planned care at the two emergency hospitals as well as from the planned care site.

I note what you say about the opportunities this affords the Board to carry out complex surgery requiring ITU backup at Hairmyres and Wishaw with the dual benefit of protecting planned list time and ensuring that emergency cases can be managed in the most efficient way for patients.

I also accept the case that it is the higher volume, lower complexity surgery which is most often disrupted on mixed sites leading to higher cancellation rates, longer waiting times and less efficient use of staff, theatres and other resources.

I have asked you to ensure that these principles, and the benefits patients can expect in terms of shorter waits for elective care and higher quality emergency care, are clearly communicated.

Concerns about the ability of neighbouring hospitals to absorb any increased demand as a result of the proposals in A Picture of Health have been raised with me on a number of occasions.

I am instructing the West of Scotland Regional Planning Group to ensure that the planning, timing and specifications for acute hospitals in Ayrshire and Arran (pending the outcome of current service configuration proposals), Forth Valley, Greater Glasgow and Clyde and Lanarkshire are taken forward on a regional basis with the full involvement of the Scottish Ambulance Service.

I am asking the Group to produce a plan, which I will require to sign off, setting out clearly how this will be achieved.

I am keenly aware of the very strongly held concerns in the local area for the future of Monklands Hospital. I consider that local people need certainty that this valuable local hospital will continue to provide them with a full range of appropriate services into the future.

I very much welcome the planned investment in Monklands Hospital included in A Picture of Health to secure its regeneration and renewal. I want to reinforce that commitment.

While acknowledging that the procurement route for the development of Monklands will need to be tested and the route which demonstrates best value for money adopted, it is recognised that this may be a publicly funded route.

I am therefore taking the prudent step of ensuring that up to £100m is provided for in the NHS Scotland capital programme to ensure that the regeneration can take place by 2010.

This £100m investment will comprise of £20m to secure the 112 bed acute adult and old age psychiatry unit and £80m to develop new facilities for acute services. This provides a clear commitment to the future of Monklands Hospital.

A Picture of Health included a proposal to locate specialist inpatient cancer services at Monklands Hospital; however consideration on this proposal was not concluded by the Board on 27 June.

I know that you are undertaking further work on this issue, and that you support our policy of providing cancer services that are as local and accessible as possible, while working with other Boards and the West of Scotland Cancer Centre (Beatson Oncology Centre) and the cancer clinical networks to ensure that these highly specialised treatments are delivered and available when patients need them.

This is a particularly important issue in Lanarkshire because of the incidence of cancer in the area. As the Board considers future arrangements to provide the best cancer services for Lanarkshire patients, I expect you to consider carefully the disposition of cancer services right across Lanarkshire. In particular, I would need to be convinced about any proposals that suggested a location other than Monklands Hospital for cancer inpatient services. While recognising that demonstrable clinical safety benefits must be given the highest priority.

In light of this I would like to receive a realistic timetable for the consideration and engagement that needs to take place before the Board comes to a decision on this very important matter.

I do not underestimate the challenge posed to NHS Lanarkshire to progress this major agenda for service change and modernisation in Lanarkshire. I recognise the hard work and deliberation by the members of the Lanarkshire NHS Board and the commitment of management and staff involved in progressing your proposals.

I hope that all concerned will seize the opportunities to contribute constructively to the implementation of the Board's proposals and so transform health services and the health of the people of Lanarkshire.

Lewis Macdonald
Deputy Health Minister