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A&E closures reversed
06/06/2007
Accident and Emergency services at Ayr and Monklands hospitals will continue, the Parliament was told today, reversing previous plans for closure.
Cabinet Secretary for Health and Wellbeing Nicola Sturgeon told MSPs she has instructed the Health Boards to produce revised proposals by the end of the year which will enable A&E services to continue at all three sites in Lanarkshire and both sites in Ayrshire.
And she set out the Government's position on future NHS service change proposals.
"I have reversed the decisions because I think that is the right thing for the public and patients in Lanarkshire and in Ayrshire. The two Boards did not in my view give sufficient weight to the concerns expressed by local people about the planned withdrawal of A&E services.
"Many of these concerns were not based on an emotional attachment to bricks and mortar - as some people have alleged - but on a critical analysis of the needs of local communities now and in the future. The local circumstances - particularly issues of geography, access and transport in South Ayrshire, and concentrations of deprivation in North Lanarkshire - form a very important context for decisions like this.
"I do not think these factors were given sufficient weight in the original decisions. And the Boards did not consult on options that retained A & E services at all of the hospital sites - so the public had no opportunity to weigh up costs and benefits. We must never forget that the NHS is a public service used by the public and paid for by the public."
Read the full text of the announcement
Ms Sturgeon added:
"Public opinion cannot and should not override genuine concerns about the safety of services. But neither can public opinion be ignored.
"Health Boards and responsible government must balance local views and circumstances with wider considerations of clinical quality, sustainability, safety, and value for money. Only then can health boards and Ministers demonstrate that they have taken decisions in the best interest of local people.
"Patient safety and the sustainability of high quality services is of paramount concern and I will always carefully consider the views of clinicians, from whom a range of views have been expressed recently."
Elaborating on her plans for a new independent scrutiny panel to probe the Boards' proposals, Ms Sturgeon went on:
"The independent panel will have a vital role in ensuring that this balance is properly struck. I will ensure that the independent panel will have access to expert clinical and financial advice in order to scrutinise the Boards' revised proposals before reporting back to me. I will look to the independent panel to endorse the revised proposals only if they are demonstrably safe, sustainable, sound and evidence-based; and only if they offer value for money and have taken account of the views of local people.
"So there is no question, as some have irresponsibly suggested, of putting clinical services and lives at risk."
In relation to the overall NHS strategy, the Cabinet Secretary said:
"As I made clear today, we support the general principles set out for the future of healthcare services in Scotland by Professor David Kerr. I also made clear that I believe these principles should be applied in a way that takes proper account of local circumstances, including factors such as geography and deprivation.
"We agree with the Kerr report's key points that it is important to shift the balance of care into communities; 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. But that does not mean automatically endorsing every decision that is taken in the name of the Kerr report."
Ms Sturgeon said she was clear that uncertainty should be minimised by ensuring that final decisions were taken as quickly as possible, consistent with proper consideration, and that as many as possible of the developments planned by the Boards should be carried forward. The Health Secretary accepted that it would be important not to set back or slow down the Boards' service plans any more than is absolutely necessary to fulfil the commitment on A&E services. She said:
"That is why we have agreed with the Boards' that their proposals - having been scrutinised and evaluated by the independent panel - should be with me for a final decision by the turn of this year. I believe this timescale will achieve the necessary balance between effective public engagement and independent scrutiny, and the need to move forward swiftly to minimise uncertainty and the impact on service development.
"When the Boards make their fresh proposals they will clarify that many planned developments are able to go ahead. There may be some planned changes, however, where further work is needed to ensure that there is a good fit with retained A&E services, and also that service developments remain affordable."
"I also want to record my thanks on the positive way the Boards, their management and staff have responded to my decision, and for their commitment to working constructively in taking this forward. To this end, I want to reiterate that I have full confidence in the senior teams and staff at both Boards."
Ms Sturgeon said that her decision on Monklands and Ayr should not be seen as opening the way to revisiting decisions on NHS service change generally. She added:
"I have made clear that I have reversed the decisions at Monklands and Ayr for specific reasons, relating to geography and deprivation. These were specific manifesto commitments.
"I appreciate that difficult decisions have had to be made and that some of these have been hard for local communities to accept. However, it would be quite inappropriate to revisit these decisions - some of which were made several years ago - not least due to the uncertainty, instability, delay and cost this would engender in the NHS.
"But where there are real concerns about planned services, I am determined to work with local people and Health Boards to address these and ensure that local communities have full confidence in the services that are provided locally."
Looking forward to the range of decisions she expects to take in her new post, Ms Sturgeon said: "It is the case that difficult decisions about the NHS will always have to be taken. It is my job to face up to these. But it is also my job to ensure that the public has greater confidence in the decisions that are taken.
"When service change proposals do come to me for decision, I will operate a presumption against centralisation. That does not mean no change in any circumstances. But it does mean that any proposals must be robust, that all alternatives have been properly considered and that the health board can demonstrate that due weight has been given to public opinion.
"To ensure public confidence in service change proposals, any future significant health board plans must be subject to robust independent scrutiny. That is why I will announce as soon as possible arrangements to embed independent scrutiny in the service change process.
Concluding her comments, Ms Sturgeon said:
"What we are doing is what any responsible Government would do. We are committed to serving the best interests of the Scottish people. We are building on the consensus that was achieved by the publication of the Kerr report to ensure that independent scrutiny and effective public engagement are fully integrated into the development of high quality, modern, safe and sustainable healthcare services.
"And where decisive action is necessary to safeguard the best interests of patients and local communities - such as in our decision to reverse the decision about Accident and Emergency services at Monklands and Ayr this Government will not shirk from taking that action."
Read the full text of the Health Secretary's announcement