Press Release
25th July 2003
Secret
Documents Reveal True Price of NHS Centralisation
800,000
Women and Children to be forced into 2 hospitals, 7 miles apart
MSP
for Greenock & Inverclyde, Duncan McNeil, has expressed his “shock and
outrage” that key documents which spell out the devastating consequences of
centralising all Argyll and Clyde’s consultant-led inpatient maternity
services at Paisley’s Royal Alexandria Hospital were kept secret during the
public consultation on the issue.
Among
the consequences exposed in the graphic documents are:
Mr
McNeil, who was anonymously passed copies of the internal files, said the
revelation completely invalidates a consultation process which was already in
breach of Executive guidance.
“This
consultation was already in tatters,” he said today.
“It was substantially curtailed and ran through holiday periods and
election campaigns. Most of the public meetings and information events were held
during working hours and were not attended by consultants.
“But,
as if that wasn’t bad enough, we now find out that even those who managed to
jump through the hoops and register their views have based
their comments on incomplete information. Their
time has been wasted
and the consultation rendered useless.
“At
the heart of the Executive’s interim guidance on how consultations such as
this should be run is a requirement for the board to be
able to clearly show that they actively involved the public in an inclusive way.
I can’t think of a more blatant breach of this requirement than
withholding key evidence from those very people whose opinions you are supposed
to be seeking.
“The
idea that the consultation was genuine or adequate has been blown out of the
water – as has the idea that
next Tuesday’s decision is just about where a few hundred babies are born. We now see that this decision will affect 800,000 women and
children who could have all their consultant-led inpatient services concentrated
at two hospitals – Paisley’s RAH and Glasgow’s Southern General – which
are 7 miles apart.
“I
therefore fully expect the Board members to give these plans short shrift at
their meeting on Tuesday.”
Argyll
and Clyde Health Board will meet on Tuesday 29th July 2003 to
consider whether to back the report of the Argyll and Clyde Maternity Services
Steering Group, which recommends that all inpatient consultant-led maternity
services in the Health Board area be centralised at the Royal Alexandria
Hospital in Paisley. Mr McNeil has written to every Board member, advising them of
this breach of Executive guidance.
“In
2001 the Executive published a policy document in 2001 entitled Patient
Focus and Public Involvement which “requires” NHS Boards to actively
engage with patients and communities in NHS decision making,” he begins. “In 2002 the Executive published interim guidance for
Boards on how to do this. The
central requirement of the guidance is that Boards should be able to clearly
show that they actively involved the public in an inclusive way.
“Sadly,
a number of serious flaws in how this consultation was carried out lead me to
conclude that this central requirement has not been met.”
More
important than the curtailment of the process, he continues, is “the fact that
those members of the public who did manage to take part in the consultation
based their comments on incomplete information.
A number of April 2002 reports to the then Trust Management Team of
Argyll and Clyde Acute Hospitals NHS Trust, examining the impact of reorganising
maternity services on accident and emergency; gynaecological; paediatric; and
anaesthetic services, have come to my
attention. While these reports
clearly spell out the knock-on effects of moving maternity services from the
Rankin to the RAH, and while they have been available internally for some time,
they were withheld from the public.
“Recent
events at the Vale of Leven ably show us that where maternity goes, other
services follow and the impact of centralising maternity services on other
health services has been one of my chief concerns throughout this process.
Not to put a thorough examination of the effects of any move to
centralise services at the heart of the consultation was therefore a serious
error in itself. But that those
contributing to the consultation were denied information on this most vital of
issues, even when it was at hand, leads me, with deep regret, to conclude that
the process does not satisfy the requirements of the interim guidance and,
hence, was not in fact a true consultation.
“With
such an integral part of the decision making process therefore missing, I would
be surprised if the Board felt able to vote to back the Steering Group’s
proposal.”
Mr
McNeil’s letter also sets out in detail more of the reasons which convince him
that the Steering Group’s “sticking plaster of a short-term fix” cannot be
accepted.
“There
are, of course, many emotional arguments in favour of retaining the Rankin’s
consultant-led status, as, indeed, there would be with any maternity unit,” he
says. “But when the cold, hard
evidence is considered, I believe that an incontrovertible case for the unit
emerges.”
Mr
McNeil then asks the Board members to consider the basic arithmetic of the
situation, saying:
“You
would be forgiven for thinking that the matter on which you are being asked to
decide next Tuesday is about no more than where a few hundred babies are born.
But, in reality, your decision will have implications way beyond the
individual maternity units and indeed the Health Board boundary itself.
It could affect a quarter of the Scottish female population.
In fact, endorsement of this recommendation could concentrate
consultant-led inpatient services for over 800,000 women and children in two
hospitals – Paisley’s RAH and Glasgow’s Southern General – which are 7
miles apart.”
He
then questions why the underlying issues which led to and drove forward the
review have not been examined, saying:
“It
is almost universally accepted that a range of factors – the way junior
doctors are trained; the European Working Time Directive; the agreement on
junior doctors’ hours; the Europe-wide shortage of paediatricians; the
application of clinical standards and Royal College guidelines; and even such
mundane matters as how shift patterns are drawn up – is contributing to what
is a massive pressure to centralise services in the NHS.
It is a matter of regret there has been no serious examination of these
issues and how they could be effectively addressed in a review which they are
driving.
“There
has been no real effort to investigate, for example, the recruitment problems in
paediatrics, or whether the way in which duty rotas are being drawn up offer the
best service to the patient and best value to the taxpayer.
Nor have I have seen any evidence that cross boundary working or more
flexible, responsive working patterns have been explored.
It is also plain that this review has been carried out in isolation, with
absolutely no reference to neighbouring Health Board reviews, including
Glasgow’s acute review.”
The
Board should not, he concludes, endorse “this drastic proposal” unless it
can be absolutely satisfied that everything which can be done to reduce the
impact of these pressures on service delivery has been done.
Implementation
of the plans, Mr McNeil also warns, will give rise to an unsustainable
situation. It will only be a matter
of time, he says, before the services transferred to the RAH were moved to
Glasgow.
“Would
any pregnant woman coming from Greenock, or Largs, or Dunoon, or Tiree choose to
travel to a consultant-led service in the RAH, when she could give birth in a
university-led unit a few minutes further up the road?” he asks.
“In that case, how can it seriously be argued that, if all Argyll and
Clyde’s consultant-led inpatient maternity services go to Paisley, they will
remain there for any length of time before that unit’s low birth rates
precipitate its closure and the consolidation of everything at the Southern
General?
“This proposal, which I fully appreciate you are under pressure to accept, is simply a short-term a fix: a sticking plaster, if you’ll pardon the cliché, over a cut which prevents us dealing with the real problem underneath.
Mr
McNeil concludes:
“We
are of course faced with significant challenges in today’s NHS.
And it is by no means the sole responsibility of Health Boards to remedy
them. The Executive and the
professional organisations must work with Boards to alleviate the intolerable
pressures which are being applied from certain quarters and I am more than happy
to reassure you that this is an issue which I will continue to pursue
vigorously.
“The
simple question facing you next Tuesday, however, is whether endorsing this
recommendation makes addressing the big, underlying issues easier or more
difficult. Does centralising
maternity services, thus opening the door to the centralisation of other
services, make it easier or more difficult to deliver stable, accessible health
services?”
ENDS
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