Meeting of the Parliament [Draft]
Meeting date: Wednesday, September 20, 2023
Agenda: Portfolio Question Time, Scotland’s Nature, Neonatal Services (Lanarkshire), Business Motion, Parliamentary Bureau Motions, Decision Time, Maternity Services
- Portfolio Question Time
- Scotland’s Nature
- Neonatal Services (Lanarkshire)
- Business Motion
- Parliamentary Bureau Motions
- Decision Time
- Maternity Services
Neonatal Services (Lanarkshire)
The next item of business is a debate on motion S6M-10497, in the name of Jackie Baillie, on protecting specialist neonatal services in Lanarkshire.15:58
According to the Scottish Government, 23 babies required the use of the neonatal unit at University hospital Wishaw last year—that is 23 babies who were born extremely prematurely, at less than 27 weeks’ gestation, or who had a low birth weight and required intensive care support. At the sick kids hospital—the Royal hospital for children—in Glasgow, there were 27 such babies; in Edinburgh, there were 33; and, in Aberdeen, there were 18. The Scottish Government, in its wisdom, has decided that neonatal services need to be reorganised, with the number of centres being reduced to three and the closure of the units at Ninewells hospital in Dundee, the Victoria hospital in Fife and University hospital Wishaw.
I will focus my remarks on Wishaw. Its unit is an award-winning service in Scotland’s third-largest health board, which serves a significant population of our country. It makes no sense to close the unit, and its closure is vehemently opposed by parents and clinicians. Today, I and the Scottish Labour Party add our voices to theirs.
The appraisal report on which ministers have based their decision is seriously flawed. In a devastating briefing to MSPs, the Government’s approach is exposed. No consideration was given to population deprivation factors in the areas that are served. No consideration was given to the lack of transport links for families or the inequality that will be caused. No consideration was given to the displacement of families from their community networks, which sustain them. No wonder there is a 12,000-strong petition opposing the move, which was started by Lynne McRitchie. Lynne’s son Innes, who is now aged 4, was born in Wishaw, and she is concerned about the level of stress and trauma that having to move extremely premature babies would cause families at a time when they are already extremely vulnerable.
The view from clinicians and senior staff members is equally stark. The data on which decisions were taken is incomplete. No up-to-date evidence base was used. No outcome data will be available, as there is no measurement of baseline. How on earth can we tell whether the model will work if we do not have that information? The Scottish Government is keen to say that it listens to experts and that it is all about evidence-based policy making—but just not when it applies to neonatal units, including the one in University hospital Wishaw. If the minister has evidence, she should publish it. If she is so sure of her ground, she should meet with the clinicians at all the units that she intends to close, and with the parents, too.
There is more. NHS Lanarkshire was not represented on the working group at all, yet other health boards were. There has been no consultation with stakeholders and no consultation with the staff at the neonatal unit or with families, and there is no sign of a Government consultation after it has made its decision. As I recall, the national health service and the Scottish Government are supposed to consult on major service changes—or do the rules not apply when it comes to the Scottish National Party?
Parents will tell you that the staff at University hospital Wishaw are highly skilled and well trained. The specialist neonatal team, including consultants, nurses, midwives and allied health professionals such as pharmacists, dieticians and occupational therapists, are literally life savers. How could the Scottish Government not speak to them? I am completely baffled by the Scottish Government’s tone deaf approach.
Its decision has had a profound impact on staff wellbeing. Nursing students who were seeking a career in Wishaw have withdrawn their applications, and we know that there will be an impact on maternity services, too. I know that the wider question of maternity services is being explored in a debate that will be led by Meghan Gallacher. Colleagues are right to point out the lack of consultant-led maternity services in Elgin, which have been promised by the Scottish Government but with no plan for recruitment or delivery.
Let me turn to another aspect of the neonatal decision, which is staffing levels. Statistics from the national neonatal audit have a very interesting story to tell about the coverage of nursing shifts. A comparison of statistics for quarter 2 of 2023—the latest available statistics—shows that, in Glasgow, coverage for nursing shifts in neonatal units was 65 per cent. In Edinburgh, the same coverage was 56 per cent. In Wishaw, the coverage was 91 per cent—yes, 91 per cent of shifts were covered—making it consistently the best-performing neonatal unit for staff coverage. Why is the Scottish Government closing a unit that has good levels of staffing, which we know matters in securing good outcomes for babies? Neonatal nursing staff at the sick kids hospital tell me that they can barely cope with the number of sick babies that they have to care for now, without adding even more.
Jaki Lambert of the Royal College of Midwives said:
“The best interests of the baby and parents must always be the focus of any service changes ... it is essential that these three units have the capacity for all the babies that will need care, and accommodation for the mothers.”
The Scottish Government would do well to heed those words, as well as the views of expert clinicians and nurses and families.
The survival of some babies will be put at risk by the decision, and the minister must listen and reverse it. SNP MSPs have the chance to pick which side they are on—the side of families and clinicians or the side of their party bosses. I know whose side I am on.
That the Parliament is concerned by the Scottish Government’s decision to downgrade the award-winning neonatal services in University Hospital Wishaw, which will result in newborn babies who require specialist care being transferred to one of three specialist intensive care neonatal units across Scotland; recognises that many families across Lanarkshire have had their newborn babies cared for in this Neonatal Intensive Care unit, and that they are deeply upset by this decision to withdraw critical services and expertise from local communities, and calls on the Scottish Government to reverse its decision.16:05
In the 75 years of the national health service, we have never stood still and we have adapted our service to meet the needs of the population. I have had the pleasure of meeting a number of parents, families and maternity staff, who all have the same aspirations: they all want the best for the babies in their care, and we must act accordingly to support that.
The approach set out in “The Best Start—A Five-year Forward Plan for Maternity and Neonatal Care in Scotland” outlined that Scotland should move from the current model of eight neonatal intensive care units to a model of three units supported by the continuation of current NICUs, which would be redesignated as local neonatal units.
The evidence is clear that the chances of survival are better for highest-risk babies when they are cared for in units by clinicians who see more of those babies and have access to specialist support services. Babies born at highest risk are defined as those who are born at less than 27 weeks’ gestation, who weigh less than 800g or who need multiple complex intensive care interventions or surgery.
Will the minister take an intervention?
I have a lot to get through, if the member does not mind.
The process of determining which units should be providing neonatal intensive care followed an options appraisal process that was undertaken by an expert group that included clinical leads and service user representatives. In NHS Lanarkshire, those representatives included the best start perinatal sub-group.
Will the minister take an intervention now?
I am not going to take any interventions.
Like Jackie Baillie, I welcome the opportunity to congratulate Wishaw General’s neonatal multidisciplinary team on being named the UK neonatal team of the year in 2023. The work that the unit does is remarkable, and hearing the words of parents who have written to me confirms that the care that it is providing is inspirational.
The “Best Start” document recommended that the new model of neonatal care should be based on the British Association of Perinatal Medicine definitions of levels of care. That moves us away from the previous descriptions of units as level 1, 2 or 3, and it describes units as neonatal intensive care units, local neonatal units and special care baby units.
I would like to reassure everyone that, under the new model, the scope of the practice that the local neonatal unit will be able to undertake is wider than the previous level 2 definition. The units will continue to provide a level of intensive care and will be able to care for babies born at greater than 27 weeks’ gestation.
The intention with the new model of care is that mothers in suspected extreme pre-term labour will be transferred, before they give birth, to maternity units in the hospitals that have neonatal intensive care units, allowing them to be cared for alongside their baby. It is recognised that that will not always be possible, and, in those cases, our specialist neonatal transport and retrieval service—ScotSTAR—will transfer those babies in specialist ambulances that are equipped to care for neonates. That has been established practice for many years. Babies receiving intensive care will then be transferred back to their local neonatal unit for on-going care as soon as possible.
The parents and carers of those babies must be supported to provide care alongside the neonatal staff. The new model of care positions parents firmly as partners in their babies’ care. It includes expansion of transitional care; improved facilities and support for parents; and expanded neonatal community care, allowing babies to get home sooner. In addition, we have already introduced the young patients family fund—formerly the neonatal expenses fund—which continues to support many parents with the costs of having babies in neonatal care.
We will now work with all health boards affected to plan for and implement the service change over the course of the next year. However, it is also important that we hear the voices of families in the affected areas. Therefore, we will also be consulting with families, so that we can take account of their concerns when the pathways and processes for the new model of care are designed, and we will set up focus groups to support that.
Will the minister give way?
I am just coming to the close of my speech.
In closing, I would like to give my personal commitment, and that of this Government, to continuing to listen, learn and act upon evidence to ensure that our NHS delivers safe, effective and person-centred care.
I want to reiterate that this decision has been made on the basis of evidence that this change will improve the chances of survival for these very smallest and sickest babies. I am sure that members will agree that parents would very much expect us to act on such evidence in the best interests of their babies.
I move amendment S6M-10497.2, to leave out from “is concerned” to end and insert:
“believes that it is vital that the smallest and sickest babies born in Scotland receive the best and safest care possible to improve their life chances; notes evidence from expert clinicians that care for babies at highest risk is safest in units that treat a higher number of patients; agrees that parents would expect the Scottish Government to act on such evidence in the very best interests of their babies; welcomes the new model of neonatal intensive care, as recommended by The Best Start report, which was led by expert NHS clinicians and service user representatives, that delivers this change; notes that local neonatal units will continue to offer care to the vast majority of babies who need it, and that no neonatal units will close as part of the new model; further notes that all families who have a baby in neonatal care can access the Young Patients Family Fund, which provides support for costs of travel, food and accommodation; acknowledges the commitment of all neonatal staff across Scotland, and congratulates the Wishaw neonatal team on being named UK neonatal team of the year in 2023.”
Unusually for such a brief debate, we have a little bit of time in hand, so members who take an intervention should get the time back. However, the interventions will need to be brief.16:10
What a cold, managerial speech with no empathy for families that was from the minister.
I draw members’ attention to my entry in the register of members’ interests—I am a practising NHS general practitioner. We are disillusioned with the Scottish Government’s stewardship of our NHS and the indifference shown by successive SNP health secretaries to many well-documented calls by local communities to support critical services.
Here we are yet again: 12,000 people support Lynne McRitchie’s petition to reconsider downgrading University hospital Wishaw’s award-winning neonatal services. The Scottish Government remains unconcerned. I ask the cabinet secretary to look the families in the gallery in the eye and tell them the truth. He does not care about their opinion.
Currently, Scotland has eight intensive care neonatal units. Under the Scottish Government’s centralisation plan to abandon rural communities, that will be reduced to three—Glasgow’s Queen Elizabeth university hospital, Edinburgh royal infirmary and Aberdeen maternity hospital.
Of course, the SNP has form when it comes to forcing mothers and babies to travel vast distances for care. In NHS Highland, women in Caithness and Sutherland have faced round trips of more than 200 miles to access obstetrics and gynaecology services in Inverness. Further along the Moray Firth, Dr Gray’s hospital in Elgin has not had a consultant-led maternity unit since Shona Robison was health secretary. Over the past five years, the majority of Moray mothers have had to face a 90-minute trip east to Aberdeen or an hour’s trip west to Inverness. From Wishaw to the Borders and from Moray to Portree, maternity services across Scotland should be provided with the resources that they need to provide crucial care to newborn babies.
Scotland is so much more than its three biggest cities. More than 4 million people live elsewhere, with around 1 million Scots living in rural and island communities. Services need to be designed, resourced and optimised accordingly. Being wedded to centralisation, apathetic to local needs, will not wash.
The Scottish Government has also ridden roughshod over neonatal patient safety by way of its May 2022 directive to health boards, which limits the use of off-framework agency nurses. I understand the need to restrict the use of agency staff and control costs, but at a time when the Scottish Government has made a mess of workforce planning, and with a soaring 6,000 nursing vacancies, the consequences of coming down hard result in unsafe staffing levels.
The directive came into force on 1 July. What has been the impact? As of 17 September, an off-framework agency—just one—tells me that, due to new controls, it has been unable to place nurses in more than 300 neonatal shifts since 1 July. Managers are openly saying that understaffing will just have to be accepted and that it is on the staff. In total, across general medical and surgical wards over the same period, the agency has been unable to fill more than 7,500 shifts because of the Scottish Government’s directive.
We have neonatal intensive care agency nurses being brought up from London to Scotland to cover shifts. We are told that neonatal staffing levels in several regions are dangerously low. We know of a paediatric cardiac consultant whose cases were cancelled due to staff shortages that could not be backfilled under the new directive.
Will the member take an intervention?
I am just about to finish. The SNP is clearly heavy handed and disregards the nuanced needs of families, which causes distress and discontent. There is a lack of empathy, and it stamps its authority on patients and staff alike. It is crucial that we pause and listen.
I move amendment S6M-10497.1, to insert at end:
“, and understands that declining maternity services is not being experienced exclusively in Lanarkshire, with Dr Gray’s Hospital in Elgin still waiting for its consultant-led maternity services to be restored, five years after they were temporarily downgraded, and with maternity services at Caithness having been permanently downgraded, leading to expectant mothers being forced to travel vast distances just to give birth.”
We move to the open debate.16:15
My daughter Rosa was born on 1 April 2017 at University hospital Wishaw. She was born at 27 weeks gestation, weighing 535g or just one pound and three ounces. She came home from hospital almost exactly five months later, having spent the vast majority of those five months in the neonatal intensive care unit that the Scottish Government plans to downgrade.
My daughter’s birth was an emergency birth. My wife’s labour was induced early because she had developed an acute infection that, left unchecked, would have killed them both. We were told that, because of our daughter’s size and gestation, she would be very likely to be stillborn or to die shortly after birth, but that the neonatal team would be on standby to do what it could. We were left hoping and praying for a miracle, but miracles do not happen—miraculous people happen. After the birth, the miraculous staff at Wishaw worked to keep our daughter alive and get her into the intensive care unit for the start of a five-month rollercoaster journey of recovery. There could not have been a stabilisation and subsequent transfer to Glasgow, Edinburgh, Aberdeen or maybe even the north of England, because she was too sick. The Government’s proposal means that Lanarkshire parents of the sickest babies, who need the most support, will be left with the choice between making a journey that they know is not in the best interests of their baby or leaving them with a skeleton staff who do not have the award-winning knowledge, experience or capacity that exists in the hospital right now.
Shortly after my daughter was born, my wife’s health deteriorated. She was haemorrhaging and had to be rushed to emergency surgery. She spent more than a week in recovery. She felt incredibly guilty that she could not be with our daughter beside her cot, but at least she could be in a nearby ward to provide the breast milk that is crucial to the survival of premature babies. I know that it would have been far too much for my wife to cope with if our baby had been moved to a different hospital before my wife was healthy enough to be discharged. However, there was also the issue that she was not our first but our second child. Sick babies are not born in isolation. It is all very well for the Government to say that travel, accommodation and food costs are covered. Although that is a good thing, parents have to fight for it and it is absolutely galling that that has been used as a partial shield for the decision. However, we are talking about moving mothers away from their communities, families, children and that vital support network. How does a mum get their kids to nursery or school in Lanarkshire and then get to Aberdeen to care for their sick baby?
I have told my family’s story, but it is far from unique. Rosas are being born in Wishaw every other week—I have met them. Their families and the staff have not been listened to. This Parliament and Government should listen to the team in Wishaw that is working miracles every day. We should be supporting the staff to do the award-winning work that they want to do and supporting families to give their baby the best start—locally, and surrounded and helped by their wider family and community.16:18
First, I pay my respects to Mark Griffin’s description of his experience. I also acknowledge that he is the first speaker in the debate who lives in and is a representative for Lanarkshire, which I am not. However, I will relate my experience.
I have three children, the first of whom was born in the Simpson memorial maternity pavilion. When she was born, not that unusually, she was not breathing and was blue, but the very adept and experienced midwife quickly remedied that with a couple of flicks to the toes and a wee bit of oxygen up the nose. The point is that there was no panic, because that person had seen that happen so many times in the past.
I will contrast that with the birth of my two sons, who were born elsewhere, in a much smaller hospital. The birth of my first son was pretty straightforward. When my second was born, his mother haemorrhaged. I think that there was real panic on the part of the midwives who were there. They were not sure what to do. I overheard a conversation about whether they should get a doctor. I do not question their commitment, compassion or expertise; it was simply a case of their not having seen what was happening nearly as frequently as others might have.
My son was then released from hospital, despite the fact that he had two holes in his heart, which were undiagnosed at that point. We had to take him back, but he could not be seen at that hospital and we had to go through to Glasgow for care. That episode left me with the impression that the greater the throughput of unusual experiences the better, and the more specialist the care becomes.
The second hospital that my two sons were born in was very convenient for me, but I would pass that up for making sure that they had the best possible care and attention. I might be wrong, but that is what I consider is underlying the changes.
It is crucial to recognise that the neonatal unit at University hospital Wishaw will remain open and that no neonatal units are closing as part of the plans. University hospital Wishaw, Ninewells hospital and medical school in Dundee, the Princess Royal maternity hospital in Glasgow, Victoria hospital in Kirkcaldy and University hospital Crosshouse near Kilmarnock will all continue to operate their neonatal units.
Of course, we are in a period of transition. In order to maximise the effectiveness of care to our newborns, the Scottish Government has opted to reconfigure the neonatal services that are on offer. It is doing so on the basis of expert advice, with a focus on providing the highest level of care in three specialist intensive care neonatal units.
Will the member give way?
My apologies, but I have only four minutes. I do not know why these debates are so short, but I do not have much time to speak.
The units for babies born with the highest risk will be based in Aberdeen, Edinburgh and Glasgow, and they will be dedicated to the smallest babies facing the most significant health challenges, ensuring that they are born where they can readily access the specialist care and services that they need. Babies born before 27 weeks, weighing less than 800g or requiring complex life support will be supported at those locations.
The rationale for the change, which the best start report recommends, is the belief that focusing care for those high-risk infants in units with the capacity to treat a high volume of patients will ultimately yield safer outcomes. That is what is at debate here.
We have heard that people do not care, but I think that everybody in the debate cares about such things. The ultimate aim is to ensure that as many children as possible—especially the most vulnerable ones—are born safely. As parents, that is what we all want.
We have heard from the minister that the changes are in line with advice from expert clinicians. Dr Lesley Jackson, who is the clinical lead for the Scottish neonatal network, and Caroline Lee-Davey, who is the chief executive of Bliss, which is a charity that is designed to improve the care and treatment of babies born prematurely or who are sick, have both voiced their support for the change. They believe that reconfiguring our services can improve the quality of neonatal services in Scotland. I think that the Scottish Government has an obligation to do exactly that. The objective is to offer increased care to those babies who need it most, while ensuring that they can return to one of the excellent local neonatal units across the country, such as University hospital Wishaw, which I stress again will remain open.
The decision to reconfigure neonatal services is based on sound evidence and expert advice. However, we must ensure, as far as we can, as has been said, that we bring the local community along with us. We have to work collaboratively to deliver the new model of neonatal care effectively for newborns and their families.
Thank you very much, Mr Brown. It is, of course, up to the members whether they take an intervention. These debates usually seem to allow very little time to do that. However, on this occasion, there is a little bit of time in hand. Therefore, if there are brief interventions, you should get the time back.16:23
The Scottish Government’s amendment rightly congratulates the team at Wishaw university hospital on being named UK neonatal team of the year 2023. It is a wonderful achievement and one that we should all celebrate, but we are in a ridiculous situation in which the Government is praising Wishaw’s neonatal unit in one breath and downgrading it in another. We need the Government to make sense. For the parents, families and healthcare professionals who know the unit inside out, the decision is absurd, out of touch and dangerous.
The Scottish Government will be making a terrible mistake if it allows the neonatal unit at Wishaw to be downgraded. The petition against the plans that has been spearheaded by Lanarkshire mum Lynne McRitchie has already been signed by more than 12,000 people. The widespread community outrage and worry is unsurprising, as Wishaw’s neonatal team are like a second family for so many in our communities.
I thank everyone who has signed the petition and I pay tribute to Lynne McRitchie, who is in the public gallery. We are also joined by Angela Tierney from Blantyre, who told me that the care that the neonatal team provides to babies, including her son Olly, is provided as if the babies were their own children—care is provided with love, compassion and enormous skill. When Angela gave birth to Olly, she was extremely ill and, like Stephanie Griffin, she could not be moved. Olly received excellent care at Wishaw hospital but, sadly, he died. He was only five days old. The memories that Angela, her husband Barry and their family were able to make in their community with Olly will stay with them for ever.
Under the Government plans, Olly would have been transferred from Wishaw and separated from his extremely ill mother, and the Tierney family would have been robbed of precious time with their Olly. The minister and every MSP should think about Olly when we vote tonight. Olly is not a statistic; he was and is a precious member of a loving family and community that continues to fundraise for team Ollybear Blantyre, raising vital funds for Wishaw’s neonatal unit in his memory.
I am so disappointed by the letter that I received from the minister last week in response to our request for a pause and a rethink. Jenni Minto attempts to justify the downgrade by saying,
“This will affect a very small number of families in Lanarkshire.”
She should tell that to the Tierneys, the McRitchies and the Griffins. As we heard from Rosa’s dad—my brilliant colleague Mark Griffin—it is a life-saving unit, and the minister would do well to listen properly to families. I and my colleagues have listened. Members should listen to Lynne McRitchie, who believes that her son Innes would not be alive today if he had been transferred to Glasgow, Edinburgh or Aberdeen. Innes is thriving today, thanks in large part to Wishaw’s neonatal team.
We have heard from Jackie Baillie that the Government’s downgrading plans are having an impact now. Several nurse recruits who had accepted job offers have withdrawn following the publication of the appraisal report in July. NHS Lanarkshire needs support with recruitment and retention, especially in the aftermath of the board’s code black status, but the plans will undermine that.
Do ministers really intend to separate families at a critical and traumatic time? How can the Government claim to be tackling inequality when it is downgrading a vital neonatal unit in one of Scotland’s largest and most deprived health boards? The strength and scale of the community reaction to the proposal should give the Government pause for consideration on whether it really represents the best start. The Government has not properly included families or staff in Lanarkshire. However, it is not too late. It should start listening, fix this flawed process and stop the downgrade of Wishaw’s neonatal unit.16:28
I welcome the opportunity to debate maternity services not once but twice today. That shows how important the issue is right across Scotland. I hope that the members who have spoken or will speak in this debate will stay for the members’ business debate after decision time so that we can continue this important conversation.
Recent developments have rightly caused outrage across Lanarkshire and the surrounding areas. Local people have set up campaign groups to object to this ill-thought-out decision. Their message is simple: they do not want the neonatal department at University hospital Wishaw to be downgraded. Why would they? It is the same department that won the United Kingdom neonatal department of the year award in 2023. It makes no sense to me that the Government has decided to reward such an outstanding department by removing the vital support that it provides to expectant mums and their newborn babies. The kick in the teeth, which members have mentioned, is that the Government’s amendment has the cheek to congratulate the department on its recent achievements. Talk about being tone deaf.
Over the past few weeks, I have been in touch with wonderful women who have shared their stories about how much they value the neonatal department at University hospital Wishaw. It is great to see some of them in the public gallery to watch this debate and the one that will follow.
I recognise and commend the efforts of Lynne McRitchie, who has been the driving force behind the campaign to stop the downgrade of the Wishaw neonatal unit. She said recently during an interview that, while the decision represents
“a real loss to parents ... ultimately it’s a real loss to babies who are born so prematurely or poorly.”
Lynne’s petition has gained a whopping 12,337 signatures. If that does not send a strong message to the Government, I do not know what will.
Among those who have contacted me are midwives, past and present, who cannot make any sense of the proposals that are outlined in the document for NHS redesign of maternity and neonatal services. They have told me that removing a vital service from the heart of the central belt of Scotland is not the answer, and they are deeply concerned about the lack of evidence to back up the loss of a vital neonatal service. Not only will Wishaw general be impacted, but Ninewells hospital in Dundee and Victoria hospital in Fife have also been selected as part of the downgrade proposals. All those hospitals are in areas with high levels of deprivation, where wrap-around care needs to be as close to communities as possible.
Let us face it: this Government does not have the best track record when it comes to maternity services. We only need to speak to mums in the Highlands to know the consequences of removing maternity services—and, by the way, maternity services at Caithness general hospital and Dr Gray’s hospital are still not fully operational. There has been no urgency from the Government to reopen them, and that has undoubtedly put expectant mums and their unborn babies at risk.
I have only four minutes for my speech, which is not a lot of time, so I am pleased that we are having two debates on the issue today. To conclude, I make a direct appeal to the minister to back the petition, listen to communities and midwives, and stop the downgrade of the Wishaw neonatal unit.16:31
Presiding Officer, you might reasonably ask why a member from the islands is talking about neonatal care in Lanarkshire. However, as members from other parts of the country regularly mention my constituency, as is their right, I make no apology for occasionally straying across the Minch. Before I say anything else, however, I recognise the authoritative and heartfelt contributions that were made by Mark Griffin and Keith Brown, in very fine speeches.
The fact is that the provision of neonatal care is an issue across Scotland, and I am acutely conscious not only of the excellent work that hospitals in my constituency do, but of the many mothers who, for various reasons, already make very long journeys away from their families to have their babies in larger hospitals on the mainland, and have done so for many years.
I am happy to take this opportunity to acknowledge that University hospital Wishaw has provided an extremely high standard of neonatal care. Countless parents are grateful to staff there for supporting them through some of the most challenging, joyful or heartbreaking moments of their lives. The neonatal unit at Wishaw will continue to provide that support and care for parents and babies in the future. The key change, as others have mentioned, is that the most premature or unwell babies will now be cared for at specialised intensive care neonatal units. As others have set out, that model of neonatal intensive care was recommended by the best start report and it was based on clinical evidence that care for babies at the highest risk is safest in units that can treat a higher number of patients. Meanwhile, neonatal units in Dundee, Glasgow, Kirkcaldy and Kilmarnock, as well as Wishaw, will continue to provide neonatal care for their populations.
As a rural MSP, I am in favour of localised healthcare provision wherever it is possible. However, where the expert advice calls for specialist units, it is crucial that patients and their families are fully supported to receive care where it is felt to be clinically most appropriate. Keith Brown alluded to the fact that ensuring the best possible outcomes for patients must be the priority.
The best start report, which was published in 2017, listed 76 recommendations as part of a five-year programme to improve maternal and neonatal services in Scotland. The Scottish Government accepted all those recommendations, including the establishment of a new model of neonatal intensive care. Within the model, the most preterm and the sickest babies will receive specialist complex care in three main centres. That approach is based on evidence showing that babies who are cared for within that kind of framework have improved outcomes.
Will the member give way?
I must make progress given the little time that I have.
The Scottish Government has taken many significant steps to support expectant and new parents. Those steps have been alluded to today. Quite rightly, the vast majority of the 5,000 babies who are admitted to neonatal care each year will continue to be treated in their local neonatal units and postnatal wards. I therefore say respectfully that I am not sure that questioning the expert clinical advice of those who were involved in producing the best start report—which is, in effect, what some are doing today—is a helpful way forward. Nor do I believe that making undeniably difficult decisions, which the NHS has to make, in the context of highly charged political debate would be entirely helpful when compared with the other option of listening to clinical advice.16:35
I begin by expressing my sincere thanks to all those who work in neonatal units across the country and who care for some of the sickest babies born in Scotland. I also thank everyone who has shared their story so bravely today.
Understandably, neonatal care is an extremely emotive subject, and it is vital that the concerns of parents and staff about the changes that are under discussion are heard and responded to. That is why it is so important that we clearly set out what those changes mean, how people in the NHS Lanarkshire health board area will be affected and, crucially, what services will look like.
University hospital Wishaw is in my region, and I have heard from people who are worried about what any changes to neonatal care will mean for staff, patients and their families. I am sure that many of us in the chamber have received correspondence from staff members who are concerned about those changes and why they are taking place. Alongside today’s debate, it is vital that the Scottish Government engages with staff from University hospital Wishaw and that a forum is provided for them in which to raise questions and have those answered.
It is important to recognise that this proposal is a result of recommendations from expert clinicians.
Does the member agree that the forum should have happened before the decision was taken and that the fact that that did not happen and that they have not been involved in the process whatsoever has led to many families being exceptionally concerned about what is happening?
Gillian Mackay, I can give you the time back.
I agree that it is vital to share all information that can be shared ahead of decisions being made to ensure that we bring communities along with us with these decisions. That includes staff and all clinicians who are working in the units.
“The Best Start” report recommended a new model of neonatal service provision based on the suggestion that the care for the smallest and sickest babies be consolidated to deliver the best possible outcomes, and that change is part of the new model. The report was produced in conjunction with clinicians.
Will the member take an intervention?
I need to make some progress. I am genuinely sorry.
The report was produced in conjunction with clinicians, and it is worth stating that the recommendations on the new neonatal model of care are underpinned by strong evidence that population outcomes for the most premature and sickest babies are improved, with regard to delivery and care, in units that look after a high number of these babies, as we have heard from other members.
Outcomes for very low birth weight babies are better when they are delivered and treated in neonatal intensive care units with full support services and experienced staff. Therefore, babies who are born at under 27 weeks, who are lighter than 800g or who need complex life support will receive specialist complex care in these units.
It is important to stress that, although that will result in care for the smallest and sickest babies being delivered in a smaller number of specialist centres, no units will close as a result, and University hospital Wishaw will continue to provide excellent care of babies that require treatment in a neonatal unit. Local neonatal units will continue to provide care, and babies will be returned to their local area as soon as they are well enough.
However, that is certainly not to dismiss how distressing it can be for parents whose babies are treated outwith their local area at what will already be a very emotional time. I absolutely recognise the points that were raised by Mark Griffin, among others, about the issues when a baby is in one health board area and the family is in another. We need to ensure that families receive all possible support and that as many of those issues as possible are taken care of.
It is vital that babies receive the best care available, but it is equally vital that we support parents and carers, and I would be grateful if the minister could advise what emotional support is available to families whose babies are being treated outwith their local health board area.
These changes are the result of expert advice and are being made so that the smallest and sickest babies can receive the best neonatal care possible. They are a sign of Scotland’s improving neonatal healthcare, but it is so important that we take people with us and that we continue the dialogue with worried staff, parents and carers who also just want to see the best for their babies.16:39
I welcome the opportunity to speak in this debate. I thank the Labour Party for using some of its debating time for such an important topic. I declare at the outset that I have a daughter who is a midwife in the Scottish NHS and that my youngest was born at Wishaw, as was my eldest grandson.
It is a timely debate for me, because I—along with my colleague Carol Monaghan—was recently invited by Ayrshire and Arran NHS maternity unit into the hospital to discuss issues affecting the care that the staff there give. I would suggest that that was a very unusual step, because it is usually we politicians who request their time. Perhaps that speaks to the real concern being felt across midwifery in Scotland. During that meeting, I committed to bringing their points to this chamber, which is why I am grateful to have this opportunity. This is what they said—politics aside.
There is a shortage of staff and a workforce planning problem, and there is a problem around retention and recruitment. I hark back to when my daughter applied to be a midwife: there were 43 places available and more than 400 applications. We now have a situation in which they are going through clearance to fill those places. Retention and recruitment are, I think, among the major problems that are leading to what is happening at Wishaw.
One of the issues raised by the group was the need to accept that, for the medical and midwifery workforce, there are increasingly medical complexities for the women using the service. Midwifery is a specialist role that has expanded over the past 10 years, but without recognition of that increase in its responsibilities.
The medical requirements for midwives go way beyond what we traditionally recognise as midwifery. The change is rapid and the level of medical intervention that we expect from them continues to grow. Professional staff, including midwives, now have degrees and complete a flying start support practice year. That requires staff not only to deliver a mentoring programme for those who are about to qualify but also to oversee new starts. A reduction in staff impacts the ability to train new staff.
They want support for early career midwives and to see opportunities for consolidation and development in maternity services so that they do not have to leave the service to better their incomes or development potential. That development stops after just a few years, which, again, speaks to the retention of staff.
They want to be able to spend time supporting women and families in an individual and holistic way, such as in relation to smoking cessation, diabetes prevention and management, how to help women keep well in pregnancy physically and mentally, and preventative health, which we talk about a lot in here—but we do not deliver the tools for our healthcare workers. Retention is a huge issue, with the pressures of the job and increasing responsibility without the support and environment to match that responsibility.
They want routes to training and development, such as Open University opportunities, to allow them to grow their own staff. That couples with an issue that I have raised many times—digital platform investment that collaborates with interfaces. That has to be the starting point for delivering a more efficient NHS.
I will not go through half of their list, but I will mention the practicalities that they raised. The delivery of maternity and community sessions in our rural areas, which was mentioned earlier in the debate, is impacted by the move to electric vehicles without the infrastructure to support those electric vehicles. That is a definite cart-before-the-horse scenario.
They are also asking the Scottish Government to stop delivering changes in process or guidance to health boards at 5 o’clock on a Friday evening, when there is little or no time to evaluate or implement those changes. Surely it is not too much to ask for the vision timeline that staff need, with dialogue including evaluation of matters that impact healthcare. It seems that the Scottish Government does not recognise that healthcare staff work shifts and will not necessarily be in the building when directives arrive at short notice.
That is just a snapshot of the issues that were raised by those on the front line. Real practical changes could be made to allow our front-line staff to do the job that they love in a manner commensurate with their commitment. It is time that the Scottish Government considered the practical impact of the interventions that they impose on our midwives. The Scottish Government needs to take the time to speak with those on the front line and to deliver a working environment that encourages and supports our midwives to stay in the service.16:44
I thank Jackie Baillie for bringing the subject to Parliament. Given the clearly personal and important contributions made by members, I am sorely disappointed that more time was not given to this emotive debate.
My constituency is covered by services provided by University hospital Wishaw, and I have had a few—not many—constituents get in touch who are keen to better understand why the decision has been taken. “The Best Start” report recommended a new model of neonatal intensive care and is based on evidence that care for the babies at highest risk is safest in units that can treat a high volume of patients. It needs to be said again that no neonatal units will close. The model of neonatal services will be redesigned to accommodate the current levels of demand, with a smaller number of intensive care neonatal units supported by local neonatal and special care units.
Will Collette Stevenson give way?
I am sorry, but I do not have any time in hand.
“The Best Start” report begins:
“Wherever women and babies live in Scotland and whatever their circumstances, all women should have a positive experience of maternity and neonatal care which is focused on them, and takes account of their individual needs and preferences.”
Surely we can all agree on that.
The new, refreshed model of maternity and neonatal care is based on the current available evidence. It uses best practice and feedback from families and front-line staff to design and further improve existing services. Clearly, the decision is major, but I do not believe for a second that it has been taken lightly. Evidence tells us that long-term health outcomes will improve for babies if they are cared for in higher-volume units.
There are approximately 50,000 births a year in Scotland. Of those, 5,000 are admitted to neonatal care. The majority of those babies will continue to be delivered in local units and postnatal wards. Around 110 to 130 babies are born under 27 weeks each year and the change will affect around 50 to 60 of them. When they are well enough, they will be moved to their local neonatal units for further care.
When news of the changes broke, my first thought was to ask how they would affect my constituents. Would they have to travel further? What support would be in place for families during a hugely testing and emotional time for them? Therefore, I was pleased to have clarity that special care services will be relocated to Queen Elizabeth university hospital. From my office in the centre of East Kilbride, it is 14 miles and takes around 27 minutes to get to the Queen Elizabeth university hospital. It is 11.6 miles to University hospital Wishaw and takes 29 minutes. For the people of East Kilbride, the difference in travel times is negligible.
The young patients family fund was launched in summer 2021 and it enables families to claim financial assistance to support them during their baby’s neonatal stay. That allows them to focus on the health and wellbeing of their child and not worry about the financial costs that they might face for travel, accommodation costs or food.
Local neonatal units, including the one at Wishaw, will continue to provide care for the babies who need it, including a level of neonatal intensive care. The decision to move to three national neonatal intensive care units has been made in line with strong evidence and input from expert clinicians, who know that specialist care will deliver improved outcomes for the smallest and sickest babies born in Scotland. Every member in the chamber is united in wanting what is best for the smallest and sickest babies.
On a point of order, Presiding Officer. I wonder whether you can provide some advice. Collette Stevenson is concerned that Scottish Labour has not given enough time for the subject. The Scottish Government has given zero time. How could we go about getting a debate in Government time to allow Collette Stevenson and others to make fuller contributions?
I thank Monica Lennon for that point of order. She has been in this institution long enough to know that that is a matter for the Parliamentary Bureau. I know that she will speak to her business manager, who will be able to make that point.
We move to the closing speeches.16:49
It is clear who understands and who does not understand the decision to downgrade University hospital Wishaw’s neonatal unit. We can clearly see who has their hands over their ears and who is not interested. The people who are watching in the gallery will see that.
The staff at Wishaw’s neonatal unit have supported families across Lanarkshire at times when emotions are at their most raw, and stress runs especially high. Neonatal units care for the most vulnerable babies, but they see parents being at their most vulnerable, too. It is no wonder that 12,337 people have signed Lynne McRitchie’s petition. The community feels blindsided by another top-down decision from this tin-eared SNP Government.
In the north of Scotland, we are all too familiar with centralisation of NHS services under successive SNP health secretaries. As Dr Gulhane said, Scotland is so much more than three cities. The downgrading of Dr Gray’s maternity unit in NHS Grampian as a result of staff shortages has been disastrous for pregnant women. They have been forced to travel miles to Aberdeen or Inverness to deliver their babies, away from their homes and their support systems. There have been harrowing stories of women having to deliver their babies on the side of the A96. It is shocking.
The Scottish Conservatives have campaigned for those services to be reinstated. I am thankful that they will be, but by the time the consultant-led maternity unit at Dr Gray’s is restored, services will have been downgraded for at least eight years. Members should think of the impact on women and their families in that time.
Under the new model of neonatal services, newborn babies who need the intervention of a specialist NICU will be transferred miles away from the Wishaw hospital. For parents, the process of caring for a premature or seriously ill baby in hospital takes place around the clock, and it can involve weeks and even months of highly specialised care. Being close to home is not a silver lining; it is a lifeline. It means being able to care for the baby’s siblings and still do the school run. It means being close to friends and family who can lend a helping hand.
Dr Sandesh Gulhane highlighted the alarming shortage of neonatal nursing staff, which means that neonatal intensive care agency nurses are being brought up from London to Scotland to cover shifts. Once again, NHS services are suffering because the SNP has botched workforce planning.
Monica Lennon talked about the ridiculous situation that we are in, with the SNP praising a service in one breath but downgrading it in another. She said that the Government’s decision was
“absurd, out of touch and dangerous.”
“a pause and a rethink”,
and she asked the SNP-Green Government
“to listen properly to families.”
Jackie Baillie talked about the fact that there has been no consultation of stakeholders. As she is, we are baffled; we are baffled that the SNP-Green Government has not listened to the community.
Meghan Gallacher said that it was an “outrage” that the community has not been listened to. She said that it was a “kick in the teeth” that Wishaw’s neonatal unit, which is the UK neonatal unit of the year, is being downgraded, and an example of the fact that the SNP-Green Government is tone deaf. She said that midwives cannot make any sense of the Government’s decision. The same will be happening elsewhere across Scotland—for example, at Ninewells hospital and medical school, in my region.
The only empathy that has been shown today by members of the SNP-Green Government was shown by Gillian Mackay. Will she, please, on behalf of the Government, listen to the women and families and ask the Government to pause its decision, which is a terrible decision that will have disastrous implications?
This SNP-Green Government is clearly intent on progressing its plans for neonatal care, despite the strength of feeling that has been shown locally. We are all concerned about the impact of the Government’s decision on women who need to be at the centre of decision making on the future of maternity and neonatal care. The SNP has got it so wrong before. For the sake of patients and staff, it cannot afford to do so again.
I call on the minister to wind up.16:54
I thank all the members who have taken part in the debate. I appreciate that some of the contributions will have been emotional and difficult, but I very much appreciate that honesty.
I need to set out that the Government has acted based on expert clinical advice on where the smallest and sickest babies will get the best treatment and will, therefore, have better chances of survival. As I have outlined, the evidence is clear that the chances of survival are better for the highest-risk babies when they are cared for by clinicians who see more of those babies and when they have closer access to specialist support services.
Maintaining high standards of neonatal care is an on-going challenge.
Does the minister accept, based on the figures that were published by the Scottish Government that I read out, that Wishaw is seeing enough babies? While I have the microphone, I will also ask the minister whether she will publish the evidence, so that everybody can consider it; meet the clinicians at Wishaw, because they have not been listened to; and meet the families.
I can give you the time back, minister.
I need to stick with the expert clinical advice that we have received.
It is important that we ensure that all babies who are born in Scotland receive the best and most up-to-date care. There is a wide range of different needs associated with provision of neonatal care, ranging from routine baby care at home, to care in a midwife birthing unit, to the most highly specialist neonatal intensive care.
Evidence shows that the chance of survival for those very small numbers of the smallest and sickest babies is improved when they are born and cared for in a specialist unit. That model is supported by a range of stakeholders and clinicians, including Bliss, which is the leading charity for babies who are born premature or sick. It recognises that the new model of care is based on strong evidence and will improve the safety of services for the smallest and sickest babies. Keeping families together is at the core of the best start plan. As part of that, we have increased access for parents to psychological support in neonatal units. I commend the great work that our leading charities, including Bliss, do in providing support for families with babies in neonatal care.
We are rolling out transitional care across Scotland, with all units being on track to have it in place in the next year.
The framework for practice, “Criteria to Define Levels of Neonatal Care Including Repatriation, within NHS Scotland”, was published on the same day as the announcement and describes the new model of care. It provides a level of flexibility that can be agreed based on local skills and experience.
There has been reference to the maternity unit at Dr Gray’s hospital, which I visited this summer, and the maternity units in Caithness and Stranraer.
Will the member take an intervention?
I am sorry, but I want to continue.
I want to be clear that those units are in very different sets of circumstances. As has been said on many previous occasions in the chamber, the Government is committed to providing care as close to home as possible. That includes the return of consultant-led maternity services to Dr Gray’s in a safe and sustainable way. That has been moving on, and I have been very clear in my directions to NHS Grampian and NHS Highland.
Will the minister take an intervention?
I will continue.
The Lanarkshire petition has been highlighted today, and I appreciate that local people will have concerns about the announced changes. I would like to clarify again that the changes will affect a small number of families in Lanarkshire. For families who have the very smallest and sickest babies, I would like to reassure them that the change is based on evidence and will improve those babies’ chances of survival and give them better life chances. I know that parents would want to act on that evidence.
There has been a lot of discussion about the young patients family fund and the important support that that gives to families to ensure that they can spend the right time with their parents. It provides assistance with travel, subsistence and overnight accommodation.
The perinatal sub-group of the best start implementation programme’s options appraisal report was also raised in the debate. Skills maintenance is a key concern for the units that are no longer categorised as NICUs. Small and sick babies will continue to be delivered unexpectedly outwith NICUs, and some babies in local neonatal units and special care units will deteriorate in smaller units and will need stabilisation and transfer, so those skills need to be maintained.
All local neonatal units will continue to deliver intensive care and care for babies who are born from 27 weeks and who need stabilisation and treatment, so nursing and medical staff will continue to have experience in delivering those aspects of intensive care. The Scottish Government will work with the Scottish Perinatal Network and NHS Education for Scotland to take forward a number of actions to ensure that appropriate learning and development opportunities are available for staff who are impacted by the changes. Modelling work is currently being commissioned by the Scottish Government to inform capacity requirements. That work is expected to conclude by the end of this year.
In the meantime, discussions are under way in the regional forum to prepare and plan for the changes, which will be further informed by the modelling. As I said in my opening speech, there will be focus groups in NHS Lanarkshire. In addition, we will continue to provide funding to health boards to help them to transition to the new model.
I thank everyone who has taken the time to speak with us to inform our picture of what more needs to be done to reassure parents and staff in our neonatal community. I thank all those who have worked with us to look at how we can best deliver the changes that are recommended by the best start report. Their experience has been invaluable in informing our approach to date. It will continue to be invaluable as we take forward our work, through ensuring that the Government does as much as we possibly can to increase the chances of survival of these very special babies.17:01
We brought the debate to the chamber to ensure that the voices of our communities are heard loud and clear. This is reckless decision making by the Government. Has the minister asked a single question on the research process? Has the minister asked why NHS Lanarkshire was not involved throughout the process?
I often question the Government’s political decision making. Its political priorities and decision making are often misplaced, which leads to significant errors in policies over which it has full control. The downgrading of neonatal services in University hospital Wishaw is one of its more significant errors to date. It is an award-winning neonatal unit situated in an area of high deprivation, and it serves a population to which it means a great deal. We heard from Jackie Baillie that, at a time when staffing levels are presented as a danger by our trade unions, the unit retains its staff. It works in an important area that it wants to continue to contribute to.
I thank Carol Mochan for taking my intervention, because the minister was not prepared to do so. Does she agree that the minister does not seem to acknowledge that Wishaw has the best neonatal team in the United Kingdom? Does she also agree that, because of that fact and the fact that there was no Lanarkshire involvement in the decision, the new model should be paused?
I absolutely agree with the member on that point. I will go back to what my colleague Monica Lennon said—make this decision make sense, because it makes no sense at all.
The service is being downgraded, which will result in newborns who require specialist care being transferred to one of three specialist neonatal units across Scotland, when they should be going to our best and award-winning neonatal unit. My colleague Mark Griffin gave us an insight into what it is like for families, and he mentioned the key point that the unit is needed every other week.
On behalf of my party, I say that we support those in the gallery and campaigners on this issue.
I hope that I can call on some of the back benchers from the Government parties—both the Green and the SNP members, and those who represent the area, in particular—to call on the Government to pause this, look at the evidence and give some transparency about what has happened. It is disappointing that members who represent constituencies in the area do not seek to ensure that the evidence is open and available for staff and families to look at.
We are told time and again that health services are best delivered when they are delivered locally in communities, and even more so in communities where there is already a lack of services or amenities or in communities with high levels of deprivation. That therefore begs the question: what is the Government thinking, and why is it not reversing the decision? The people of Lanarkshire and the area that is served by the unit deserve so much better. I can say categorically that we will continue to fight this. We need to ensure that the communities are heard.
It is disappointing, as usual, to read the SNP’s amendment to today’s motion. Yet again, it is about the SNP; it fails to recognise the importance of this issue and the importance to the community, and it fails to mention any of the concerns that these families and communities have.
The minister needs to meet staff, consultants and families from the area. Indeed, the minister needs to take some interventions from MSPs, particularly those who represent the area.
Despite what Collette Stevenson’s contribution indicated, one family with a newborn being forced to travel miles for care is one too many when they could get expert support in their own area. We have heard about the complications with stress, about the cost and about the way in which families will feel after the event. We must take those things into consideration and not dismiss them.
Members have outlined fully why they support the unit and the risk that is posed to premature babies if the change is made. We do not need to change things and have one thing instead of another; we can have both. That is clear from the debate.
Publish the evidence. Make it transparent. Make sure that we know what is actually happening.
The expertise on these wards is second to none. The community links are strong and the trust that is placed in the service that is provided is at the highest level. It would be a mistake to put any of that at risk.
In closing, I ask the minister to fully consult all of the population of the area and the MSPs in the area and to make all of the evidence transparent to us.
The concludes the debate on protecting specialist neonatal services in Lanarkshire.