SNP Delivers On Pledge To Save Two A&E Units Marked For Closure

A key manifesto pledge by the SNP is expected to be delivered today with the announcement that two hospital accident and emergency departments earmarked for closure will now be saved.

In her first major announcement since becoming health secretary, Nicola Sturgeon will set out how the Executive will reverse the decision to close emergency units at Monklands in Lanarkshire and Ayr Hospital.

But while the move has been welcomed by those who campaigned against the closures, there has been high-level criticism of Ms Sturgeon and her party.

The issue has even caused splits within the Scottish Labour Party.

Andy Kerr, Labour’s health spokesman and a former health minister, said he believed the strategy developed by the boards was best for the future of services. But Karen Whitefield, Labour MSP for Airdrie and Shotts – whose constituency includes Monklands – welcomed the commitment to keep the hospital’s A&E unit.

And John Reid, the Home Secretary, whose constituency covers Monklands, has also spoken out against the closure.

Last week, Ms Sturgeon left parliament in doubt about her plans. In response to a parliamentary question, she said: “I have made clear that we will reverse the previous decisions on Accident and Emergency services at Monklands and Ayr hospitals.”

Yesterday, Martin Watt, a consultant at Monklands, said A&E services in Lanarkshire would not survive with only two units.

“If you take a hospital like Monklands which sees 65,000 patients in A&E each year, where are they going to go?

“The other A&Es will be overwhelmed. Some of the people will be minor injuries, but it is not always obvious what is a minor injury on first sight.”

Alex Neil, SNP MSP for Central Scotland, said: “The key thing is the reversal of the daft decision to close Monklands and Ayr A&E, which would be a danger to life and limb in these areas.”

Mr Neil said he also hoped Ms Sturgeon would halt further private finance initiatives planned in Lanarkshire.

Ms Whitefield said: “I never agreed with this decision and always believed that the case for retaining full A&E services at Monklands was overwhelming.

“However, for the A&E to function properly, it is vital that Monklands keeps its intensive care unit and anaesthetist cover and I would ask the minister to provide an assurance that these services will be retained.”

Ms Whitefield also said she hoped Ms Sturgeon would give a “cast-iron guarantee” that the planned investment of £100 million to refurbish Monklands would stay.

But Mr Kerr condemned the turnaround on A&Es, saying the decision would “end up costing lives”.

Dr John Browning, a former medical director of NHS Lanarkshire, has also said the decision to close the department should not be reversed.

He said moves to keep it open would lead to its slow collapse, rather than the managed closure proposed for 2009. Dr Browning, who retired in December, said: “Lanarkshire cannot support three A&Es.

“Without the changes we proposed, the service will deteriorate and collapse. We proposed a managed wind-down; this is obviously better than closing it in an emergency.”

But yesterday Mev Brown, who stood at the elections for the Scottish Voice NHS First party, said that move by the SNP to reverse the decisions was best for patients.

He said: “The A&E at Monklands is the busiest in Lanarkshire and also the most efficient. These patients could have faced having to travel to Glasgow if the other A&Es in Lanarkshire were closed because they were too busy.

“The SNP’s decision is clearly the right one.”
Q&A: A&E

Why do the health boards want to close the A&Es?

NHS Lanarkshire and NHS Ayrshire and Arran believe they cannot sustain all the A&E services they currently have running, including services such as intensive care which are also needed to support A&Es. There are issues over having adequate numbers of staff to run a safe service, as there are many vacancies for consultants in Scotland.

What have they offered as an alternative?

Plans include community casualty units, which will be created to help deal with some of those with minor injuries who would have gone to A&E. Better transport links between hospitals are also promised.

What is the argument in favour of centralising services such as A&E?

Research suggests patients do better if they are treated by doctors who handle lots of cases. If doctors see fewer cases, they could lose their skills. Concentrating doctors in fewer locations could also help meet rota demands.

Why is there opposition to the closures?

Patients are worried that if their nearest A&E closes they will have to travel further in the event of an emergency. Doctors are also concerned that closures mean other services will be overwhelmed.

How did the boards reach the decisions to close their A&E departments?

NHS boards are obliged to hold consultations when making major changes to their services. These are overseen by the Scottish Health Council, which has to make sure NHS boards take into account the views of the public. In the cases of Monklands and Ayr, the council agreed that a proper consultation had taken place.
How have the political parties reacted to the issue of A&E closures?

The SNP has always taken a strong stance against the closures, saying from the outset that if they won the election they would immediately reverse the decisions. The plans were approved by the last Executive, under Labour and the Liberal Democrats. Former health minister Andy Kerr said the changes were necessary, but he clashed with local Labour MSP Karen Whitefield and Home Secretary John Reid MP, whose constituencies include Monklands.

The Scottish Conservatives have also criticised the downgrading of Ayr Hospital. During the election, a new party, Scottish Voice NHS First, stood with a manifesto against the A&E closures.

What is the opinion of the medical community?

Doctors and health chiefs are divided over whether it is best to close the A&Es. Professor David Kerr, the author of Scotland’s blueprint for future health services, attacked the SNP’s decision. Prof Kerr, a cancer specialist, said such a U-turn would be “emotional and irrational”. Dr John Browning, who retired as medical director of NHS Lanarkshire in December, said the move would lead to the eventual collapse of A&E services rather than change in the managed way proposed by the board.

However, others have supported the SNP’s stance. Martin Watt, a consultant at Monklands A&E, has attacked the decision to downgrade his hospital and spoke out ahead of the elections.

Does the reversal of the decision to close the A&Es mean that no more services will be allowed to close?

No. Nicola Sturgeon has already said that she will consider any new proposals on their merits but will “operate a presumption against centralisation of services”. It already faces a new challenge after NHS Greater Glasgow and Clyde proposed changes to the Vale of Leven Hospital.