Dumfries & Galloway Community Hospitals - Members Debate

Tonight's members' debate is of huge importance for the communities in Dumfries and Galloway that will be affected by the health board's proposals which would see the loss of five community hospitals if approved by the Cabinet Secretary. I would first like to pay tribute to the local action groups and campaigners who have expressed eloquently the need to retain their hospitals.

I welcome the news that the Cabinet secretary will be meeting with Kirkcudbright action group members, but I do believe that she should visit each of the communities affected, to speak to key people first hand. I have invited her to Langholm and would extend an invitation for her to meet action groups in Lochmaben, Moffat and Thornhill also.

I've met patients, relatives and staff over the last few months. It's clear that community hospitals provide a vital link between the patient, the relative and a truly local, high quality health service of which these communities are quite rightly very proud.

But I want to make clear from the outset that this isn't about misguided emotional attachment to an out of date arm of the NHS.

This is about the real prospect of losing invaluable, well used high quality face to face human care that many fear simply will not be replicated in the home. Elderly and palliative care is second to none in these hospitals and this provides comfort not only to patients at the end of their lives, but also to relatives.

But they also provide other primary services.

As a GP led service attached to the local health centre, Kirkcudbright hospital treats patients of all ages and provision includes physiotherapy, chest and limb x-rays, podiatry, palliative care, surgical pre assessments, blood transfusions and rehabilitation. It has a minor injuries casualty unit and is very well equipped to deliver all of these services.

Crucially, the medical centre with GPs, nurses and community care staff is in the same building, providing a direct link between staff and patients to ensure good coordination of all aspects of patient care.

So Kirkcudbright is a good example of how community hospitals can be used for other services to maximise staff skills and to create a one stop shop with multiple uses. I welcome the health board's wish to invest in the area, BUT, instead of building new facilities at the expense of other buildings I would urge the health board to rethink its plans and to think hard about reinvesting into the existing community hospitals. With some creative thinking, can these hospitals not become multi functioning centres of excellence in each community with integrated services to serve the whole population?

The health board talks about a dwindling workforce. But having high quality, multiple-provision hospitals on your doorstep is exactly one reason to stay and work in your community as a health professional. Yes, people will retire, but let's give people entering into the NHS a chance to work in their own communities. Could the health board for example not work with the local college to ensure a safe supply of staff?

Let's not remove local employment opportunities.

These hospitals are critical in ensuring people get access to healthcare. If they're removed, the fact is that there will be consequences for visiting relatives who can't get to see their loved ones because of lack of public transport. The logistics are just not feasible for someone who doesn't have access to a car.

This together with cuts in swestrans funding of £230,000 does not bode well for relatives wanting to visit, which could have knock on consequences for patient recovery.

Funding for the new builds is unclear. The health board has not secured the finance for the new builds that would replace the five hospitals - it will have to make a business case to Scottish Ministers. I therefore cannot see how such a long term project can be planned on the basis of bidding for money at different stages. If any part funding bid fails, will we end up with a mix of services which ultimately costs more money because it's neither one thing nor the other? Will there be a loss of service provision in the transition from one state to the next? These are all questions constituents have asked me but which I cannot answer because I do share those concerns.

I wish to be very clear that I and others welcome the health board's wish to invest in services, BUT, this money surely could be invested into existing buildings to maximise their potential.

In terms of community care, there is no 100% assurance that the local authority has resources to cope with elderly care services transferred to it as a result of closures. How would the funding work for this part of the proposals and could we be given a guarantee that elderly patients would receive the same level of quality care in their home as seen in the community hospitals? And there's no guarantee that a private sector provider could fulfil the staff requirements to take care of elderly people in the home.

Deputy presiding officer, I am glad that the NHS has reacted to my request to extend the ongoing consultation, but I would urge NHS officials to radically overhaul their plans and think creatively about investment in existing facilities; I would ask that the cabinet secretary comes to these communities and meets with key local people and considers the bigger picture before coming to any decision - the social impact for patients and relatives, the employment opportunities community hospitals provide to local people, and the need for and the benefits of investment in these facilities rather than a blanket closure approach.

Deputy presiding officer, the CS gave geography as one of the reasons to save Monklands and Ayr A and E Wards. I would ask her to consider very carefully the expansive geography of D and G. Re Ayr and Monklands the CS also stated at the time that - "boards did not in my view give sufficient weight to the concerns expressed by local people". Well people in D and G ARE concerned; they fear a loss of service and I share that concern. Removing community hospitals from this rural and remote area will be a backward step in the delivery of integrated healthcare across the region.

I hope the CS will listen to these communities also.