Meeting of the Parliament (Virtual)

Meeting date: Thursday, February 4, 2021

Official Report 1031KB pdf

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Princess Alexandra Eye Pavilion

The final item of business is a members’ business debate on motion S5M-23806, in the name of Miles Briggs, on the Princess Alexandra eye pavilion. The debate will be concluded without any question being put.

Motion debated,

That the Parliament finds it regrettable that the Scottish Government has reportedly said that it is not in a position to fund a new eye hospital in the foreseeable future; is concerned that the removal of £45 million of funding for the replacement Princess Alexandra Eye Pavilion in Edinburgh, which is over 50 years old, has implications for the care received by patients in Lothian; understands that waiting times for routine treatments, such as for glaucoma, can be extremely long; believes that NHS Lothian has been consistently underfunded by the NRAC funding model, and notes calls both for clarity from the health secretary regarding infrastructure funding in the NHS Lothian area and for that NHS board to be fairly funded when the budget is set out in January 2021.

17:08  

I thank the MSPs who signed my motion, which led to my holding this members’ business debate. I pay tribute to the organisations that have provided useful briefings ahead of the debate, and I thank them for their work to support blind and visually impaired people, their families and carers not only in Lothian but across Scotland.

I think that I speak for Edinburgh and Lothians representatives when I say that the decision by Scottish National Party Government ministers to cut £45 million of funding from NHS Lothian for the replacement Princess Alexandra eye pavilion came out of the blue and is concerning.

From the significant number of emails and messages that I have already received from constituents, I know that any decision to remove and close eye services in Edinburgh will not be acceptable. The initial agreement document on the redesign of eye services in NHS Lothian, including the reprovision of the eye pavilion, which the board published in 2018, makes clear that the current facilities at the pavilion are no longer fit for purpose and need to be replaced.

In recent years, significant numbers of NHS Lothian patients have received treatment in the local private sector as a result of insufficient capacity in existing services. It is clear that a replacement eye pavilion is needed to ensure that NHS Lothian is capable of meeting current and future demand and to improve the efficiency and throughput of theatres for ophthalmology, which is currently not feasible at the eye pavilion.

NHS Lothian initially evaluated nine options for future service provision. Establishing a new hospital at the Royal infirmary of Edinburgh’s bioquarter site was evaluated as the optimal proposal and also scored highly when appraised against other key areas. Those included: research space so that more patients can be recruited into clinical trials, leading to better treatments and, ultimately, greater clinical effectiveness; and co-location with good research and teaching facilities, which helps to attract and retain the best clinical staff and to reduce travel between sites, thereby increasing the time available for important clinical care.

The business case for reprovision of the eye pavilion sets out other ambitions, which I believe are essential to meeting the current and future needs of people living with sight loss in Lothian and the east of Scotland. It should be a purpose-designed facility in order to make the best use of resources. Bringing significant improvement to the patient care experience should result in improved ability to respond to developments in digital imaging and will aid diagnosis and clinical reviews.

As RNIB Scotland’s briefing for the debate makes clear,

“Ophthalmology is already Scotland’s largest outpatient speciality. Demand for eye health services continues to increase, with more people waiting longer to be seen. Preventing avoidable sight loss is a priority for all Scottish Health Boards”,

as it should be for the Scottish Government and all political parties. The briefing continues:

“Around 178,000 people in Scotland live with a significant degree of sight loss, around 4,300 of which are children and young people. This number could eventually double unless we act to prevent avoidable sight loss.”

Therefore, vital local services are critical.

NHS Lothian and the east of Scotland have the fastest-growing population in the country. We know that, as well as an ageing population, additional eye care needs will be placed on our health service in future. NHS Lothian’s initial impact assessment of the redesign of eye services and the reprovision of the eye pavilion reported a projected 20 per cent increase in demand for new and reviewed out-patient appointments between 2020 and 2030—that was just Lothian-wide. Between 2013 and 2030, we are expecting a 42 per cent rise in demand for in-patient and surgical day case services, of which approximately 80 per cent will be for cataract surgery.

I welcome the additional capacity for surgery at the new elective centre at St John’s hospital in Livingston, which ministers have outlined. However, that provision will also be accessible by other health boards; it will not in any way provide for the closure or replacement of the eye pavilion.

On too many occasions in the past 13 years, SNP ministers’ decisions to centralise and cut services have been taken without real clinical or patient consultation. I have already outlined my concerns to the cabinet secretary, and I welcome the positive engagement that she has had with me on the issue so far. However, I fear that we are already seeing that process happening with the eye pavilion.

As Sight Scotland stated in its briefing for the debate, Scotland has the potential to be

“a world leader in eye health research and ... a new eye hospital in Edinburgh, linked to existing academic and research institutions in the city”

could help to progress that goal. The pioneering research into eye disease and the clinical research that are undertaken at the eye pavilion are of vital importance and must be protected. It is groundbreaking work, which we must ensure that we progress.

I wanted to bring the debate to the chamber because, as we find ourselves in the current lockdown and in the middle of the pandemic, and with the Parliament and the public finding it more difficult than ever to scrutinise decisions, I believe that we need the cabinet secretary to pause and to rethink the closure and replacement of the eye pavilion.

I would like ministers to agree to undertake an independent assessment of all options. It would be totally unacceptable for Scotland’s capital to lose its eye hospital and, indeed, for Edinburgh to become one of the few UK cities not to have an eye hospital. I hope that the cabinet secretary will take on board those concerns and understand the impact and unintended consequences that such decisions can have on patients, their families and their carers, as well as on the highly valued professionals who currently work at the eye pavilion in Edinburgh.

I look forward to hearing other members’ speeches this evening.

17:15  

I am grateful to Miles Briggs for securing today’s debate on the Princess Alexandra eye pavilion in Edinburgh. The issues that he raises in his motion, such as the worries about safety for patients attending the pavilion, waiting times and the chronic underfunding of NHS Lothian, reinforce how important it is for the Scottish Government to fund a replacement for the eye pavilion and not give up on it. I hope that the debate will provide convincing arguments to reverse the decision, which will have a detrimental impact on our constituents right across the Lothians.

Numerous constituents have reached out to me—I imagine that other members have experienced this—because they are concerned and worried about the withdrawal of the £45 million that is needed for the new eye pavilion, which, as RNIB Scotland said in its excellent briefing, was all set to go ahead in spring last year. NHS Lothian announced the contract on its website saying:

“The £45 million construction contract is part of a £68.5 million project procured through the Health Facilities Scotland framework, will replace the existing Princess Alexandra Eye Pavilion in Edinburgh city centre, which opened in 1969.”

It went on to say:

“It is expected the new hospital will support the delivery of a quality eye service to approximately 84,000 outpatients per year and will carry out nearly 12,000 operations per year by 2030.”

We really need to know what has changed. What has happened with that contract?

A friend who got in touch in advance of today’s debate said:

“I cannot express enough that location in a central place is so important for eye medicine, emergency treatment by eye specialists and clinics”.

Her personal experience was that sight loss can happen very fast and that, because the detached retina can die in a short space of time, fast access to medical treatment is vital. About four years ago, her brother attended the Edinburgh eye pavilion at 3 am, because his eye was haemorrhaging. Being able to see an eye specialist at that time was so important. His journey to Lauriston Place took about 15 to 20 minutes and he was treated, given medication and reassured.

Some constituents have been in touch to talk about pressures of having to travel to the Golden Jubilee hospital in Glasgow. Given that, in most cases, driving is not possible following an eye treatment or when living with the side-effects of an eye problem, the journey forces them to navigate multiple buses and trains to access NHS services. That is not good enough.

According to Sight Scotland, there are 14,500 people living with sight loss in Edinburgh and nearly 12,000 people living with sight loss across the rest of the Lothians. Sight Scotland expects there to be a further 3,000 people living with sight loss in Edinburgh by 2030. It cannot be right that those living with sight loss are unable to access services in their local area. The issue is wider than simply that of physical access to healthcare. Early access to effective treatment, on-going specialist primary care and hospital treatment are crucial to ensuring that people have the support that they need to live well with sight loss. RNIB Scotland highlights the rise in sight-threatening conditions such as diabetes, and our ageing population, which will increase the number of people affected by sight loss unless action is taken.

We must ensure that, moving out of the pandemic, we are not removing services from those who need them the most. That is austerity and it has failed across the UK. We cannot have it in Scotland. Removing vital services from those who are vulnerable is no way for us to move forward. I appreciate that the Scottish Government is facing huge challenges, but it has also overseen the underfunding of NHS Lothian over the years, via the NHS Scotland resource allocation committee—NRAC—funding model.

The removal of the £45 million funding falls short of protecting my constituents. That decision needs to be reversed as soon as possible.

I call Jeremy Balfour, to be followed by Daniel Johnson.

[Inaudible.]

Mr Balfour, I cannot hear you. I will come back to you. I will take Daniel Johnson next. You need to log off and log back on, Mr Balfour.

Mr Johnson, I saw you a moment ago—there you are.

17:20  

I am thankful that I am not delivering this speech by mime, given the way in which I had to vote yesterday. I sympathise with Mr Balfour.

I thank Miles Briggs for securing the debate, because Edinburgh’s eye pavilion, with its specialist eye surgery unit, has been hugely important to all the people who have had to use it in recent years. I do not think that the debate would be happening if it were about any other service. I do not believe that people would stand for the loss of cancer treatment services, heart surgery or any other specialist surgery or treatment in Edinburgh. Why is eye specialism any different?

The things that the eye pavilion does are truly outstanding. The staff perform miracles: they restore people’s sight. I discovered in recent months that, following a detached retina, my friend John had surgery performed at the eye pavilion that saved his sight. We cannot lose that specialism from the city.

We have to question the impacts of the dispersed model that is proposed, which will apparently see specialist surgeons travel to localities to deliver their services rather than perform their highly skilled operations in a familiar place. We have to question the disruption to people who will have to travel to different places rather than the central location with which they are familiar—people who have lost much of their sight and who cannot drive, for obvious reasons. We have to question the impact of the loss of the critical mass of expertise and skills. We know that it is critical for specialisms that people perform operations as much as possible and that the bringing together of people who have performed more of those procedures means that they are better able to deliver successful outcomes for their patients.

The dispersed model appears to be a consequence of cost cutting, but £45 million is a drop in the ocean of health spending. The proposed option is clearly not the preferred option of the health board—as Miles Briggs set out, the board had a clear business plan and made announcements that set out how the re-provision of the pavilion would improve healthcare for people who need eye treatments—nor is it that of the professionals and surgeons, who have made it clear that they do not favour it, do not want to travel and fear the loss of expertise from that centre of excellence.

As Miles Briggs pointed out, the removal of funding will leave Edinburgh as one of the few UK cities without a specialist eye hospital or unit, and that surely cannot be tolerated.

This is a major change in the clinical model. Where is the evidence that the change will deliver what is needed? Where is the consultation with the people who provide the services or the people who will use them? Where is the negotiation with ophthalmologists and optometrists, and what are the implications of the change? What will be the impact of the closure of this central specialist eye unit?

We are seeing the destruction of a centre of excellence for budgetary reasons and a major change in clinical delivery without any substantial strategy or national consultation. How many people will lose their sight because of the loss of this key, priceless service from this city?

Thank you very much, Mr Johnson. I will try again with Jeremy Balfour.

17:24  

Can you hear me now, Presiding Officer?

We have lift-off, Mr Balfour.

I thank Miles Briggs for bringing the debate to Parliament this evening. The motion mostly notes that the Scottish Government is not in a position currently, or “in the foreseeable future”, to fund a much-needed new eye hospital for NHS Lothian.

The current hospital opened in 1969 and was deemed unfit six years ago. Back in 2018, an initial agreement was approved by NHS Scotland, and work was due to begin in March last year. However, two years later, nothing has happened and, all of a sudden, the Government has announced that funding is no longer available. That setback will create numerous complications for patients in the Lothian area who require care and treatment for their eye health, considering that early diagnosis and treatment is the best way to prevent sight loss.

As we have heard, there has been talk of services moving to Livingston, but that has been a recent development and that centre was not part of the original plan. For patients who have problems with their eyes, that will mean additional unnecessary travel for treatment, which will result in their using more buses, trains or taxis. The current building, on Chalmers Street, which I visited recently, has a maintenance cost that is exceeding its budget and has many faults, including with the roof, which needs major repair. It also has inadequate accessibility, because lifts in the building keep breaking. Staff and patients find it difficult to park, and there is a worry about confidentiality due to the lack of space when meeting patients.

A reallocation to the Edinburgh bioquarter site, which is currently the home of the Royal infirmary of Edinburgh and the Royal hospital for children and young people, would ensure continuity of care from admission to treatment and out-patient services. The building would be better for patients, as it is better designed and would meet their needs. There must be scope for the building to deal with the increase in numbers that we are likely to see in Lothian over the next 10 years—around 25 per cent in the number of out-patients and up to 40 per cent in those requiring surgery—as well as for the continued development of digital imaging technology for eye care.

In his motion, my colleague Miles Briggs makes reference to the fact that NHS Lothian has been consistently underfunded by the formula for health board funding in Scotland. It is time that the Government gave NHS Lothian a fair share of the funding that is available for health, to ensure that a new, fit-for-purpose and modern eye hospital is built to give the people of the Lothian area the best possible care. Overall, the need for a new eye hospital in Edinburgh should be a priority for the Scottish Government’s health budget, and we should stop being left behind compared with other regions in Scotland.

17:28  

I join the chorus of approval for Miles Briggs’s having taken the time to make members’ business available for this important matter.

The Corstorphine community sight-loss group is likely one of the most formidable collections of individuals that one would ever to meet. They love the eye pavilion. I have visited them a couple of times and they have put me through my paces. For them, the convenience of having the eye pavilion in our nation’s capital is palpable. They are concerned—I have talked to them extensively about this, not only through casework, but because I have become quite friendly with them—that our nation’s capital losing the eye hospital represents asset stripping on a massive scale.

It has been said several times in the debate that Edinburgh would become one of the only major cities not to have a dedicated eye-care facility. As we have heard several times, the current premises on Chalmers Street were opened in 1969 and are now clearly not fit for purpose, although the facility is much loved in our nation’s capital. We all know people who rely on it and people who have used it in an emergency. I was very nearly shipped there in 2011 when my toddler eye-gouged me in a particularly rambunctious bout of horseplay, and scratched my lens with a deeply unsanitary fingernail. Thankfully, I was able to be treated by our nearest optician. It was a close-run thing, but it was reassuring to know that the eye pavilion was there.

When the facility was classed as unfit for purpose, NHS Lothian embarked on a considerable capital procurement project. As we have heard, nine different options were considered and lots of work went into the tenders. The initial agreement for the new hospital was signed off by NHS Scotland as long ago as February 2018, and a construction company was given the contract for it in July the same year.

However, out of the blue, NHS Lothian said at the start of January that it had been informed by the Scottish Government that it would no longer be funding the £45 million replacement. The reason for that is not entirely clear. I hope that, in her closing remarks, the Minister for Public Health and Sport will give members some reassurance that there is no link between that decision and what has happened with the haemorrhage of public cash through the sick kids hospital debacle, because the confluence of the two things is uncanny and troubling. I would like that to be clarified for the record.

When people have sight loss, familiarity of location really matters. For Jeane Freeman to suggest that the elective treatment sector could be built in Livingston is devastating to people with sight loss in our community. Familiarity of location really matters to people with sight loss, because the orbit of their universe can be delineated in part by their journeys for treatment or consultation at the hospital. They know which buses to get and where to get off, and they know what road infrastructure and road furniture exists between them and the building. They are going to have to learn a whole new suite of travel in order to access a new facility out in West Lothian.

Optometrists who are known to me personally have referred to the decision as “a disaster”. As we know, demand for high-quality eye care will only grow with the city’s growth and the ageing population. I support Miles Briggs’s call for an independent consultation on the future of the eye pavilion.

One of the most compelling interventions that I have seen in the debate on the future of the eye pavilion is from the charity Sight Scotland. It says that the business case for replacing the hospital is utterly compelling, that it scored highly in relation to the research base and that more patients should be recruited into clinical trials, which would lead to better treatment. Why would we remove that opportunity from citizens in our nation’s capital?

I will finish with the words of Sight Scotland. It says:

“We are concerned not proceeding with the new eye hospital will not support the best access to treatment for patients and also risks the potential Edinburgh has to be a world leader in research and development in eye health.”

I hope that the Government will listen to the cross-party calls that are being made this evening for it to rethink its ill-fated decision and reinstate plans to design and build a new state-of-the-art eye-care facility in Edinburgh.

17:32  

I am pleased that Miles Briggs has brought the subject to the chamber for debate tonight. Several members have covered the background to the issue, so I will not repeat it, but I stress that the situation is just the latest in a long line of debacles in the NHS Lothian area that have been caused by the Scottish Government’s running of our greatest public service—the national health service.

If we look at the Audit Scotland report, we see that only two out of eight waiting times were being met pre-Covid. Just this week, I have been advised that the waiting time to see a psychologist in the NHS Lothian area is 24 months. That is absolutely unacceptable, and the situation is the same across many disciplines.

Almost half of the £207 million black hole in the NHS budget is for NHS Lothian. Is that the reason for the cancellation of the project? We are still paying £1.4 million a month for a sick kids hospital that has not treated a single patient. What a scandal that is. The children’s ward at St John’s hospital is still not operating on a 24/7 basis, seven years on from the start of the problem. I say to the people who are campaigning for the eye hospital that if they do not run a diligent and vigorous campaign, it will be streamrollered and the hospital will be closed. That is the lesson from the St John’s children’s ward.

The Government is now refusing to fund the project. This is a Government that was elected on the platform of keeping healthcare local. Do members remember that? For some people, healthcare will be local, if they are in Livingston. That is a good thing; I believe in local healthcare. However, for someone travelling from the Borders or East Lothian, healthcare will not be local. It takes someone travelling from Dunbar by train two hours to make the 45-mile journey to Livingston.

Lothian has the fastest-growing population in Scotland, with 133,000 more people expected to be living there by the middle of the century. Twenty-six thousand people in the region have sight loss, and that number will increase dramatically. A 50-year-old facility simply cannot cope with that volume of demand—it cannot even cope with current demand.

We need for the NHS a funding formula that reflects population growth and accepts and remedies the fact that we have tired and inadequate infrastructure, which everyone says is not fit for purpose. Is the minister happy—I hope that she will respond to this—that more public money is leaking out of the NHS and into the private sector because of how the eye-care situation is being dealt with?

We need an NHS that is fit for the 21st century and we need services that are modern and able to cope with the demands on them. I hope that there will be a huge public reaction to the situation. I hope that we will see the anonymous civil servants and others who are advising ministers exposed, and that the decision will be overturned.

17:36  

I am grateful to Miles Briggs for raising this important issue. I know, from all the speeches that we have heard, just how strongly and passionately people feel about it, and I absolutely appreciate that. That is why I want to update members on how we are improving services.

During the pandemic, there has been amazing innovation in what healthcare can be delivered remotely and in community settings. The establishment of the Lothian emergency eye-care treatment centre, in a matter of days in April, was testament to the skills of the workforce and their willingness to deliver outstanding care, and they deserve our thanks for that.

That rate of change was only possible because of the work that was already under way to modernise and improve services. We have seen fundamental changes in recent times in how eye-care services are delivered. One really positive development is that lower-risk patients can now be safely reviewed in virtual clinics, which means that they can enjoy quality care and the convenience of being seen locally.

Many more patients are now being cared for by highly qualified optometrists in their own communities. For example, as a response to the pandemic, an additional 7,125 people in Lothian with long-term conditions will be reviewed by community optometrists over the next six to nine months. A flexible approach is being used in NHS Lothian, where optometrists are supporting the existing workforce in hospital eye services as well as reviewing some patients within community practices. NHS Lothian is also supporting a national pilot study to safely discharge lower-risk glaucoma patients to accredited community optometrists. That will provide an excellent service to patients that is also much closer to home.

New technology is changing what facilities are required to carry out some eye surgeries. For example, a cataract treatment theatre is being used in NHS Grampian for local anaesthetic cataract surgeries. With our investment in the new elective care centre in Livingston, NHS Lothian can significantly increase its theatre capacity for more complex procedures.

What is needed from an eye hospital, now and in the future, has fundamentally changed, so we have needed to look again at the eye pavilion proposal. The cost of that proposal was large: £83 million, not the £45 million that the motion suggests. As I have outlined already, there are new, better and more efficient ways of meeting eye-care requirements, so we have asked NHS Lothian to look again at its plans for eye-care services and at what it can do with its existing estate and the new elective care centre in Livingston.

We have demonstrated our readiness to invest in infrastructure where that is the right thing to do, but we have to be sure that our investments are justified by need. With the level of change and innovation that is happening just now, we no longer think that it is. I know that that decision will be disappointing to some people, and I completely understand that, but I hope that the Parliament will understand the need to make the best use of resources and the need to keep our investment decisions under review and costs under control.

The issue of waiting times has been raised—I think that Neil Findlay mentioned them. I absolutely regret that waiting times, including for eye surgery, have increased significantly over the past year, but I think that colleagues will appreciate that that has been one of the consequences of the pandemic. We are committed to reducing waiting times as part of the national health service’s recovery from the Covid pandemic, but building a new eye hospital that would not be ready for almost four years at the earliest would not reduce those waits. The most effective ways to reduce waiting times are through the measures that I have already outlined: more services being provided by community optometrists, the greater use of virtual clinics, the expansion of the use of new technology, and increasing our elective surgery capacity.

Miles Briggs’s motion mentions the NRAC model and a few other members mentioned that, too. The Scottish Government’s approach has been to move health boards towards their NRAC share gradually over a number of years. To move NHS Lothian to its NRAC share would require an equivalent reduction in funding for other boards. I highlight that the NRAC formula is an objective measure that is updated annually and that it is not clear on what other objective measure NHS Lothian should receive more or at whose expense that should be. NRAC is simply not relevant to the funding of major infrastructure projects. They are funded and prioritised on the basis of need for investment. The NRAC formula is not used for them.

I have already mentioned the new elective care centre in Livingston. That will provide elective surgery in a much more convenient location for the residents of West Lothian and will help to provide the elective surgery capacity that we need for the future.

That is not the only example of the Scottish Government’s investment in Lothian’s health infrastructure. In 2017, we opened the £45 million phase 1 of the new Royal Edinburgh hospital and, last October, the £69 million East Lothian community hospital was completed. The construction of the new sick kids hospital, which is already hosting services, will be completed imminently, and we are spending over £20 million on upgrading the Edinburgh cancer centre. I absolutely refute any suggestion that NHS Lothian is not receiving its share of infrastructure investment.

In conclusion, I highlight and reiterate that the way that eye-care services are delivered is changing and will continue to change. We are moving further and faster towards convenient care closer to home, wherever possible. The measures that I have outlined will improve those services for patients and deliver care closer to their homes.

We have a responsibility to ensure that our investments are future proof. Sometimes, that means that expensive infrastructure projects are simply not the right investments to make. We will continue to work closely with NHS Lothian to make sure that eye-care services are provided effectively and to get waiting times down as soon as it is safe to do that.

Meeting closed at 17:43.