 Gaelen nhw'n cael ei oddyęig yn thosehu. A poors mwyn cycaf i'r ardal y cwm y dyw The members who wish to speak in this debate, please press the request to speak buttons as soon as possible. I call on Miles Briggs to open the debate. At around seven minutes please, Mr Briggs. Thank you, Deputy Presiding Officer. I would like to start by thanking colleagues from my own party and from all the other Opposition parties in Parliament for supporting my motion and allowing this evening's debate to take place. I'd also very much like to welcome constituents and others to the public gallery this evening, including East Scotland's Clef patients and parents, especially Yvonne MacLachie, who has done such a fantastic job in campaigning on this issue, spearheading the online petition, which now has attracted the support of more than 6,000 people across Scotland and which I was pleased to accept this afternoon on behalf of the Parliament. During the Scottish Parliament election campaign, I met a number of Lothian parents who expressed real concerns at the way in which the consultation to centralise clef pallet surgery in Scotland was being handled. I made a promise that I would support them and take up their cause if elected to Parliament. What I found heartening and incredibly positive is to hear their personal family stories repeated again and again by parent after parent, stories of the excellent treatment and best possible quality surgery their babies and children have received from the Edinburgh sick kids surgery team, and the life-changing and life-defining difference that this has made to so many babies and children across Scotland. It is not an oversight to say that the clef lip and pallet surgery carried out by surgeon Felicity Meindale in Edinburgh is world leading and that the outcomes are some of the very best that any child or parent could ask. It is not just down solely to Ms Meindale but the first class team that she has surrounding her, theatre staff, post and pre-op staff, highly skilled clef nurses all working closely together. The audited outcomes for the Edinburgh surgical unit explain why parents are right to have such faith in it. Official information on UK standards for speech outcomes following surgery to repair clef pallet shows that the results for children treated in Edinburgh are very high and consistently so. With the vast majority of children having speech within normal range within five years after surgery, beating national targets and putting Edinburgh amongst the top performing units in the whole of the UK, I am sorry to say that this information was not part of the options appraisal official consultation process and was only made available as a result of freedom of information request, something that is of real concern to parents and campaigners. This information should have been made available and I am sorry to say feeds into the genuine worries about other aspects of what I can say seems to me to being a flawed consultation process. One which has failed to justify the suggestion that the east of Scotland service is in any way unsustainable and one which has left clinicians and staff in Edinburgh feeling their views have been totally ignored. I am sorry to say that there are recurrent instances of a lack of transparency, openness and accountability surrounding the whole consultation. We also need to recognise that the Edinburgh team does not just enjoy the support of parents and other clinicians across Scotland and the UK but has an international reputation for its care, research and expertise. Indeed, such is its standing that the Edinburgh unit is due to host the prestigious international congress on clefflip, pallet and related craniofacial anomalies in 2021. 1,800 professionals from over 70 countries are set to attend the 2017 conference in India and similar numbers will be expected for the Edinburgh conference. How embarrassing will it be for Scotland if Ms Meindale feels forced to leave the NHS and neither she nor a cleft surgery unit is any longer based in the host city Edinburgh? I am also concerned at the unintended consequences of closing the Edinburgh surgery unit. At present, St John's hospital in Livingstone is home to the adult cleft pallet care service, which is supported by Ms Meindale and her team. The impact which a closure of the Edinburgh unit will have on adult services in the area and patients who receive their treatment there has never been outlined. In fact, from my investigations, I can only draw the conclusion that this has indeed not been considered or worse still overlooked. Many parents have also expressed concern to me about the additional stress and pressures that would be placed on them and their children through the extra time, travel costs and time off work that would be required to travel to Glasgow. The Scottish Government talks about accessibility in our NHS, but the centralisation plans would make access more difficult for many families in eastern Scotland. It is perhaps also worth noting that it is not long since the Aberdeen service was closed and parents and children were supported through the Edinburgh service. Taking all those points together, widespread parental and community support for the Edinburgh surgery unit, outstanding audited outcomes and international reputation concerns about the consultation process and worries about accessibility of a single service based in Glasgow. It is hardly any wonder that the cleft lip and pallet association and many others are struggling to understand the rationale behind proposals to centralise the service in Glasgow and believe the case for changing the current two-site model simply has not been made. I want to be clear that this is not an issue of Edinburgh versus Glasgow and must not become one. Rather, it is about supporting a two-site model that works and that is sustainable and can be made even more effective through the collaborative working of the surgeons across both sites. This twin centre model works successfully elsewhere in the UK and it is about maintaining and preserving the international centre of excellence that is built up and has delivered such specialist expertise, knowledge and care. Deputy Presiding Officer, sometimes Governments make bad decisions. I have no doubt in my mind at all that the closure of the cleft lip and pallet surgery unit at the Edinburgh sick kids as well as the potential loss of an internationally recognised specialist surgeon to our NHS would be a backward step for our health service. I hope that in bringing this debate to the Parliament that I have given Scottish ministers a chance to pause and reflect and prevent this from happening. I will end by urging the Scottish Government to listen to the very clear views of parents and clinicians and ask that they do not approve the centralisation plans but rather support the retention of what is a successful and valuable two-site model. That is in the best interests of parents, clinicians and crucially babies and children born in Scotland needing this specialist surgery and care. Can I first of all please say to those of you who are very welcome in the public gallery that I understand the strength of feeling that you are here to support. Could I ask, though, that you refrain from clapping from now on? Perhaps at the end, once the debate is over, we can allow that for the contributions that people have made. I now call on Angus Macdonald to be followed by Neil Findlay. I appreciate the opportunity to join this debate on the centralisation of cleft lip and pallet surgery, and I thank Miles Briggs for taking this important issue to the chamber. I have a specific interest in this, as I have constituents who will be directly affected by the proposal to move these services. The cabinet secretary and the minister will be aware that the current provision of specialist cleft surgical services at the Royal Stick Children's Hospital in Edinburgh is exemplary. The recent consultation and report finding that centralising those services in Greater Glasgow and Clyde is the best decision to make. I think that it does not fully take into consideration the impact that this will have on families reliant on this service in the east of Scotland. Of course, we must also take into consideration the service provided in Edinburgh itself, which is led by a pioneering and world-class surgeon whose record of excellence speaks for itself. In Edinburgh, there is a multi-disciplinary team that works side by side with the patients and the surgeon to ensure that everything runs smoothly and that progress is made after every surgical event, and a hospital that is known to its patients is somewhere that they can rely on to get the job done are all very valid reasons as to why the Government should consider ensuring that support services are retained in Edinburgh. As I mentioned at the outset, I have constituents who will be directly affected by the movement of these services, and I can say with some confidence that they are dismayed that this service provision is not going to be as close to them as they need it to be. I have a great deal of sympathy for their opposition to move this service to Greater Glasgow and Clyde and would ask that any centralisation plans be paused to allow further consideration and to ensure that the specialist expertise, knowledge and care that has been built up in Edinburgh is not lost. I understand that change can be a good thing and I understand that there are financial pressures on all NHS boards throughout the country. However, it is my opinion that, in this instance, having a surgical team in a single area bodes well for the provision of services in the long term, however, for these services to be taken from Edinburgh presents us with a deficit, which is geographical in nature, and with the real possibility that world-class surgeons may or may not be able to relocate when or if the service is moved. I have, for some time now, been in touch with my constituent in relation to her concerns over this issue and have raised the issue with the cabinet secretary on more than one occasion when the proposal was highlighted to me. Understandably, she is worried about the impact that this will have on her family in the short term. Moving from one area to another can sometimes feel as if they have to start again. Moving clinical notes from one health board area to another gives insight into the patient and their history, but it does not mean that they really know a patient. All those relationships that have been built up over many years and in certain circumstances will potentially have to be rebuilt from the ground up. Putting myself in the position of a young child who is already in a situation where they are facing surgery to enable them to live a better quality of life going forward must be a very daunting prospect to begin with. To have the upheaval of being treated in another hospital where they are unfamiliar must be an added stress that does not necessarily need to be the case. I was contacted by a retired consultant plastic surgeon John Howard Stevenson, who was the adviser in the specialty of cleft surgical services to the chief medical officer and clinical director of special services in NHS Tayside, which included the disciplines within reconstructive plastic surgery and dentistry crucial to successful outcomes in cleft lip and palate reconstruction. During his period in office, those services were centralised in Edinburgh when Ms Felicity Meandale was appointed as a consultant with responsibility for those patients. He wrote to me saying that the clinical evidence supported services has been retained in Edinburgh and that a world-class surgeon and the service that she had built up in Edinburgh was not only one of the best in the UK but was recognised as being of an international standard. I would like to quote him direct, Presiding Officer, quickly. He said, since her appointment, she has developed a service for patients with cleft lip and palate in Edinburgh serving the east of Scotland, which has delivered the highest quality of services evidenced by the internationally agreed outcomes standards within the discipline. Those results clearly demonstrate consistently higher results than anywhere else in Scotland and on a par with the best internationally. To achieve those, it is essential to build up a close team involving specialities such as speech therapy, and Felicity has been very successful in building up and maintaining such a team. Further, patients and their families have the highest regard for her and her team. To relocate cleft services from Edinburgh, centralising in Glasgow will undermine an outstanding service and goes against the overwhelming clinical evidence, which surely must always be the defining factor in deciding where a service should be located, which unequivocally confirms Edinburgh as the base from which patients undergoing cleft lip and palate repair in Scotland can expect the best outcomes. I realise the amount of time, Presiding Officer. However, I have more to say. Yes, but I think that we have heard enough much. I would urge the cabinet secretary to seriously consider the option of retaining this world-class service in Edinburgh. I have Mr Finlay to be followed by Alison Johnstone, please. Thanks to Miles Briggs for securing this very important members' debate. The proposal to end the surgical service at the Sick Kids in Edinburgh and to centralise the cleft lip and palate service in Glasgow comes against the backdrop of huge financial pressures on our NHS. The boards across Scotland are having to find huge amounts of money in black holes in their budget. NHS Lothian alone this year has an £84 million deficit. Beds close, posts cuts and legally set targets to be missed. The centralisation of services like that, I believe, are directly linked to budget decisions, but will, of course, be dressed up and presented as service improvements and redesign. There will be much more to come. We have just fended off the plans to centralise children's services and now we are on to the next stage of the process. I come to this conclusion. There appears to be no other credible explanation for the move that we are debating today. In fact, this decision has provoked complete bemusement among many stakeholders, patient groups and doctors. People are, frankly, at a loss to understand why this decision has been made and some serious questions hang over it. The outcomes in Edinburgh appear to be better. If the whole issue in healthcare just now is about outcomes, then why is a service with excellent outcomes being closed down and centralised? Perhaps the minister could confirm if the better outcomes in Edinburgh have been taken into account when making this decision. What about the excellent continuity of care to be found in other regions such as Tayside, Grampian and Highland? Relationships built up over the past 10 years will be compromised. Why is a service that has developed those excellent relationships across the east of the country not being nurtured and protected? Just to be very clear that this is about the surgery and that it locally provided support, whether it is on the dodontics or through dentistry, those will still be and continue to be provided locally. Neil Findlay? We may come back to that. What is the evidence base being used to justify ending the twin-site surgery centres? When we see twin-site working well in other parts of the UK, has that approach not worked in Scotland? If so, could the minister share the evidence that tells us that this approach has not worked? That is one of the many concerns that have been highlighted. Given the evidence and the justified criticisms of parents and campaigners, there appears to be only one explanation for that decision. Once again, it boils down to cuts to public services and our NHS, dressed up and camouflaged as service redesign and improvement. The Scottish Government makes its own choices, and many of them are bad choices that are not serving the people of Scotland well. That decision is simply the latest in a long line of centralising decisions that I have brought roughshod over the wishes of patient staff and campaigners. It is about time that the Government has started to use the powers of this place to ensure that adequate funding is provided to our NHS and other public services. We can do it. We need the political will. After all, those are the services that the public needs, and they are the services that I believe civilise as a society. There is no doubt in my mind that the Clefflip and pallet service and Edinburgh are providing a vital service that we should value and protect. As such, the cabinet secretary should intervene, reconsider and then reverse that decision. A decade ago, the SNP trashed the care report and cynically exploited the NHS for electoral gain. Whatever happened to the mantra of keep healthcare local? Presiding Officer, for the minister and the cabinet secretary and the Government, the sky is dark with chickens coming home to roost. The chief medical officer talks about the concept of realistic medicine, while that is the reality of the NHS in Scotland in 2016. I congratulate Miles Briggs on securing a debate on this very important issue for young children needing cleft surgery and their families, both in Lothian region and across the country. I thank the Royal College of Surgeons for their views and guidance. I understand that they support the principle of centralisation, where there are clear clinical benefits for doing so. It can help staff to specialise further and support high clinical standards. However, in the short time that I have today, I want to voice the principle's concerns raised with me by constituents and professionals about the pending decision to centralise all cleft surgery. Concerns around how the review of surgery arrangements has been conducted, the quality of the consultation and the impact of cleft care in the Lothian region and across Scotland. I have some doubts that the premise on which the review of services has been conducted is reasonable. It was launched because the current model of delivering a single service over two sites has not—it is claimed—resulted in a properly integrated service. However, instead of considering why that has not happened and what could be done to improve integration, the cleft management board proceeded straight to considering new options. Indeed, some members of the panel that appraised the options in October last year queried whether it was worth evaluating the status quo at all, and so I am concerned that it was not given a fair hearing by the appraisal panel. The lack of detail as to why the current arrangement is not working was criticised by a large number of submissions to the options appraisal from parents. Clinicians, parents and the cleft lip and pallet association—the charity representing patients with clefts and their families—have repeatedly asked for information about what aspects of the current arrangements were not working, but they feel that an answer has never been fully provided. They have publicly stated that they have not been provided with sufficient information to make an informed, evidence-based decision on whether or not to support those proposals. According to surgeon John Clark, twin site cleft services operate well across the UK, for example in Liverpool and Manchester. Considering why integration has been more successful elsewhere compared to Glasgow and Edinburgh, it does not appear to have been a significant part of the appraisal. Until we are certain exactly where problems delivering the existing service lie, what further support could improve those, can we be sure that moving to a single site service is the most appropriate solution? I would suggest not. The appraisal document makes reference to the significant differences in the outcome between the Glasgow and Edinburgh surgery sites, but were those differences fully taken into account, that concern has been raised by a number of surgeons formally involved in cleft care. Edinburgh's track record in terms of the percentage of children having normal speech after primary surgery, bar exceeds that of Glasgow. According to John Hammond, retired consultant orthodontist, the number of children treated in Glasgow of failing to achieve the normal speech benchmark is 60 children in every 100 undergoing palatal repair surgery. A failure rate almost doubled that in the east. Now, although I am by no means suggesting that this is outwith the normal range of success for cleft surgery, there are nonetheless clear differences on a number of measures of success, and we should seek to understand why. It is worth noting that representatives of families scored the current arrangement more highly than either centralisation than either centralisation option during the options appraisal, but it is not clear how that figures in the final decision. Deputy Presiding Officer, in light of the National Specialist Service Committee's observation that there were shortcomings in the consultation process, I urge the minister to look again at those proposals, with particular reference to the excellent surgical outcomes that were achieved in Edinburgh and the strong views of patients and staff. Given the concerns of patients and staff cited in the consultation report, the concerns about the overall consultation process, expressed by the National Specialist Service Committee, it is absolutely unclear that a single-site service based in Glasgow will lead to better clinical outcomes for current patients. Given that twin-site cleft services operate very well elsewhere, further steps must be taken to look at supporting the current service in Edinburgh to assure continuity of care for patients and families in Lothian and the east of Scotland. I am delighted to support the motion that was submitted by my colleague, Miles Briggs, on this very important issue. I would also like to echo some of the remarks on this matter that was raised by colleagues across the chamber who made compelling arguments in favour of retention. This is a very emotive subject, as can be seen from the many thousands of submissions put forward by concerned parents and campaigners, some of whom sit behind me today. One of the first meetings that I had as an MSP following the election in May was with such campaigners and, indeed, my first correspondence with the cabinet secretary was about this very service. I completely empathise with the position of these campaigners and want to use this opportunity to defend the cleft service in Edinburgh. I have a personal perspective to offer two, and my nephew and I were born with cleft pallets, and they have both been through the Edinburgh service with great success. The cleft care Scotland network noted that the central in Edinburgh performs nearly half of Scotland's cleft surgical procedures each year, and over half of those are for patients who reside in the Lothian region. In that sense, it is easy to see this simply as a local issue. However, it is important to realise that the reach of this service goes far beyond this city, far beyond the Lothian region and, indeed, far beyond the central belt. I represent the Highlands and Islands, and, according to the NHS's consultation document on this proposed change, a figure of between 5 to 10 per cent of the total number of Scottish patients come from my region. As a result, I have been contacted by parents, patients and their families, who come from my region, a long, long way from the city, but who have used the Edinburgh Search Centre because it is a world-renowned service and possesses one of the world's leading cleft surgeons in Dr Felicity Meender. We should listen to some of the medical experts. Isabel McCallum, the former clinical director of the Edinburgh Sick Children's Hospital, has questioned the clarity of the proposals, saying that it is not at all clear how patients would benefit from a centralized service and how the clinical service would be enhanced. Maureen Harrison, the former CEO of the Sick Kids Friends Foundation, also stated that she did not believe that centralisation would be the best way forward for children in the east of Scotland. It is clear from the 6,000-plus supporters who have signed the petition, set up to oppose centralisation of the service, that many of them have not just benefited from the existence of two cleft centres in Scotland but believe in the retention of two centres. It is also clear that there is support across this chamber for both centres to remain. I was very grateful to hear the contribution of Angus MacDonald because I have to say that it is disappointing to note that no SNP members, even Lothians SNP MSPs, have actually signed Miles Briggs's motion. Presiding Officer, the evidence that I have seen and heard from campaigners show this process to be rushed and lacking any consideration for the voices of the people who have benefited from the cleft surgery service in Edinburgh. Former health professionals have questioned their proposals and thousands of people have added their voices to the debate. I believe that there is a clear and compelling argument to retain this important service and, accordingly, I will be supporting the motion today. I now call on Aileen Campbell. Around seven minutes, please, minister. Everyone here shares the same desire. We want to ensure that the cleft surgery is safe and consistently able to deliver good patient outcomes. Miles Briggs is right that the work that our professionals do creates a life-defining difference to children and families' lives, and he was right to point to that in his opening remarks. I am well aware of the strength of feeling from those who oppose a recommendation to consolidate cleft surgery in Glasgow. I recognise that they believe that they are raising real concerns about the proposal. Therefore, welcome tonight's debate from Miles Briggs and the constructive contributions from Angus MacDonald, Alison Johnstone and Donald Cameron. I particularly want to thank Donald for his personal reflections on tonight's debate. It presents an opportunity to help to inform our shared understanding of the issues that are involved, and tonight's debate also allows us to clear up some of the issues that others have raised. I personally place on record my thanks to Yvonne MacLachie, whom I met earlier today, who shares our ambition for improvements but does so with passion and dedication, so I want to thank her for her time and for articulating her concerns and that of the others who I know are here in the chamber this evening. Our national clinical strategy is our blueprint for health and social care over the next 15 years. It is one of the key drivers that will help us to deliver transformational change across our NHS. The strategy makes it clear that if we are to provide the best outcomes for patients, services need to be planned on a population-based once-for-scotland basis. We must look to increase collaborative working across NHS Scotland to deliver services that will benefit all patients no matter where they live. In delivering an NHS that is fit for the future, patients should rightly expect our health services to be safe and sustainable. Sustainable means services must be consistently able to deliver high-quality treatment and care. The recommendation to consolidate cleft surgery—it is important that we remind ourselves that it is only a recommendation—has been made with the national clinical strategies ethos in mind. Patients should expect no less. In response to Neil Findlay, that has nothing to do with costs. It is about ensuring high standards of services and the proposals that we have brought forward are cost-neutral. Experience also tells us that patients and families want the best treatment available and are willing to travel to access the excellent care that our highly specialist services provide. However, in delivering transformational NHS change, there will be those who oppose it and who have genuinely held concerns articulated by many members here this evening. Maintaining two centres remains an option, but the two-centre model, as it stands, raises questions of sustainability, particularly with a single surgeon operating alone in Edinburgh. Services need to be resilient to unexpected absences, so patients receive their surgery when they need it. I know that some families are worried that a surgeon might leave if the recommendation is approved. Let me be absolutely clear that we do not want that to happen, and we will do what we can to keep all the surgeons working here in Scotland. However, we must design a national clef surgery service that is resilient to such risks, and we must plan and deliver services that will achieve the best outcomes for all of Scotland's patients. That is why one option is a collaborative three-surgeon team. It has been suggested that a single team will be better able to share the workload to learn from each other and improve patient outcomes in a collaborative manner for the benefit of all clef patients across Scotland. There are alternative options, as we have heard this evening, from Miles Briggs and Angus MacDonald and others who have contributed to this debate, and we are seriously considering each and every one of them. Whichever service model is adopted, we very much hope to retain the specialist knowledge that we have here in Scotland and build a collaborative three-surgeon team that works well together. Work is under way, which is actively seeking to support the Glasgow and Edinburgh surgeons to make that happen. In terms of the 2021 conference that Miles Briggs referenced, that will be an opportunity to showcase good results across the whole of Scotland and not just concentrating on one area. Differences in speech outcomes have also been highlighted as an issue, and work is on going to look at these data in more detail to try and understand what they tell us. We shall consider the findings alongside all the information that will guide our decision making. The online petition clearly indicates the strength of opposition to the proposals from the east, but it is important to highlight that it suggests that there will be a reduction in local clef services if the recommendation is approved. In response to that and the concerns raised by Miles Briggs about the impact on other related services, I have been given a category assurance that the proposed change is really only to clef surgery. Orthodontics, speech therapy, dental services and support from specialist nurses will continue to be delivered locally. In addition, specialist outreach clinics will be retained. There is a clear commitment to ensure that what can be done locally will be done locally. In terms of St John's in Livingston, has she been aware of the impact that this is going to have on services there, potentially for adult patients who are seen by the Edinburgh team there? What can she say about that and the potential future of that service? What we are clear about is that the proposals that have come forward to us are only about the surgery. What we want to make sure is that people can access the local support that they need, where they need it, close to their home and continue to get that much-needed support, which is essential for the smooth recovery process after surgery. There has also been much criticism from the east about the options appraisal process and the public consultation. Clearly, there are lessons for the NHS to learn and to actively reflect on. I am vexed to hear from Yvonne about her concerns that she raised with us at this afternoon's meeting. However, the Scottish Health Council has also indicated that it is broadly content with the consultation. Nevertheless, we must take heed of the concerns that have been raised about the process. I very much hope that you will recognise that the Scottish Government is listening. The cabinet secretary has met the Edinburgh surgeon, as well as the petitioner, to hear their concerns first-hand. Ms Robison also intends to visit both Edinburgh and Glasgow teams to hear their views. We have also received a steady flow of correspondence and are aware of all the arguments against consolidation, and I am pleased that this debate has presented a further opportunity to ensure that people's voices are heard. I am sorry that I am in the last 10 seconds. You can, if you wish, minister. We have some time in hand. Mr Finlay, that is for me to say, not you. Jackson Carlaw. Mr Carlaw, you have to be better prepared than that. Sorry, I apologise. I was interested to hear that Ms Robison will be visiting both these centres. I wonder if the minister, on that basis, would ask the minister whether she would be prepared to come to Parliament and make a statement on the basis of the evidence that she has so that, at a later stage, when she is fully briefed as she sees on the issue, there would be an opportunity for members to question her on that. I will guarantee that there will always be a mechanism to make sure that there is a way to ensure that Parliament is kept up-to-date with the procedures of taking that decision and to make sure that Mr Carlaw and Miles Briggs and many who have contributed this evening get a chance to know when the timeline will be around the decision-making. However, Ms Robison, I can just reiterate, is taking careful consideration of all the views, of all the opinions, but wants to make sure that she engages with the two teams where the proposals concentrate on. Now, while there are clearly differences of opinion on what is best for Scotland's clef patients, all views have been and continue to be taken into account. No decision has been made. The decision whether or not to accept the recommendation rests with ministers. Again, thank you to the parents and families here this evening, and I can assure you that we will give every consideration to everyone's views and will make a decision in due course. Again, I would like to pay tribute to Miles Briggs for bringing this debate to the Parliament, pay tribute to the parents who have attended this evening, and thank those who have made positive constructive contributions this evening. Please continue to engage in the dialogue as we work through the proposals that are presented to ministers.