 The decision on major service change proposals in Glasgow and Clyde. The cabinet secretary will take questions at the end of her statement, so that there should be no interventions or interruptions. I would encourage all members who wish to ask a question off the cabinet secretary to press their request to skip buttons now. I welcome the opportunity to inform members of the decisions that I announced on Friday, 19 January, on service change proposals submitted to me by the chairman of NHS Greater Glasgow and Clyde. On 14 March 2017, NHS Greater Glasgow and Clyde submitted major service change proposals for Clyde, inpatient and day-case pediatrics services. That was followed on 16 August by the board submitting major service change proposals for rehabilitation services in the north-east of Glasgow, including Lightburn hospital. Before I turn to the detail of each proposal, I want to explain my decision making process. Given the significance of the proposals, I took appropriate time to consider them. I asked for and received advice, including expert clinical views. I also visited the paediatric ward, the Royal Alexander hospital, the new royal hospital for children on the Queen Elizabeth campus, and Lightburn hospital. Alongside those visits, I met local stakeholders, including campaigners, seeking the retention of paediatric services in ward 15, as well as patients and carers. Considering the proposals for Lightburn hospital, I met the local Parkinson's group. I also received reports from the Scottish Health Council confirming that the NHS Greater Glasgow and Clyde had complied with and met established guidance on engaging and consulting with local people, providing them with the opportunity to make their views known. I will now address my decision on the Lightburn hospital service change proposals. I want to make it clear that I have carefully considered all the available information and all the representations that are made to me. In doing so, I had to consider whether the board had made a compelling case in the best interests of patients and whether the board had credible and viable plans for the provision of high-quality local services. I have been consistently clear during the board's review process that the final proposals had to effectively address the concerns that resulted in our rejection of the previous Lightburn closure proposals in 2011. Concerns were raised by local people that those concerns are not being addressed in the current proposals. Considering the proposals, my paramount concern was that, if they were to be implemented, they would result in the removal of a significant and highly valued healthcare facility in one of the most deprived communities in Scotland. I wish to record that I accept the local clinicians' views and have given very careful consideration to them and their support for the closure of Lightburn hospital. However, I had to balance those views against concerns that I have, that the proposed replacement of local community and support services are not yet sufficiently developed to support the closure. Presiding Officer, I want to make clear that this was not an easy decision. I fully agree that healthcare services cannot be static and that the reform will sometimes be necessary. In my letter to the board setting out my decision, I have acknowledged and welcomed their commitment to work with other planning partners to develop as a priority a health and social care hub in East Glasgow. I have reiterated to the board that engagement with and involvement of the local community is of paramount importance in any future planning. That is, of course, applicable to all NHS boards when considering any service redesign, and I will take the opportunity to reinforce that at my next meeting with NHS chairs. I will now turn to my decision to approve the board's proposals to transfer in-patient and day-case paediatric services from ward 15 at the Royal Alexander hospital in Paisley to the Royal hospital for children in Glasgow. Presiding Officer, I gave long and hard consideration to this proposal, and it has been one of the most difficult that I have been required to make in my time as health secretary. As in my consideration of the light-burn proposal, I have carefully considered all of the information available to me and all of the representations that are made to me, including the board's submissions, advice and evidence provided by officials and expert clinical advice. My judgment had to be on whether the board had made a compelling case in the best interests of patient care, whether it had credible and viable plans for the provision of high-quality local services and whether the proposals were consistent with national guidance. Having taken time to come to a decision, I have approved the board's proposals. In coming to this decision, I recognised that it was only the in-patient and day-case services that would transfer and that the majority of patient cases would continue to be seen and treated locally. I would stress that the accident in emergency departments at both the RAH and underclined royal hospitals will continue to receive paediatric patients who self-present, alongside the continuation of outpatient clinics as well as specialist community paediatric services. The board has made a compelling case for those proposals, which have attracted overwhelming clinical support. Only today I received a letter from the lead paediatric clinicians and the chief nurse for paediatrics in neonatology at the RAH and the Royal hospital for children, reiterating their clinical support for the proposals. They have told me that the change will help implement the standard set out by the Royal College of Paediatrics and Child Health to ensure that high-quality healthcare is delivered to children and young people and that the implementation of those standards will contribute to better outcomes for children and young people. We also highlight the benefit to patient care of having access to dedicated on-site subspecialty medical teams such as cardiology, neurology, nephrology and respiratory medicine to name but a few. This is further supported by the submission of Action for Sick Children Scotland, now Children's Health Scotland, to the board's consultation. Their submission concluded that the most compelling argument is that clinical standards are there to support the best quality healthcare for all of the children of Scotland and we feel that this would be best achieved by moving ward 15 to the Royal Hospital for Children. The local clinicians also offer the reassurance on emergency care that they do not nor do they see any risk to future patients affected by the change in an emergency pathway that directs general practitioners and the Scottish Ambulance Service to the Royal Hospital for Children instead of either the RAH or the Royal Hospital for Children. The change is clear for all concerned. I recognise that, from the representations that I received and the meetings that I have attended that many local people from the Paisley area in particular will be deeply disappointed by that decision. I recognise that the services that families have received from ward 15 have been highly valued and that there are understandable concerns about access to the specialised services to be transferred to the Royal Hospital for Children and how those will be integrated into those outpatient and community services that will continue to be provided locally. There are also issues about transport and financial support and family support and information services. That is why I have approved those proposals on two conditions. One, that the health board must maintain and continue to improve community-based paediatric services and maintain local provision. Two, that the board must work directly with families from the Paisley area on specific individual treatment service access plans to be complete before any service changes are made, ensuring that there is a full understanding of what services and support will be available to them and from where. The letter from the Glasgow clinicians also gives an assurance that the open access families currently attending ward 15 will be fully involved in planning how the changes will affect their child. Any specific concerns that they have will be addressed on an individual basis. I have spoken to the board chair and reiterated the conditions that are set out in my letter of approval. I have received a letter from him giving me that assurance. I hope that local families, members of the campaign group and members here today will understand that I have made the decision in good faith, as informed by all the available evidence and representations. With the underpinning conditions that I have put in place, I believe that this decision is in the best interests of children across the Clyde area. Miles Briggs will be followed by Anna Sauer. I thank the cabinet secretary for advance copy of her statement. On 1 May 2016, Nicola Sturgeon promised the public in relation to ward 15 at the RAH. I quote, There are no proposals to close that particular ward. I believe in local services with access for local people. Here we are today, two years on. At that time, NHS Greater Glasgow and Clyde had initially begun looking into moving in-patient paediatric services from RAH in 2011, when Nicola Sturgeon was health secretary. The closure of the ward to inpatients had been on the board's preferred option since 2012, when she was also health secretary. The board stepped up efforts to centralise services after the opening of Glasgow's new royal hospital for children in 2015, when she was the First Minister. Did the First Minister forget all of this when she promised at a public event in 2016 that she was not or was she intending to attempt to mislead the public before an election? I believe that today we will go down as Nicola Sturgeon and the health secretary's Niclegg moment in this Parliament, and now we see this health secretary and the back benches from the SNP hanging their heads in shame of this decision to justify this decision to Parliament, breaking a key election pledge made to families across the west of Scotland. Does not this ward closure come on top of the SNP's failure over children's hospital services and the long-going incidents that we have seen, as long as closure of the kids' inpatient ward here in St John's in Livingston just goes to demonstrate that the public cannot trust a word that the First Minister or SNP Government says when it comes to our local health services? First of all, can I address the issue that Miles Briggs first raised about the First Minister's comments on 1 May 2016? Let me say two things very clearly about that. First of all, the Greater Glasgow and Clyde health board approved its proposals on 18 October 2016, well after the comments on 1 May, but more importantly than that, the Scottish Government received that submission on 14 March 2017. Almost a year later, plus, that was the first time that I have made this decision, the first time that I saw the clinical advice that I have based my decision on. It is that clinical advice that is absolutely critical here. I have based my decision on the clear clinical view, including from those very clinicians who work with these kids on ward 15. That decision, as I said in my statement, is about delivering better outcomes for children and young people. When Miles Briggs or anyone else says that I am wrong in my decision, they must also be saying that these clinicians are wrong in their decision. I am not sure on what basis Miles Briggs is able to say that, what experience or evidence he will put forward to say that those local clinicians are wrong. I, as a politician, cannot say that those local clinicians are wrong. That is why I have accepted their evidence and that is why I have accepted this decision, albeit how difficult it was. Just to reiterate, for all those families, plans will be put in place absolutely before this goes ahead. I hope that that is of some reassurance to the families concerned. I thank the cabinet secretary for advance sight of our statement and I pay tribute to the Save Lightburn campaign and the Kidnead Award campaign. Local residents and service users are tirelessly fighting to protect their local services. Services that they were promised would stay open during the election. Sadly, while one is celebrating for now, the other is rightly distraught and dismayed. However, the reality is that we should never have been here in the first place. When faced with a leaked cuts paper, the Government denied any proposals to close lightburn or the REH pediatric ward even existed. Neil Bibby was called a liar. Paul Martin was called a liar. Kezia Dugdale was called a liar. The campaigners were accused of scaremongering, but now the closure is confirmed and 8,000 patient cases will be transferred to the already overstretched QEUH. That is a result of cuts imposed by this Government and a workforce crisis that is overseen by this cabinet secretary. However, not a single MSP on those benches has the backbone to call out for what it is. Where were the local MSPs, George Adam, Tom Arthur and Derek Mackay? Nowhere. Where was the local MP, Mary Black? Nowhere. When confronted by a local resident live on national television, Nicola Sturgeon said, and I quote, that there are no plans to close this ward, I pledge to keep hospital services local. This is a betrayal of local people. How can we ever trust a word this cabinet secretary or this Government ever says again? As I said to Miles Briggs, the submission from the board came to me on 14 March 2017. That was the first time that I saw the clinical advice on which I have based my decision. If Anasawa is saying that that is the wrong decision, he must also be saying that the local clinicians who have treated these children for many years are also wrong in their clinical judgment, because that, as a politician, is what I have based my decision on. If Anasawa thinks that he knows better than those local clinicians, he better say on what evidence he has that can make that stack up. Now, Anasawa mentioned the cuts paper. Let me say two things about that. One is that the issue of finance is quite important here, because in relation to the ward 15 at the RAH, it is estimated that there is about £840,000 that will be reinvested in local services, pediatric services at the Royal Alexander hospital and at the Royal hospital for children. Every penny of that will be reinvested in pediatric services at both of those hospitals. Had I been wanting to save money on Anasawa, it would have been the light-burn proposal that I would have given the go-ahead, because it would have saved £4 million. That is about nothing about money. That is about the clinician's view of what is better outcomes for children and young people. As a politician, I cannot ignore clinicians who tell me that, for children and young people, there will be better outcomes by this decision. I challenge any politician in this place to ignore that clinical advice. Does the cabinet secretary agree with me that the decisions that are announced on Greater Glasgow and Clyde's health board major service change proposals show that the review process is robust and evidence-based and that, where there are good reasons in line with the Scottish Government's national clinical strategy and other policies to overturn health board proposals, such as, in the case of Lightburn hospital, the process reaches the correct decisions? What I can say is that, with the Lightburn proposals, they were not developed to a stage that was viable or credible. There is the idea of the East End hub, which in essence is a good idea, but it has to be developed. What we want to see is, in terms of the sites for that hub going forward, for the Lightburn site to be considered as part of that. There is far more work for Glasgow to be done around developing that hub, which, as I think we would all agree, has some merit. It was at such an early stage that I could not possibly have approved it in the form that it came into me. Can the cabinet secretary confirm, when she expects the agreement process to conclude for families currently receiving treatment at ward 15 at the RAH, and what will happen if agreements cannot be reached? I have made it very clear to the board, to John Brown as the chair, that for those families who have complex health needs—and there are around 200 of those families, many of whom are on the open access agreement—those plans have to be in place before those changes go ahead. The board, John Brown as the chair, has written back to me agreeing that. The clinicians in their letter also say that that is important. What needs to be very clear in all those plans is access to the new hospital, how that will happen, but also about the local services that will still be provided to those families. That is one of the conditions that I have made it very clear. One of the conditions on approval of that is that all those plans need to be in place, and that is something that I will certainly hold the board to. Neil Bibby, followed by Alison Johnson. Over 17,000 people supported the campaign to stop the closure of the kids' ward, including NHS staff, and patients with direct first-hand experience of the excellent care that it provides. Parents such as Karen Meagle have told her story to the Paisley Daily Express today about what it means for her eight-year-old son, who has a life-limiting condition. The way that SNP politicians nationally and locally have behaved has left local families feeling totally betrayed and without any trust left in this Government. Throughout this process, the cabinet secretary assured families that she would listen. Well, he could not have been clearer. Why have they been ignored? The cabinet secretary has snubbed parents with this announcement. Will the cabinet secretary agree to come to Paisley and explain her decision directly to the parents who are affected, or will she snub them again? Neil Bibby, I did not snub the parents. I met the parents and listened to their concerns. I also listened to the local doctors who have been involved in treating those same children. Therefore, I had to make a decision, and the decision that I made was based on the very clear local clinical advice from those doctors who know the children very well indeed that this was in the best interests of those children, that they would get better outcomes—not worse outcomes—better outcomes from being treated at the new children's hospital. No politician would ignore that clinical advice. What is important now is that the board get on and develop those plans so that the families have the assurance that, around the access arrangements, they will have at the state of their new hospital less than seven miles away. I visited the hospital last year in family support and information services, and I learned about the incredible work that they do supporting parents, patients and their wider families. I met parents, too, of children. They had taken their child to hospital, their child was admitted immediately, and they found themselves practically living in the hospital for weeks. I was surprised that much of that important work was largely funded and reliant on charitable donations. Given that there will be increased demand on those services in the hospital, the major service change will generate increased demand. Will the cabinet secretary take steps to ensure that the service is fully funded and sustainable? Those families who are travelling further, who are away from home for longer, who are leaving caring responsibilities behind, will be properly supported. Can I first of all thank Alison Drosie for her question? Yes, reassure her. Part of the commitment that the board has given around the reinvestment of £840,000 is to ensure that there is a build-up of local services, not just at the Royal Hospital for Children but also at the REH. Part of that is about making sure that there are plans in place for those families, whether that is travel or subsistence or any other, and, importantly, that they know about that. I also just wanted to reiterate a point about making sure that, where emergency care is required, the clinicians are very, very clear that the change in the emergency pathway that directs the GPs and the Scottish Ambulance Service to the Royal Hospital for Children is a better and safer model. There is clarity about where children are going in an emergency situation. I reiterate again that, for a lot of the care, particularly around outpatient facilities and local community paediatric services, they will remain delivered locally. For children who are accessing the A&E services at the Royal Alexandra hospital, 86 per cent of children in the Paisley area will continue to be seen at the front door of the Royal Alexandra hospital. The vast majority of children in that area, going through A&E, will continue in the same way as they do at the moment. Alex Cole-Hamilton will be followed by Fulton MacGregor. In her statement, the cabinet secretary says of her decision to close the children's ward at the Royal Alexandra hospital, that it has been one of the most difficult that I have been required to make in my time as health secretary. That reflection should give us the measure of how significant this closure is, not just for the cabinet secretary but for the families who rely on it and those members in this chamber who have fought to save it. Will the Government now commit to honour those motions already passed in this chamber, to bring such decisions to Parliament before they are taken, to allow members to debate and scrutinise those proposals, so that, in particular, we might give better voice to the people such closures will affect? Alex Cole-Hamilton says that those are difficult decisions. I met with the parents and the families and I understand the strength of feeling here, but as the cabinet secretary required to make those difficult decisions, I have to take a step back from that. As a politician, I rely on the expertise of those who, first of all, know the children very well and who can give me the best advice about what is the best, effective and safest care. In this case or any other case, the clinical advice is critical. That has to be the decision-making process, because otherwise, what we would have are service change proposals where there are issues about patient safety, potentially, brought here for debate on the floor of Parliament, so our decision is going to be made about patient safety on the basis of a vote in this place. I do not think that that is a credible or a safe way to make changes to our health service. The decision rests with me and I have made this decision on the basis of what the clinicians have told me is in the best interests, is the best outcome for those children and young people, no other considerations. I would hope that every politician in this place would understand that you cannot ignore that. Unless there is a paediatric specialist in this place, I do not think that there is. I am not, so I rely on the expertise of those who advise me. That is the basis of this decision. That is why it is the right decision. Fulton MacGregor, to be followed by Jamie Greene. Thank you, Presiding Officer, and I will remain to the chamber and appeal to the health secretary. The cabinet secretary has mentioned several times today already the clinical advice that she received. Can she further assure the Parliament or explain to the Parliament what weight she gave that advice from clinicians, as opposed to other evidence that she heard? I had a meeting with the local clinicians at the hospital and what I heard directly from them was compelling. It was about the fact that they would be able to provide better outcomes for those children and young people because of the range of back-up services that are at the state of the new children's hospital less than seven miles away. That is a very clear set of evidence and guidance to me. As a politician, I rely on that. Subsequent to that, the letter that the clinicians sent to me that I received this morning reiterated that and reiterated the importance that they saw of working with the families around the plans, particularly those families who have been on what we have called the open access arrangements. The clinical advice has been compelling. As a politician, I could not ignore that advice. That is the basis of my decision—nothing else. That is the basis of my decision, and that is why I had to make the decision that I have made. Jamie Greene, to be followed by George Adam. The cabinet secretary in her statement that both A and E departments at the RAHC and Inverclyde will continue to receive paediatric patients who self-present without explicitly stating that they will continue to receive and accept all forms of emergency cases, including those presented by ambulance. Can the cabinet secretary confirm that there are no plans to divert any emergency care from Inverclyde to the RAHC, or can she outline any scenarios under which the decision might be taken to instead take a patient to the RAHC instead of their nearest A and E? That already happens. The Scottish Ambulance Service already takes those children that will require the services of the Royal Children's Hospital, the new Children's Hospital, and they take them directly there at the moment. Those decisions will be made on the basis of the clinical decision making, depending on what the illness is of the children. Of course, when children are concerned, the risk is managed very carefully, indeed, so they will always err on the side of caution. That has always been the case for all our local hospitals. Where the state of the hospital is in Glasgow, of course, with all those back-up services, if they are not absolutely sure what is wrong with their child, they will always err on the side of caution and go straight to the children's hospital. I would have thought that people would understand that that is the right thing to do. However, I would reiterate in terms of self-referrous parents who turn up with their child, go through the door of the RAHC, or indeed any other local hospital. That will continue, as it is at the moment, and 86 per cent of those will be seen and treated within the Royal Alexandra hospital. I hope that that can reassure the member. George Adam is one of the main concerns that has been raised by my constituents. Can the cabinet secretary assure and reiterate that the plans are put in place for the open door families, including on transport links, before any service changes are made to world 15 at the RAHC? Can I say to George Adam that the issue that he raises is important because the families that he refers to on open access or open door arrangements are those families who have children with complex health needs. Therefore, what is important is that the plans that are put in place to make sure that continuity of care and treatment will be put in place—the board has given me that assurance—and the clinicians themselves who are involved in working with those children every day in the here and now have given me that assurance. I expect that there were arrangements to be in place before that change goes ahead and I would confirm that to George Adam. There is no getting away from the fact that the First Minister was asked in a TV debate whether the children's ward at the RAHC would close and she was clear that she would not close that ward. The cabinet secretary knows that there were proposals to close the ward before May 2016. The First Minister has given similar commitments to my local community about the Vale of Leven hospital and the vision for the Vale. Did she consult the First Minister about her decision? Was the First Minister copied into the minute of the decision? Was the minute ever circulated? That is fundamentally a matter of trust. The key question for me is whether we can now trust anything that the First Minister tells us. As I have said on three occasions, there was no proposal to close a particular ward that had come to us. The proposals only came to the Scottish Government on 14 March 2017, and that was the only point at which we saw the clinical evidence in favour of the decision. Given that the decision is based on clinical evidence alone, that is the first time that I saw that clinical evidence. The decision is, yes, Jackie, really, that was the first time that I saw the clinical evidence was after 14 March. Speaking to the local clinicians has been a fundamental part of my decision making. The decision is my decision as laid out and required to be my decision. Of course, the First Minister has been made aware of my decision and she accepts it fully. Claire Hawke had to be followed by Neil Findlay. Thank you, Presiding Officer. I refer members to my register of interests. I am a mental health nurse with an honorary contract with Greater Glasgow and Clyde NHS. Given the welcome decision to reject the closure of Lightburn hospital, I would like to ask the cabinet secretary how she would expect the board and planning partners to take forward the provision of health and social care in partnership with the local community. I can say to Claire Hawke that a lot of work has to be done around Lightburn and around the hub. It was at a very early stage and not in a viable form to approve. However, in it is the concept of something quite good. I think that it is quite exciting the idea that you would have a range of local services not currently available in the east end of Glasgow under one roof under the model of a hub, but far more work on the detail is required. What I have said to the chair, as I expect them to take that forward now, in a way with the partners that they work with, particularly the local authority, but also the local community and organisations such as the local Parkinson's group. I would expect all those organisations and the local community to be fully involved in the development of a viable proposal for the future hub within east end of Glasgow. Neil Findlay, to be followed by John Mason. In 2016, Nicola Sturgeon said live on TV during an election debate that there was no plans to close the children's wars at the RAH in Paisley. For six years there have been staffing problems on top of staffing problems at St John's children's ward in Livingstone with assurances that it would not be closed. How can parents, children, grandparents and local people who join me on Friday at a protest at St John's believe a word the cabinet secretary or the First Minister says about the future of children's services in Livingstone, given their blatant betrayal of the people of Paisley? The only person who is talking about the closure of the paediatric ward at St John's is Neil Findlay, which is rather surprising. Can I say this about St John's? As he knows, a report from the Royal College of Paediatrics and Child Health was received by NHS Lothian in October last year. It concluded that the preferred option for both it and NHS Lothian continued to be a 24-hour consultant and tier 2 cover model for St John's. The college recognised that the development of this model is a long-term solution that required a successful recruitment campaign of which NHS Lothian has been working very hard to do and has had quite a lot of success, as he knows well. I would have hoped that he would get behind NHS Lothian, where the clinical advice to me is that that is a service that should continue. There is no proposal that has come to me with clinical advice that the ward in St John's should close. I would have thought that Neil Findlay would be better placed in focusing on supporting his local hospital in the recruitment campaign rather than scare mongering, which at least he could put people off. It is a serious point, because if potential doctors are looking at whether or not to apply for a post that covers St John's, are they likely to be encouraged or not by what Neil Findlay is saying? I would suggest that he should be very careful in encouraging people to apply for those posts rather than the opposite. I am sure that that is what the local clinicians at St John's would be encouraging him to do. John Mason, I wonder if the cabinet secretary would agree that the key people for the health provision in the east end of Glasgow are the people of the east end of Glasgow. Would she also agree that, given the better transport links, Parkhead hospital site is the best place for a new hub and other health facilities? What I have said to the chair and the board is that, in taking the proposal forward and developing it into a viable proposition, they should continue to explore the parkhead and the light burn sites. What is important is that there is the development of something that can meet the needs not just of the existing local services in the east end of Glasgow but of what further services can be developed in one of the poorest communities in Glasgow. That is an exciting opportunity to do so, but it has to engage the local community properly, and that is the challenge that I have put back to the chair and the board. I thank the cabinet secretary and members for their contributions. That concludes our statement on major service change proposals.