►
Description
Members' Business Debate on the subject of—
S5M-01639 Liam McArthur: Island Health Boards—That the Parliament considers local NHS boards to be key in delivering frontline services across Scotland’s distinct communities; believes that a one-size-fits-all approach rarely works, particularly in delivering health care in Orkney and Shetland where, more often than not, island communities require different solutions to the central belt; acknowledges that the nature of delivering health and care services in rural and remote island communities inevitably requires additional resources; recognises that decisions about how those services are most effectively delivered are best made locally; considers therefore that concerns that the Scottish Government’s intention to “examine the number, structure and regulation of health boards” could lead to the amalgamation of NHS boards to the detriment of providing the best possible health care in the islands, and notes calls for the Scottish Government to undertake to protect island health boards, including NHS Orkney and NHS Shetland, in its forthcoming review.
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A
Okay,
the
final
item
of
business
today
is
a
members
business
debate
on
motion
number
one
639
in
the
name
of
Liam
McArthur
on
island
health
boards.
The
debate
will
be
concluded
without
any
questions
being
put.
So
would
those
members
who
wish
to
participate?
Please
press
the
request
to
speak
buttons
now
and
I
call
on
Lynn
McArthur
to
open
the
debate
around
seven
minutes.
Please.
Mr.
McCarrick
thank.
B
You
very
much
deputy
presiding
officer.
Let
me
start
by
thanking
colleagues
for
the
cross-party
support.
That's
allowed
this
debate
on
island
health
boards
to
take
place.
I,
look
forward
to
hearing
the
contributions
of
those
able
to
participate
this
afternoon.
Didn't,
of
course,
the
minister
passing
was
slightly
surprised
that
no
SNP
MSP
felt
able
to
support
my
motion,
which
I,
don't
believe,
really
says
anything
on
Julie
controversial.
Indeed,
in
her
recent
response
to
me
in
my
colleague,
tabish
Scott,
the
health
secretary,
very
reasonably
I
thought
accepted
many
of
the
same
points.
B
He
acknowledged
the
unique
nature
of
the
islands
that
NHS,
Orkney
and
NHS
Shetland
are
very
distinct
communities
and
that
the
respective
NHS
services
are
experienced
in
the
demands
of
serving
those
populations.
So,
as
I
attempt
to
set
out
why
I
believe
our
Island
health
boards
deserve
protection,
I'm
encouraged
by
what
appears
to
be
a
decent
amount
of
common
ground
between
myself
and
the
health
secretary.
Nevertheless,
the
First
Minister's
intention
set
out
in
her
programme
for
government
to
examine
the
number
and
structure
of
Health
Board
has
set
alarm
bells
ringing
in
orkney
and
shetland.
B
From
my
conversations
with
those
directly
employed
in
delivering
health
and
care
services
in
Orkney,
as
well
as
the
many
members
of
the
public
we've
been
in
touch
with
me
over
recent
days,
there
could
be
no
doubting
the
strength
of
feeling
or
the
determination
to
resist
any
dilution
of
local
control.
Some
of
those
concerns,
I
know,
will
not
be
confined
to
the
island
communities
that
Tavis,
Scott
and
I
represent.
That
is
because
all
the
evidence
shows
large
scale.
Structural
changes
inevitably
distract
attention
away
from
the
day-to-day
business
of
delivering
services.
B
They
can
affect
morale
and
the
ability
of
organisations
to
recruit
and
retain
staff,
and
the
savings
often
used
to
justify
them
invariably
proved
elusive.
If
not
illusionary.
Anyone
dating
this
need
only
look
at
what
has
happened
since
the
government
decided
to
create
a
single,
centralized
police
force
five
years
on
and
surely
only
Kenny
MacAskill
believes
this
has
been
a
success
or
delivered
what
was
promised.
A
review
of
how
health
boards
are
performing,
of
course,
is
prudent,
given
the
crises
were
seeing
in
many
areas
of
health
and
care.
B
Professional
reviews,
perhaps
even
overdue,
but
I,
would
caution
against
believing
structural
reform.
Is
an
answer
to
the
Maiden's
prayer,
certainly
for
rural
in
Ireland
area,
such
reviews
tend
to
signal
a
refreshment
of
services
and
decision-making
into
the
centre,
and
this
matters
not
least
to
those
who
rely
on
these
key
services
at
NHS
or
tonie's
AGM.
Earlier
this
week,
the
locial
local
patient
group
voiced
its
opposition
to
NHS
ortley
being
subsumed
within
a
larger
board.
Serving
a
wider
geographic
area.
Preserving
NHS
or
tonie's
identity
is
important.
That
identity
shapes
the
ethos,
priorities
and
approach.
B
Little
wonder,
then,
that
is
such
anxiety
in
the
islands
at
what
might
be
lost
in
any
move
to
centralized
services
and
decision-making,
bringing
together
different
boards
with
different
identities.
Even
priorities
offers
no
guarantee,
or
indeed
much
likelihood.
The
island
needs
would
be
effectively
haired
understood,
far
less
mate.
Moreover,
it
would
remove
the
ability
to
be
nimble
in
responding
to
local
needs
to
develop
in
conjunction
with
communities
themselves,
services
that
best
suit
the
island
circumstances
and
to
enhance
the
skills
of
staff
and
ways
that
ensure
both
quality
and
breadth
of
provision.
B
This
is
not
an
isolationist
approach.
Island
health
boards
already
work
collaboratively
with
counterparts
on
the
mainland
NHS
grampian
is
the
obvious
example
with
respect
to
the
Northern
Isles,
but
there
may
be
opportunities
in
future
to
work
with
others
in
providing
specialist
treatment
that
it
would
be
impractical
to
let
the
deliver
in
an
island
setting.
Here
again,
though,
a
note
of
caution.
B
If
the
government
plans
to
marriage
mainland
health
boards,
it
must
take
account
of
the
impact
on
all
patients,
for
example,
recent
problems
affecting
the
oncology
department
in
Aberdeen,
so
some
orkney
and
shetland
cancer
patients
offer
treatment
in
them
d
in
Glasgow
and
what
treatment
itself
may
have
been
exceptionally
good.
I
with
Aberdeen
Isles
patients
face
more
complex
travel
arrangements
and
limited
access
to
the
support
structure
provided
by
clan
in
the
Red
Cross
in
the
Northeast,
but
far
from
reducing
the
service
is
available
in
the
islands.
I
want
to
see
these
increased.
B
This
ambition
is
shared
by
NHS
or
any
staff
patients
and
local
communities
themselves
who
see
this
as
crucial
in
their
efforts
to
attract,
retain
and
effectively
serve
their
populations.
The
recent
decision
to
locate
the
CT
scanner
in
Oran
II
is
a
case.
In
point,
speaking
to
the
staff
involved,
I
know
the
scanner
has
already
made
a
big
difference
in
terms
of
early
diagnosis,
allowing
more
effective
treatment,
improving
and
in
some
cases,
saving
lives
justifying
the
long
hard-fought
campaign
and
more
is
possible.
B
Such
an
approach
can
therefore
help
improve
patient
care,
reduce
travel
and
accommodation,
costs,
unlock
economies
of
sales
scale
and
open
up
more
interesting
career
paths
for
those
working
in
health
and
care
in
our
Islands,
and
this
last
point
is
important.
Given
the
challenges
faced
in
recruiting
and
retaining
staff
in
remote
and
rural
settings,
the
Royal
College
of
Surgeons
again
shone
a
light
on
this
issue
last
weekend,
their
report.
Well,
there
are
no
easy
solutions.
We
need
to
do
more
to
give
those
in
training
a
taste
of
what
Island
working
has
to
offer.
B
We
need
to
develop
a
workforce
comfortable
across
a
range
of
general
skills,
rather
than
training
ever
more
specialists,
and
we
must
ensure
more
aisle.
Students
can
access,
Scottish
medical
schools.
Widening
access
needs
to
be
about
reality,
not
just
about
poverty.
At
the
same
time,
there
is
no
escaping
the
fact
that
financial
incentives
will
play
a
part
in
this
equation,
as
well:
deputy
presiding
officer,
delivering
good
quality
health
and
care
in
our
Islands
to
a
population
living
longer,
but
with
more
complex
conditions,
presents
enormous
challenges.
B
Meeting
those
challenges
is
beyond
the
the
gift
of
simply
any
health
minister,
decent
transport
links,
for
example,
including
reliable
air
services,
and
a
note.
The
Transport
Minister
bye
bye
morning
walk
side,
which
is
helpful.
The
availability
of
good
mobile
and
broadband
coverage
routinely
and
compellingly
raised
by
GPS
and
nurses
throughout
my
constituency.
These
and
other
factors
fundamentally
affect
the
way
in
which
health
and
care
is
delivered
in
Orkney.
In
turn,
the
way
in
which
health
and
care
is
delivered
in
Orkney
has
a
fundamental
bearing
on
the
economic
well-being
and
sustainability
of
the
islands
I
represent.
B
So
my
plea
to
the
Health
Minister
today
is
to
ensure
that
this
review
and
it
would
be
helpful
to
hear
a
little
more
about
the
time
frame
and
the
process
involved
protects
Island
health
boards
recognizing
their
unique
status
and
the
risks
inherent
in
submerging
them
within
larger,
less
responsive
or
less
accountable.
Setups
failure
to
do
this
would
drive
a
coach
and
horses
through
the
government's
commitment
to
island
proofing.
More
importantly,
it
would
undermine
the
ability
of
health
and
care
provision
to
be
tailored
to
the
specific
needs
of
our
island
communities
that
cannot.
A
C
Deputy
presiding
officer
I'd
like
to
thank
Liam
MacArthur
for
bringing
this
motion
to
the
chamber
today
and
commend
him
for
his
efforts
in
highlighting
concerns
about
health
services
within
not
just
within
his
own
Oakley
constituency,
but
also
acting
as
a
champion
for
the
islands.
I
have
signed
this
motion.
C
The
needs
of
people
in
rural
and
remote
areas
of
Scotland
are,
of
course,
vastly
different,
so
those
are
people
living
in
more
densely
populated
areas
and,
as
such,
require
a
very
different
approach
to
the
provision
of
healthcare
services.
This
is
the
case
even
more
so
in
Island
constituencies
such
as
orkney
and
shetland,
but
also
in
the
Western
Isles
and
in
the
many
smaller
islands
within
our
garland
butte.
C
Because,
time
and
again
when
it
comes
to
the
organization
of
our
public
services,
we
have
seen
an
increasing
drive
to
centralized
services
by
this
government.
We've
seen
it
with
our
fire
services
following
amalgamation,
we
have
seen
it
with
our
police
with
the
creation
of
a
single
force,
and
we
all
know
of
the
many
problems
that
have
been
reported
in
that
we
are
even
now
seeing
it
in
education,
with
proposals
announced
a
few
weeks
to
go
by
John
Swinney,
to
create
regional
education
boards,
taking
powers
away
from
local
councils
and
centralizing
them
to
a
larger
body.
C
C
So
today,
presiding
officer,
deputy
presiding
officer.
Let
me
finish
with
a
question
to
the
minister:
a
repeater
call
that
I
made
in
early
July
for
clarity
on
these
proposals.
Will
she
give
clear
details
today
all
the
scottish
government's
plans
for
the
organizational
structure
of
NHS
brought
in
scotland
and
if
she
is
unable
to
do
that
today,
will
she
tell
us
when
that
announcement
will
come?
Thank
you.
D
You
presiding
officer
first
I
have
to
declare
an
interest
I'm
a
pharmacist,
registered
with
the
general
pharmaceutical
council
until
my
election
and
me,
I
was
employed
by
NHS
Highland
I'm,
really
grateful
to
lea
MacArthur
for
the
opportunity
to
speak
in
this
debate.
I
represent
the
Highlands
and
Islands
region,
an
area
which
covers
nearly
half
the
land
mass
of
Scotland
and
has
served
by
six
different
health
boards.
I
want
to
take
the
opportunity,
first
of
all,
to
acknowledge
the
aspects
of
today's
motion,
which
I
believe
we
can
all
agree
on,
like
mr.
D
MacArthur
I
believe
that
often
island
communities
do
require
different
solutions
to
the
central
belt.
I
would
go
further
and
suggest
that
many
communities
require
their
own
solutions.
It's
clear
that
providing
health
and
care
services
in
remote
communities
requires
a
higher
per
capita
investment
and
I
recognize
that
decisions
about
how
these
services
are
most
effectively
delivered
our
based
made
locally.
D
Unfortunately,
I
can't
in
all
conscience
agree
that
the
potential
amalgamation
of
any
chess
boards
would
be
to
the
detriment
of
the
best
possible
health
care
in
the
islands.
As
a
health,
professional
I
was
encouraged
to
ask
regularly
if
the
way
that
we
had
always
done,
things
was
necessarily
the
best
way.
Innovation
and
change
is
vital
to
improving
health
care.
We
should
always
be
looking
for
ways
to
improve
the
way
that
public
services
are
provided
and
forever
the
financial
constraints.
Our
focus
must
be
on
patient
outcomes
and
on
quality
of
care.
D
Governance
and
quality
must
not
get
lost
during
the
reorganization.
Bigger
health
boards
could
be
just
as
capable
of
reflecting
the
needs
of
a
community
as
smaller
ones.
The
key
to
success
is
for
the
individuals
on
the
ground
in
the
small
local
operating
units
to
be
empowered
to
deliver
local
solutions.
I
can
absolutely
understand
that
the
people
in
the
Northern
Isles
might
be
frightened
that
they'll
lose
their
voice
and
I
can
assure
that
people
all
over
the
Highlands
and
Islands
share
the
same
concern.
We
know
very
well
that
a
one-size
approach
doesn't
fit
all.
D
In
fact,
NHS
Highland
is
an
example
of
a
large
health
board
area
which
covers
remoted
and
urban
areas,
island
and
mainland.
And
if
you
look
at
the
example
of
Health
and
Social
Care
integration,
it
operates
different
models
to
suit
local
needs.
So
there
are
none
lead
model
agency
in
one
part
of
Highland,
a
lead
agency
model
in
one
part
of
Highland
and
an
integrated
joint
board
in
Argyll
and
Bute
model.
If
there's
to
be
a
change,
it's
vital
that
the
engagement
and
consultation
process
enables
us
to
make
an
informed
decision.
D
People
must
have
the
opportunity
for
discussion
and
a
chance
to
identify
any
benefits
as
well
as
risks.
Some
things
are
already
done:
Wales
Scotland
wide,
so
NHS
national
procurement
uses
combined
buying
power
to
get
a
base
deal
on
buying
drugs
and
the
savings
go
right
back
into
patient
care.
I
have
heard
from
people
working
in
Island
health
boards
that
it
can
be
difficult
for
smaller
health
boards
to
compete
with
larger,
better
resourced
ones,
to
attract
certain
skilled
staff.
D
It
is
probably
easier
to
conduct
research
and
develop
specialist
knowledge
and
expertise
in
the
large
centers
having
fewer
health
board
areas.
Might
just
encourage
the
shearing
of
this
precious
resource,
or
at
least
remove
some
of
the
barriers
for
staff
and
remote
areas
to
tap
into
that.
There
may
also
be
a
possibility
of
reducing
duplication
of
effort
all
over
the
country
and
I
would
pose.
The
question
could
having
fewer
health
board
areas,
reduce
unnecessary
variation
and
practice
and
outcomes
mate.
It
actually
improves
the
quality
of
care.
D
False
boundaries
are
an
issue,
and
this
proposed
change
could
see
them
disappear.
The
most
important
question
in
this
debate
is:
how
can
we
best
deliver
high
quality
care
to
communities,
and
we
have
to
answer
that
question
by
looking
at
the
evidence,
consulting
widely
and
I
hope.
That
is
exactly
what
that
of.
You
will
do.
E
Can
I
congratulate
Liam
MacArthur
aim
for
securing
this
debate
and,
while
examining
structures
of
health
boards,
we
need
to
make
sure
that
the
structures
are
fit
for
purpose
service.
Delivery
must
be
at
the
forefront
of
decision
making.
The
structures,
then,
must
be
what
delivers
that
best
for
the
service.
I
would
Islands
are
unique.
People
who
live
and
work
on
the
mainland
I
think
that
weather
can
be
disruptive
and
they
don't
recognize
the
challenges
that
places
on
island
life.
Whole
island
life
is
wonderful
in
many
ways.
E
You
can't
plan
in
the
same
way
that
you
would
in
the
mainland
and
that
people
take
for
granted
here,
it's
normal
to
plans
disrupted,
because
the
way
that
they're
for
providing
services
on
an
island
must
have
at
the
heart
of
them
the
determination
that
systems
will
work.
In
spite
of
whether
we
don't
expect
lesser
services,
we
simply
simply
that
we
expect
services
to
be
delivered
differently
depending
on
local
circumstances.
E
E
Take,
for
instance,
a
the
patient
transport
budget,
which
was
rolled
up
into
the
Highlands
and
Islands
Health
Board
settlement
for
this
year,
and
I
find
this
wedding
because,
due
to
the
size
of
Island
Health
Board
budgets,
which
are
small,
they
don't
have
the
same
economies
of
scale
to
absorb
these
changes
and
I
believe
that
the
funds
transferred
to
meet
those
costs.
They
were
not
sufficient
and
cuts
will
have
to
be
made,
and
these
cuts
must
not
have
a
detrimental
effect
on
patients.
E
However,
as
I
speak
to
people
about
that,
I'm
staggered
by
the
number
of
people
who
have
been
taken
off
island
for
routine
checkups
that
they
feel
are
unnecessary.
It's
disruptive
to
their
lives,
because
these
checkups
could
have
been
carried
out
for
them
locally.
Using
video
links.
Therefore,
Island
health
boards
and
their
patients
need
to
be
able
to
request
and
to
receive
consultations
via
telehealth
and
I
know
the
island,
health
boards
of
the
technology
and
expertise,
because
they
use
of
themselves
inter-island.
E
What's
missing
is
that
clinicians
on
the
mainland
appear
to
be
reticent
and
embracing
this
technology,
and
this
wouldn't.
They
therefore
augur
well
as
those
the
health
boards
that
won't
have
would
embrace.
The
technology
were
then
put
in
charge
of
delivering
services
to
islands.
If
they
had
the
technology,
it
would
provide
better
services
to
be
patient
centered,
and
that's
why
the
island
health
boards
use
it
themselves
responding
to
local
needs,
aim
from
people,
maybe
not
on
the
main
line,
main
island
but
and
other
small
islands
that's
around.
E
If
the
health,
these
health
boards
who
understand
these
challenges
were
to
disappear,
we
would
lose
that
knowledge
and
patients
would
be
worth
or
worse
off
as
but
what
we
need
from
the
larger
health
boards
as
a
better
understanding
of
the
needs
of
remote
and
rural
communities,
and
they
need
to
fit
tele
health
facilities
into
their
consulting
rooms.
And
what
we
need
from
the
government
is
better
broadband
in
a
rural
and
remote
I
and
island
communities
so
that
they
can
access
those
services.
E
But
it's
not
just
a
mainland
health
boards
that
have
to
change,
but
also
services
like
the
Scottish
Ambulance
Service
that
operate
a
more
model
for
urban
areas
that
simply
doesn't
work
in
rural
areas,
either
as
either
as
an
emergency
service
or
as
a
patient
transport
system.
We
do
need
change,
but
the
change
must
be
of
the
mindset.
Rather
than
of
the
structure.
Therefore
presiding
officer,
we
need
to
protect
the
local
knowledge
and
support
these
health
boards
to
deliver
for
their
patients.
F
They
are
significantly
impeded
by
by
geography.
But
a
the
motion
also
goes
on
to
talk
about
one
size,
not
fitting.
All
and
and
I
would
I
would
agree
with
that,
with,
with
some
exceptions
and
of
previous
speakers
have
alluded
to
them.
There
are
things
like
standard
of
care.
There
are
things
like
terms
and
conditions
of
staff
and
they
should
be
protected.
F
However,
administrative
arrangements
had
configured,
but
there
are
challenges
associated
to
that
too,
and
in
the
previous
session,
I
wrote
to
the
cabinet
sector
with
health,
about
the
challenges
faced
by
the
delivery
of
training
to
those
involved
in
a
social
Kia
from
early
small
islands,
and
no,
of
course,
does
an
assessment
if
needs,
but
there
has
to
be
a
practical
approach
to
how
that's
delivered,
which
beers
and
mind
will
quite
literally
time
and
tide.
So
these
are
best
done
locally.
I've,
no
doubt
about
that.
F
An
island
communities
do
require
different
solutions
and
we
have
impact
assessments
that
inform
a
lot
of
our
decision-making
and
that's
building
here,
but
I
have
to
say
it
s
hard
to
change
mindsets
and
that's
a
two-way
thing.
That's
not
been
rural,
rural,
urban
and
I.
Don't
think.
That's
necessarily
a
very
clear
understanding
of
what
some
of
the
practical
implications
are
and
these
solutions
come
from
communities.
So
I
would
commend.
F
There's
a
new
innovative
model
of
care
for
the
small
islands,
em
in
hi,
auntie
off
board
area,
the
new
car
model
of
health
and
care
services
created,
managed
and
owned
by
the
Alaskan
native
people,
and
that's
seen
a
situation
where
violence
of
egg
and
mock
a.m.
come
up
with
their
own
solutions
to
problems,
and
it
delivers
jobs
there
and
now
inevitably
requires
additional
resource.
There's
another
freeze
it
in
the
emotion
and
that's
very
important
because
of
clearly,
as
has
been
said,
that
our
additional
travel
and
other
costs
associated
with
travel.
F
The
cost
of
everything
has
the
travel
either
daunted
and
an
example.
We
are
the
one
size
fits
all
the
delivery
of
training
which
moved
from
a
situation
when
islands,
islands
had
the
the
enterprise
had
the
their
budget,
which
took
conciseness
of
actual
cost
and
whence
skills
development
Scotland
take
that
all
over
they
moved
up
F
capita
head
well
that
desperately
impacts
and
some
of
the
small
providers.
Indeed,
a
training
went
out
of
business
just
last
Friday
there,
so
all
decisions
are
best
made
locally
in
the
best
Mead.
F
From
an
informal
basis,
a
colleague
mentioned
NHS,
Highland
and
I
can
stand
at
the
north
end
of
that
and
look
over
to
mr.
MacArthur's
constituency.
Enorme
I
can
stand
at
the
southern
end
and
look
over
to
Glasgow.
That's
a
ridiculous
size,
and
that
set
we're
not
the
model
we
should
be
be
looking
at
in.
It's,
certainly
not
the
Moodle
on
promoting
one
that
has
nearly
other
size
of
Belgium
in
wheels
without
gangland
on
so
integration
of
Health
and
Social.
Care
has
been
a
factor
and
I,
don't
know
if
that's
a
factor.
F
That's
prompted
some
of
the
proposals
coming
forward
from
the
scottish
government,
but
I
would
be
said
certainly
suggesting
in
my
party,
be
suggesting
more
rather
than
less
local
management
decisions,
though
the
collaboration
will
continue.
There's
no
doubt
about
that
and
not
every
health
board
can
and
indeed
could,
probably
have
every
specialism
butters
of
hair
for
mr.
McArthur.
The
scanner
in
ortley
has
me
that
made
a
difference.
They
are
tailee
health
and
the
IT
infrastructure.
Thunder
pendous,
very
important
NHS
is
a
shared
resources,
a
shared
resource
and
it's
a
very
valued
public
service.
F
G
You
very
much
presiding
officer
I,
welcome
the
opportunity
to
contribute
to
today's
V
and
congratulate
Liam
MacArthur
on
securing
parliamentary
time
for
an
important
subject
for
Orkney,
and
indeed
all
our
island
health
boards.
As
a
member
of
the
Highlands
and
Islands
covering
an
area
the
same
one
masters
Belgium
I
know
that
a
one-size-fits-all
model
will
never
work
for
such
diverse
and
distinctive
communities.
For
me,
it
can
never
be
the
same
health
care
provided
in
Kirkwall
as
it
is
in
Keith
and
I.
G
Think
Leah
MacArthur
alluded
to
that
and
I
was
encouraged
when
he
said
a
letter
from
the
cabinet
secretary
for
health
also
accepted
these
distinctive
challenges
in
very
different
communities
within
the
same
Scottish
parliamentary
region.
But
the
signs
are
that
the
SMP,
despite
having
the
fingers
burnt
with
many
other
mergers,
are
moving
on
further
with
the
centralization
of
services.
G
Do
worry
when
I
listen
to
Timothy
taught
as
a
backbench
a
simpie
MSP,
not
recognizing
the
failures
of
these
may
I
will
give
way
in
a
second
if
it
should
like
come
in,
but
the
failure
of
these
mergers
and
just
assuming
that
they
want
these.
Similar
problems
won't
happen.
If
you
merge
and
a
make
bigger
the
health
boards
for
the
only
ones
all
good
way,
I
can.
D
G
G
As
people
are
closer
to
these
communities,
it
doesn't
mean
just
because
you
love
the
ER
that
you
should
have
to
be
out
with
services
being
lost
and
I
think
what
we
should
be
looking
at
is
delivering
services
locally,
which
is
exactly
what
we're
discussing
in
the
debate
today,
not
merging
into
far
bigger
functions
and
then
places
like
muddy
get
lost
unforgotten
about,
and
that
is
a
serious
concern
in
our
Olivia.
But
NHS
Orkney
serves
a
population
of
approximately
2025
21
and
a
half
thousand
people
and
the
challenges
for
that
Health
Board
are
well
known.
G
The
620
staff
employed
by
NHS
Orkney
do
a
fantastic
job
and
Scottish
conservatives
commend
them
for
the
role
they
play
across
the
Orkney
Islands
I
know
when
presenting
the
NHS
or
in
the
annual
review,
which
leave
MacArthur
mentioned
earlier.
This
week,
Kathy
Cohen
took
the
opportunity
to
acknowledge
the
efforts
made
in
Orkney,
in
particular
on
the
aisles
to
help
recruit
and
retain
staff.
They
are
a
key
asset
and
they
will
be
troubled.
I
think,
by
some
of
the
proposals
coming
forward
from
the
scottish
government.
G
Now
I'm
hoping
to
meet
with
the
chief
executive,
Cathy
Kevin
soon
and
I
previously
made
with
the
chairman
of
the
board.
Ian
Kenna,
bruh
and
I
knew
how
passionate
they
are
about
delivering
the
best
possible
care
to
local
people
as
locally
as
possible,
and
that's
why
it's
difficult
to
hear
some
of
the
examples
given
about
people
having
to
go
as
far
as
Dundee
to
get
vital
treatment.
G
Now,
I've
always
found
that
the
base
decisions
are
made
locally
and
with
the
flu
involvement
of
those
affected,
and
while
there
is
no
firm
proposals
on
the
table,
it
is
clear
that
the
statement
made
by
this
minority
and
I
you
know
focus
on
that.
This
minority
Scottish
Government
is.
He
will
examine
the
number
of
the
structure
and
the
regulation
of
health
boards
as
a
Scottish
Conservative
MSP
for
the
Highlands
and
Islands
I
would
urge
the
Scottish
Government
to
consult
fully
on
their
plans.
G
It's
worrying
that
the
RCA
noted
in
their
brief
for
this
debate
that
there
has
been
little
or
no
engaged
on
the
government
stated
intention.
The
briefing
continues
by
suggesting
this
could
lead
to
a
perception
that
change
is
being
introduced
by
stealth
by
a
government
talking
behind
closed
doors
that
cannot
be
allowed.
I.
Welcome
to
these
to
be
which
allows
us
the
opportunity
to
beat
to
the
beat
openly
in
Parliament
and
I
will
be
listening
carefully
and
with
great
interest
to
the
scottish
government's
response
to
the
point
meet.
Thank
you.
H
Deputy
presiding
officer
can
I
begin
by
with
other
colleagues
thanking
Leah
McArthur,
bringing
this
debate
to
Parliament's
afternoon,
but
also
to
concentrate
I
want
to
just
briefly
concentrate
on
the
care
that
medical
staff
bring
to
the
islands
and,
in
particular
to
say
thank
you
to
the
Gilbert
being
staff
and
indeed
across
the
NHS,
for
the
care
they
brought
to
my
father
recently.
The
sometimes
take
these
things
for
granted,
but
the
professionalism
of
our
staff
is
I,
think
worthy
of
mention
in
a
debate
which,
in
some
ways
is
around
process
and
structure.
H
H
Is
the
right
thing
to
do,
but
let
us
have
instead
of
just
the
language
of
this
some
concrete
examples
from
the
minister
today,
which
illustrate
why
this
government's
taking
as
matter
forward
and
also
hoping
the
windup,
as
other
members
have
said
today,
that
she
will
commit
to
bringing
forward
the
proposals
the
government
have
to
Parliament.
It
is
known
that
this
can
be
done
by
simply
ministerial
direction,
by
which
I
mean
the
any
changes
to
the
structure
of
Health
balls
and
so
the
geographic
coverage
of
our
geographical
health
boards
instead
I
hope.
H
The
minister
today
will
confirm
that
if
the
government
do
conclude,
they
plan
to
bring
forward
proposals
to
Parliament
that
will
be
done
through
primary
legislation.
So
there
is
full
and
proper
scrutiny
and
consultation,
as
as
other
members
of
mention
of
any
proposals
in
this
area.
I
want
to
just
make
a
couple
of
points
on
the
general
issues
that
have
been
raised
very
well
by
members
from
across
the
Parliament
thus
afternoon,
and
the
first
one
is
on
health
and
care
joint
integration,
as
audit
Scotland
have
made
very
very
clear.
H
This
is,
to
put
it
mildly,
challenging
it's
a
challenging
right
across
Scotland,
but
it's
certainly
challenging,
as
as
as
mr.
Ross
was
mentioning
in
the
context
of
areas
where
there
aren't
coterminous
boundaries.
It
therefore
seems
just
beyond
belief
to
me
that
anyone
would
propose
merging
the
islands
whether
they
be
the
Western
Isles
or
the
north
miles
with
mainland
health
boards,
and
therefore
making
that
integrated
joint
board
situation
even
more
challenging
and
therefore
hope.
On
that
argument
alone.
The
minister
would
recognize
the
importance
of
maintaining
the
geographic
consistency
of
what
has
been
worked
on.
H
That's
not
to
say
that
these
purple
that
what
is
now
happening
in
terms
of
merging
social
care
and
health
isn't
difficult.
It
certainly
is-
and
that
is
best
illustrated
by
last
week's
shuttle
times,
where
the
joint
integration
board
in
Shetland
decided
not
to
close
award
in
a
guild
would
be
in
hospital
and
Loic,
not
least
of
which,
because
of
the
argument
put
forward
by
one
of
the
members,
I
may
say
one
of
the
counselor
members
who
pointed
out
that
the
intermediate
care
teams
needed
to
deliver
the
care.
H
That
would
happen
were
that
ward
to
close
wasn't
yet
there
in
in
terms
of
one
care
team,
as
opposed
to
the
four
that
would
be
needed
now.
That's
an
example,
I
think
of
the
important
point
here
of
the
accountability
of
our
local
health
services,
to
sensible
arguments
about
the
geography
that
we
all
face,
and
those
seem
to
me
that
seems
to
me
that
the
principal
argument
around
not
making
a
change
in
this
area.
H
The
second
one
is
that,
where
the
structural
form,
as
we
have
seen
time
and
time
again
in
Scotland,
the
management
tier
through
no
fault
of
their
own
then
concentrate
not
on,
in
this
case,
patient
care,
but
on
their
own
jobs
and
the
future
of
their
organization.
That
will
assuredly
happen
and
you
look
no
further
than
three
Scotland
for
the
way
in
which
chief
constables
across
Scotland
had
to
deal
with
their
own
staff
and
the
consequences
of
that
change.
H
I
hope
the
government
do
at
least
recognize
that
pointer
will
be
prepared
to
respond
to
it
and
finally,
deputy
presiding
officer.
The
scent
essential
point
here
in
terms
of
designing
care
and
designing
health
in
local
areas
is
around
the
expertise
of
those
who
are
involved
in
that
service.
I
suggest
that
our
recruitment
challenges
not
just
I,
know
in
Orkney
of
scheflen,
but
also
right
across
the
Highlands
and
Islands,
as
many
have
reflected
in
recent
days.
H
I
You
very
much
presiding
officer
and
can
I
welcome
Lima
coffers
motion
and
the
opportunity
to
discuss
the
points
raised
in
it.
This
government
has
placed
the
needs
and
aspirations
of
our
island
communities
at
the
very
center
of
our
agenda
and
will
continue
to
do
so
and
I
welcome
the
opportunity
how
to
talk
about
how
we
are
delivering
on
that
commitment.
The
review
of
Health
Board
structures,
functions
and
relationships
with
local
authorities
hasn't
yet
begun.
However,
I
can
reassure
members
that
the
final
proposals
would
ensure
that
the
unique
needs
of
our
Islands
are
reflected.
I
The
parliament
has
not
yet
got
a
timetable
for
this
legislation.
Cabinet
is
still
in
discussion
on
the
initial
papers
and
this
legislation
will
be
brought
forward
in
the
normal
way
and,
of
course,
we'll
go
out
to
consultation
with
all
those
who
wish
to
be
involved
in
it.
But
we
have
a
commitment
to
locally
delivered
services
where
possible,
and
we
know
that
health
care
services
of
our
islands
are
experienced
in
serving
unique
needs
of
their
populations.
I
Delivery
of
those
excellent
services
is
something
the
staff
of
these
islands
should
be
rightly
proud
of
and
is
ruled
a
grant,
and
others
said.
Health
care
professionals
know
their
populations
and
their
needs,
and
that
is
precisely
the
direction
of
travel.
Nhs,
orkney
and
shetland
are
both
developing
new
models
of
care,
so
services
can
be
delivered
locally
where
previously,
patients
had
to
travel
to
the
mainland,
for
example,
and
each
a
shetland
have
successfully
worked
with
the
Golden
Jubilee
to
provide
a
shared
pathway
for
patients
undergoing
joint
replacement
in
Glasgow.
I
Nhs
Orkney
are
also
increasing
locally
delivered
services,
including
enhanced
chemotherapy
and
gynecology
lee
macarthur
lily
macarthur
mentioned
the
funding
for
the
CT
scanner
200,000.
That
has
enabled
the
board
to
acquire
the
this
scanner
and
enabling
the
provision
of
800
scans
in
Orkney,
where
previously
patients
had
to
travel
to
the
mainland.
This
is
local
delivery,
where
it
wasn't
before
John
Finney.
I
Moremore,
yes,
I
accept
that
in
a
somebody
from
NHS,
grampian
I
know
about
the
clan
services,
they
have
worked
with
people
locally
in
in
delivering
that
and
recognize
the
huge
contribution
made
by
the
islands
to
the
services
and
at
Aberdeen
Royal
Infirmary,
but
local
there's.
The
liberty
of
such
services
is
only
possible
with
the
workforce
to
support
it
and
we
recognize
the
challenges
of
recruiting
staff
in
these
unique
areas.
We
also
know
that
island
boards
are
leading
the
way
in
designing
models
of
care
that
maximize
the
contribution
of
the
whole
healthcare
team.
I
What
I
was
saying
before
John
Finney
I
intervened
was
that
there
is
more
that
we
can
deliver
locally,
not
less,
and
that
is
the
direction
of
travel
in
in
Shetland.
The
largest
GP
practice
has
improved
access
to
the
health
care
center
by
successfully
introducing
advanced
practice,
skill
mix
to
their
primary
care
team,
which
now
includes
GPS,
advanced
nurse
practitioners,
practice,
nurses,
nurses
and
pharmacists.
It's
not
simply
within
the
health
service
that
we
seek
to
work
more
effectively
for
patients
through
Health
and
Social
Care
integration.
We
have
continued
to
build
on
the
islands.
I
Long
history
of
joint
working
across
the
public
sector,
it's
empowered
local
communities
in
the
islands
to
develop
and
sheep
their
health
and
social
care
services.
It
also
allows
them
to
take
control
of
how
best
to
use
resources
based
on
their
detailed
understanding
of
the
needs
of
their
populations.
Local
people
are
developing
local
solutions.
That's
community
empowerment,
that's
devolution
to
local,
compared
communities,
not
the
centralization
that
Liam
McArthur
and
Donald
Cameron
tried
to
assert.
B
B
Walk
for
taking
intervention,
I
really
couldn't
disagree
with
any
of
what
she
said,
but
as
John
Finney
just
illustrated.
This
has
been
going
on
for
some
time.
I
think
that
the
the
islands
have
demonstrated
their
willingness
to
work
collaboratively
with
in
the
islands
and
between
the
islands
and
larger
health
boards.
The
concern
is
a
major
violent
health
boards
into
a
larger
health
board
area
dilute
the
voice
of
that
health
board,
which
at
the
moment
can
stand
alone
and
make
its
representations
as
it
sees
fit.
Maureen.
I
What
and
because
there
are
no
firm
proposals
yet
on
the
table.
Liam
MacArthur
is
just
surmising
that
that's
what's
going
to
happen,
I
think
the
cabinet
secretary
said
in
reply
to
both
Liam
untouch.
What
we
want
to
do
is
reduce
unnecessary
back
gloom,
back
room
duplication
and
remove
structural
impediments
to
better
care,
given
that
we
now
have
integrated
joint
boards.
Do
we
still
need
to
have
the
health
boards
as
well
or
do
we
need
a
sister
act
structure
that
reflects
the
change
and
that
has
taken
place?
I
I
All
trying
to
reduce
the
amount
of
time
that
folk
need
to
travel
to
the
mainland
and
in
terms
of
what
Douglas
Roth
said
as
a
Keith
going
I
expect
the
patients
in
Keith
and
coral
to
get
the
same
high
standard
of
care.
However,
it
might
be
delivered
differently
and
someone
made
the
point
about
artificial
boundaries
and
that's
exactly
the
situation
that
people
in
Mary
find
themselves.
They
may
want
to
go
to
Inverness,
rather
than
read
more
if
it
can
be
delivered
at
dr.
Grey's,
then
all
the
better.
I
So
we
have
got
to
remove
the
artificial
boundaries
that
currently
exists
and
the
commitments
I
think
have
been
seen
by
this
government
with
the
appointment
of
the
islands
minister.
Who
is
here
with
me
today
and
everything
that
we
will
do
in
the
future
has
I
think
we
have
said
that
we
will
island
proof.
So,
in
conclusion,
I
think
it's
right
and
proper
for
this
government
to
review
the
existing
structures
to
support,
improve
and
patient
care.