The recent Scottish Labour campaign on Monklands Hospital (MH) in NHS Lanarkshire (NHSL) was deeply flawed, and we must learn lessons from it.
It was divisive and alienating for sections of the hospital’s catchment area, and failed to engage with basic facts on every aspect of the issue.This is worrying given the party’s aim to campaign in ways that ensure progressive and improved outcomes for patients.
The campaign was led by Richard Leonard, and culminated in a parliamentary debate and vote. It argued that a planned replacement hospital must be built on the current site in Airdrie and not on a new site at Gartcosh, the preferred choice of NHSL, which was in the middle of a long-running and substantial public consultation when Labour’s campaign was launched.
The Scottish NHS faces a host of serious challenges at both local and national level. It is right that this has always been, and continues to be, a priority for Scottish Labour in campaigning inside and outside of parliament. Many of the problems faced are extremely serious, such as the acute shortage of general practitioners and Audit Scotland’s recent concerns about the financial sustainability of the service. There are also rapid changes in medical care to consider and the rise in numbers of elderly patients. These and other challenges are very familiar. Many of them are complex and intractable.
Alongside longer term financial planning, this must include effective leadership, and much more engagement with communities about new forms of care and the difference they make to people’s lives. Caroline Gardner Auditor General for Scotland
Ignoring the evidence
The challenge for any campaign is to consider the evidence in its specific context, understand communities on the ground, and develop new thinking and ideas. Surprisingly, given its high profile, the campaign on plans for the MH replacement did not engage with the available evidence on key issues, displayed a poor understanding of the catchment area of MH, and failed to consider the risks to patients and staff of building a smaller hospital on a congested site.
The first problem with the campaign was that it showed no interest in what kind of hospital patients and staff in Lanarkshire need and want in the 21st century. The hospital catchment area is projected to experience the steepest rise in the number of over-75s in Scotland in the coming years, and serves areas with high levels of poor health and deprivation. So the challenges are considerable, both to provide more capacity and to use that capacity more intelligently.
As you would expect, a great deal of work has been done on this by NHSL. Briefly, the proposal is for a low-rise hospital design incorporating green spaces where aspects of hospitalisation that cause stress and pose health risks for patients are designed out. The proposal has been driven by a model of care developed by clinical staff at MH, where the right facilities are next to one another and where patient journeys determine where key elements sit.
The Gartcosh option scored highest among the participants – public and patient representatives, NHS Lanarkshire staff and key partners such as the Scottish Ambulance Service. A subsequent financial analysis of all the proposals, which took into account the appraisal results, has confirmed a new hospital at Gartcosh as the highest scoring option. NHSL
The planned design requires a 40 acre site. It is proposed to have a transport hub on the hospital campus, which is next to a railway station and is served by a well-developed major road network. The plans are ambitious, even inspiring, and substantial work has been done on modelling patient and staff journeys in accessing the hospital.
The failure by the party’s campaign to consider the clinically-driven design meant that the campaign ignored the issue of whether it was even possible for NHSL’s ambitious plans to be realised on the current site – a point to which I will return.
A longstanding hospital desert
The second problem is exemplified in a statement made early in the campaign that no one should have to leave town to use their hospital. The speech appeared to imply that the hospital simply served Airdrie, and to ignore its real catchment area. Later in the campaign this was widened to Coatbridge and Bellshill and ‘other areas’. In fact the hospital also serves the northern corridor of North Lanarkshire including the substantial towns of Cumbernauld and Kilsyth. The entire northern area is a long-standing hospital desert and patients there have had to leave town to access a hospital for generations.
It was not clear if this early speech and later utterances demonstrated simple ignorance of the actual catchment area of the hospital, or a willingness to ignore and therefore render invisible a substantial proportion of patients using the current and future replacement hospital. This was all the more galling because patients in places such as Cumbernauld and Kilsyth have enormous difficulty accessing the current hospital (indeed all NHSL hospitals) by public transport and many have to resort to expensive taxis. The transport issues being highlighted by the campaign are already an issue for the current site. So staying on the current site does not resolve the question of access for all of the hospital catchment area.
The third problem was the assumption that the logistics of building on the current site need not detain the campaign. In fact the logistics make for grim reading and jeopardise not only the current design but progressive outcomes for all patients wherever they live.
Challenges to health of patients and staff
Building on-site would mean closing the car park and hospital services on the periphery of the campus, such as the very busy David Mathews Diabetes Centre, for several years. This would be enormously difficult for patients and staff alike. Where would patients and 100s of construction workers park in the highly congested residential setting? How would the small-scale residential road network cope with the construction traffic as well as hospital traffic? Moreover, the current hospital is full of asbestos, and demolition on an operational site poses real challenges not least to the health of patients and staff.
The site is just too small. It is in a congested area, and it suffers from other infrastructure deficits including very poor drainage and sewerage. An insistence on building on that site would compromise the carefully developed design determined by an enlightened model of patient care. It would require staff to work in a very stressful setting, and would probably mean a high-rise design without the green spaces and patient centred approach – in fact, a second rate 20th century hospital. This would be a tragedy for generations of patients.
My last problem with the campaign was the way in which it was careless and disrespectful of the civic engagement around the proposals, given that the public consultation was in full swing throughout the campaign. This consultation involves various stakeholders including community councils, health service unions, individual citizens and indeed clinical and ancillary staff across the different phases and elements of the consultation.
Learning from mistakes – and lessons for Labour
The current phase of consultation utilised social media, public meetings and a wide range of innovative engagement to get its point across. People in my community were talking about it. There is also evidence from this phase that NHSL has learned from earlier phases and has pushed the question of transport and access up the agenda as a result. The presentations led by clinical staff were excellent. [See below for NHSL links]
Despite all this, the consultation was described in parliament, according to reports, as not engaging people meaningfully, and the campaign saw fit to launch a petition (focused on a small geographical area) before the current consultation phase was even closed. Civic and consultative processes matter in a democracy, and not just in this context. They encourage active citizenship, public money is spent on them after all, and community councils and other stakeholders work hard in debating issues and submitting a response. This entire activity was effectively ignored by the campaign.
Labour’s campaign petition encouraged people to believe that the years of sifting through options in earlier consultation phases could be ignored, and to believe that a first class hospital on the current site was deliverable when clearly it is not. Campaigns that are doomed to fail and ignore the evidence actually obstruct meaningful engagement and are ultimately alienating for communities. It certainly succeeded in alienating large numbers of patients living in the northern corridor which the campaign chose to airbrush out of the equation.
Communities in Cumbernauld campaigned hard for a Cumbernauld hospital in earlier phases of the consultation on the replacement hospital, but that would have reversed the access problems and left patients living near the current hospital with the awful problems of access currently experienced by patients in the north corridor.
The Gartcosh proposal offers the possibility of a state of the art hospital with a planned transport hub on campus at the heart of a major road network and next to a railway station. Further community and trade union campaigning and negotiation will be required to ensure there will be good public transport and access for all patients and staff, not just those living in the specific area Labour’s campaign concerned itself with.
Ensuring Scotland’s NHS not only survives but develops in the coming years will take all of our creative resources. Nothing about the choices we face is easy and superficial slogans and unsophisticated campaigns will not help. We must be concerned with evidence, developing new policies, doing things differently and respecting communities and staff on the ground. This campaign ignored all the evidence and demonstrated a poor understanding of the issues and communities involved. Scottish Labour can and must do better than this.
This article was first published on Labour Hame
Featured image: University Hospital Monklands, courtesy NHS Lanarkshire
NHSL Monklands Replacement/Refurbishing Options pre-briefing May/June 2018
NHSL Consultation on Replacement or Refurbishment University Hospital Monklands
Audit Scotland: NHS in Scotland 2018