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INSIDE TRACK: Report on hospitals sparks difficult questions

I don't usually duck thorny issues in this column, but today I am hesitating.

Do I really want to re-open the can of worms labelled: "centralising Scottish hospital services"?

I have written tens of thousands of words already about plans to axe frontline departments, the uproar this provokes and the lengthy decision-making process. When Robin Cook spoke to rowdy applause at a packed public meeting regarding the withdrawal of services from St John's Hospital in Livingston, I was there with my notebook. When police were called to Airdrie Town Hall because a crowd were on the doorstep, unable to fit into the chamber to discuss the proposed closure of Monklands A&E, I was occupying a seat and trying to catch John Reid, the former Westminster health secretary, who was fighting for his constituents' hospital.

I sympathise with patients who describe frightening emergency situations and fear what a longer trip to A&E will mean for, say, a strapping chap who insists his wife drive him to hospital because his chest pain can't possibly be a heart attack.

I think their genuine concerns about centralisation were often poorly addressed when so many health boards were busy axing departments eight years ago.

But I have also interviewed numerous doctors who feel they can deliver safer care if they are spread over fewer sites, and I believe they have patients' interests at heart.

Back in 2005-06 there was an emphasis on the desire of clinicians to specialise in narrow medical fields, and I was never convinced about the need to reshape hospital services around their ambitions. However, the medical community now appears to have acknowledged that patients need an army of experienced generalists as well as experts on knees and throats.

The army we have now, however, does not seem to be big enough. Read the rapid review of hospital services in NHS Lanarkshire, triggered by high death rates at Monklands, which was published on Tuesday. It paints a picture of what medical shortages mean: patients left for days without a visit from senior medical staff, nurses struggling to find doctors when patients go downhill and those at risk of deterioration going unchecked.

Alex Neil, health secretary, says this is due to the way resources have been managed in Lanarkshire, not a lack of staff and certainly not because medics are spread too thinly across three hospitals. Saving Monklands A&E was, after all, one of the SNP's much trumpeted 2007 election policies.

However, it is worth noting the previous chief executive of NHS Lanarkshire, Tim Davison, was flown into NHS Lothian as interim boss when James Barbour suddenly left last year amid the waiting times fiddle scandal. This must have had an impact on leadership, and it was not of Lanarkshire's making.

Progress on reducing hospital mortality has been behind the average for Scotland in Monklands and Hairmyres hospitals since 2007. So it has spanned two bosses, one so highly regarded he was tasked with turning around another troubled health board.

Is Mr Neil hesitating to ask difficult questions about Lanarkshire's problems? He shouldn't. The care of his constituents is at stake.

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Health

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