NHS managers have struggled for years to persuade people in Scotland of the need to cut A&E departments.
NHS managers have struggled for years to persuade people in Scotland of the need to cut A&E departments.
Today an expert panel, chaired by health economist Dr Andrew Walker, has announced it too is unconvinced.
It acknowledges every health board in Scotland faces significant challenges and that any service which does not evolve will eventually become unfit for purpose. But in two scathing reports it says this does not justify downgrading emergency services at Monklands Hospital in Airdrie, Lanarkshire, and Ayr Hospital, Ayrshire.
The arguments put forward by the health boards concerned are unceremoniously shattered by the panel. In fact, the way the boards are accused of ignoring evidence and failing to provide data at times raises questions of competence. For example, the scrutiny panel examined the information pack NHS Ayrshire and Arran produced on the future of Ayr A&E.
It found: "Studies that questioned the safety of ambulance response times and distances tended to be overlooked or criticised while studies that suggested longer ambulance journeys were safe were quoted without comment."
The same pack is said to be missing a number of calculations - such as the number of people currently treated at Ayr Hospital who would have to by-pass it in an ambulance if proposed changes were implemented.
These packs were used by representatives, including doctors and members of the public, to score alternative proposals for Ayr A&E. The scrutiny panel notes: "The board made decisions about how the scores of different groups were to be combined. This gave twice as much weight to the views of NHS managers as doctors."
Similar problems are raised with the way NHS Lanarkshire has presented the case for centralising services away from Monklands Hospital.
The panel said it appears that "the board selected quotes and papers that supported its case, without reflecting others that provided a differing view".
Difficulty filling consultant vacancies has long been cited by NHS Lanarkshire as a driver for change, but the panel cites interviews with newly appointed staff which confirm it "offers an attractive working environment". The level of on-call work did not appear to be a problem, nor were doctors put off because they could not sub-specialise in a particular medical field.
The reports could prove to be explosive. It is not just the reasoning of two health boards which is being torn apart. Views put forward by royal medical colleges are being called into question.
Dr Walker is clear his remit does not include previous decisions about other A&E departments, such as those in Glasgow and Livingston.
However, he does believe that there is a need for Scottish research showing how treatment by a specialist in a bigger hospital affects recovery. The scrutiny panel found there were "limited" medical fields where large, specialist centres benefited patients. These include major trauma, although as just 2-3% of trauma patients fit this category, the panel guards against making everyone travel further for this gain.
Dr Walker said: "For the majority of treatments the studies are quite old and come from America and Canada and they may not apply in Scotland in 2008. We need to update the evidence base to ensure the decisions we are making are robust."
How the medical community will react to all the assertions remains to be seen. The scrutiny panel, which includes Dr Ian Anderson, an A&E consultant, Martyn Evans, director of the Scottish Consumer Council, and Angela Scott, head of the Chartered Institute of Public Finance and Accountancy in Scotland, is said to support unanimously the documents published today.
Dr Walker said: "I would urge anyone surprised by our findings to read our reports."
