SCOTLAND'S second largest health board is to press ahead with hugely controversial plans to close hospitals, sell off land and bring specialist acute care services together to create modern centres of excellence.

The Sunday Herald has learned that NHS Lothian is to recommend to its board on Wednesday that it proceed with the largest ever review of health services in the region, toughing it out amid widespread public opposition to the proposals.

"Standing still is not an option, " NHS Lothian chairman Brian Cavanagh insisted last week, but critics have branded the recommendations "tactless" and even "heartbreaking".

Cavanagh is adamant that the status quo is not an option with the introduction of European legislation limiting working hours for junior doctors, a new Mental Health Act, action required on waiting times and a growing emphasis on tackling health inequalities in recognition of the fact that middle-class patients tend to get better treatment than their poorer counterparts.

These pressures apply across Scotland, meaning NHS Lothian's service review points the way forward for health boards around the country.

Cavanagh stressed that pounds-180 million of extra money - gained through ongoing savings, selling off land and an increased budget allocation (up 7-per cent) - is to be spent on services over the five-year programme titled Improving Care, Investing In Change.

The programme includes a pounds-75m new-build Royal Edinburgh Hospital; the shifting of services to St John's Hospital in Livingston, guaranteeing its long-term future; and a focus on moving toward more local delivery of services.

At the same time key specialist services will be concentrated in centres of excellence.

If the board approves the recommendations, they will go to Health Minister Andy Kerr.

Campaigners are particularly incensed at proposals to close the Royal Victoria Hospital (RVH) - which was at one time an internationally renowned centre for geriatrics and still provides services for the elderly - and transfer services to a pounds-15m purposebuilt facility at the Western General Infirmary.

This is to be funded by selling off the RVH site for between pounds-20m and pounds-30m. The land on which the 200-bed hospital stands is a prime development site on Craigleith Road, between Comely Bank and Blackhall.

Under the option to be recommended on Wednesday, long-term care beds for the elderly will be lost, although the board insists modern care facilities bringing services closer to communities means not as many beds are needed as before.

Phyllis Herriot, secretary of the Edinburgh area council of the Scottish Pensioners' Association, dismissed the proposals as a "farce". She said that "hundreds and hundreds" of people had written to the board asking that the Royal Victoria be improved and upgraded into a centre of excellence for older people.

"I'm disgusted and very disappointed. We were more or less knocking our heads against a brick wall."

Herriot said that "greed not need" was driving the sale of the RVH site.

"My stomach's turning at the whole set-up. We need the Western General Hospital as well as, not instead of the RVH.

It's disgraceful that Edinburgh, that once led the way on social services and health care, should fall so far behind. It comes as a shock and is heartbreaking. Something has got to be done about it."

Other campaigners highlighted the fact that the health board has gone down the road it preferred from the outset despite a three-month public consultation exercise last year which was extended due to the volume of response.

"These consultations with the public are a sham. I'm just absolutely raging at the behaviour of that organisation [NHS Lothian], " said Dr George Venters, chairman of the Scottish Health Campaigns Network, an umbrella body representing various local campaigns against hospital reorganisation.

"They have made their minds up and presented options that are not options.

They're making decisions in the managerial interest and political interest but not the public interest. It's appalling."

Shona Robison, SNP shadow health spokeswoman, echoed this view.

"It's quite tactless that these proposals are being put forward at a time when communities are being consulted by the Kerr Commission on how health services should look in Scotland for the future. That these two things are happening at the same time will, I think, astonish many people affected by these proposals."

Cavanagh maintained, however, that the board listened fully during the consultation process, and had taken on every view. "I think the board has established its bona fides [honest intention] as a listening board. I think we have clinical support for the changes."

He continued: "The biggest mindset to change is from one of bricks and mortar. The thrust of Lothian isn't just about hospitals. It's about how we deliver a primary-led NHS.

That's the big challenge."

But Cavanagh conceded that NHS Lothian should better communicate its decisions after Wednesday's meeting.

"I see this as a new start about how we work on a regular basis with the public, keeping them informed on what what we promised we would and, more importantly, on what we need to do next."

"We need to recognise the human dimension, " he added.

alan. crawford@sundayherald. com WHAT'S PROPOSED A pounds-75m development at the Royal Edinburgh Hospital to take expanded community mental health services, acute in-patient beds, increased accommodation places, and psychiatry of old age services.

A pounds-15m Midlothian hospital to replace Loanhead geriatric and Rosslynlee psychiatric hospitals.

And a pounds-15m Musselburgh primary care centre.

NHS Lothian will import the English Hospital At Night scheme, where nurses carry out jobs once done by junior doctors at the Royal Infirmary, Western General and St John's, Livingston.

Emergency surgery and trauma orthopaedic services already removed from St John's. The board has agreed to shift specialist head and neck services there, bringing in an extra 4500 patients a year.

It is also to become one of three teaching hospitals.

The Royal Victoria Hospital site to be sold off and services transferred to a purpose-built, pounds-15m facility at the Western General. The land sold off for between pounds-20m and pounds-30m.

Herdmanflat Hospital for psychiatric care is to close.