Malcolm expresses guarded optimism about independent scrutiny of the NHS
Independent Scrutiny of the NHS Malcolm Chisholm (Edinburgh North and Leith) (Lab): After reading the consultation document and some of the responses to it, I support the concept of independent scrutiny that has been outlined and am inclined to support the third option. As it makes clear, such an approach is not entirely new. Indeed, the first sentence in the section that outlines the third option says:

"The NHS has used the approach of an independent, expert panel a number of times in the past", and it gives the example of the group that reviewed maternity services in Glasgow - which, as it happens, I announced in a parliamentary debate in 2004.

Independent scrutiny represents another step towards establishing an open and effective procedure for bringing about service change that is based on developing options with people, not on presenting options to them. It is fair to say that such an approach has been evolving over a number of years and that, as I say, this is the next stage in the process.

Some NHS boards have been much better at this type of approach than others. Returning to the example of maternity services in Glasgow, I felt that there was great frustration that direct intervention was possible only at the end of the process. It would be useful to be able to intervene before formal consultation takes place although I realise that under the proposals such intervention would be made not by the minister but by the scrutiny panel. That is consistent with the approach that was adopted in the Kerr report, which said that all options for service redesign must be considered before centralisation on grounds of resource or workforce constraints is considered.

A key question for a scrutiny panel is whether all the options have been examined. In relation to the Vale of Leven hospital, the scrutiny panel recently said that all the options had not been properly considered, which was a reasonable intervention at that point. The scrutiny panel's key task of assessing whether all the options have been considered is part of its more general commentary. It is useful to have a check in the system at that point, which will be crucial in giving people more confidence in the process, and it might potentially lead to a wider range of options being available - I say "potentially" because there might be little need for comment if a health board has done its job properly.

In my day, I always used to commend Tayside NHS Board and lament the fact that other health boards did not engage the public and put forward options to the same extent. If they had, the whole process would have proved much more successful. Perhaps we should hope for a withering away of the scrutiny panels in time, as boards get better at producing a range of options with a comprehensive evidence base.

Part of the purpose of the debate is to ask questions. Margaret Curran and others have done that, and I am sure that the minister will reply to them. An obvious question is about the nature of the panels. As it happens, last night, I asked a health activist in my constituency what she thought of them. Her response was that it depends who is on them. That is a crucial issue, although the way of forming the panels that the consultation recommends seems entirely reasonable. It might be desirable for a wider range of groups to be approached on the nomination of panel members but, apart from that, the general approach seems right.

There is also the issue of the degree of change that will be referred to panels. People have asked about that in the consultation responses and elsewhere, and the cabinet secretary has substantially addressed it. It is vital that there is clarity on the respective roles of the Scottish health council and the expert scrutiny panels. In general, people seem content with the proposed arrangements, but there might be an issue if boards work collaboratively to develop options for change. Will the scrutiny panel look only at the options, or will it look at how they have been developed? That question might already have been answered, but I have no doubt that it will be dealt with in the summing-up speech.

The key question is what happens when the evidence is contested. Page 12 of the consultation document says: "The board would be able to reflect their conclusions" - the panel's conclusions - "in the final proposal for public consultation." Does that suggest that the board can take or leave the panel's recommendations? A few questions remain to be answered but, in general, as the consultation responses indicate, there is overwhelming support for the external scrutiny process and I am happy to lend my support to it.
March 12th 2008, (Columns 6825-7)