Something quite remarkable happened in Holyrood yesterday.
The SNP minority government experienced a rare defeat after all opposition MSPs united behind a Labour motion calling to protect local NHS services.
After the government's amendment, committing to "maintaining and improving safe and effective local services across Scotland" was defeated, the 62 SNP MSPs abstained from the final vote, meaning that the Labour motion was passed by a margin of 64 to 0.
Labour, the Liberal Democrats, the Conservatives and the Scottish Greens want the government to call in proposals affecting services across Central Scotland. What is particularly concerning is that proposals to reshape services could be made without ministerial approval, and the opposition parties believe this is an unacceptable situation. As Labour's Anas Sarwar said: "It would be a democratic outrage if we allowed health boards to proceed with these decisions without individual members of this parliament or indeed this minister having a say."
The health board proposals for service change affect maternity services at Inverclyde Royal Hospital and the Vale of Leven Hospital, children's services at the RAH in Paisley and orthopaedics at Monklands Hospital in Airdrie (all, oddly enough, places I've previously worked). Glasgow's Centre for Integrated Care and Lightburn Hospital could also be affected, with the latter potentially facing closure. There can be little doubt that much of the decision making is being driven by financial pressures, resulting in plans for increased centralisation of services.
It's very easy to jump on the emotive "save the NHS" or "keep our local hospital" bandwagons. I've done it myself when there's been good reason. But I'm also sufficiently aware that clinical needs are constantly evolving and therefore how we provide NHS services should, too. There are often perfectly valid clinical reasons for revisiting service provision. However, how we do this is vitally important and the process must be transparent and accountable. There has to be adequate consultation, and there must be opportunities for ministers to have a full discussion with, if necessary, the option to oppose such changes.
Cabinet secretary Shona Robison said it would be “inappropriate” for her to discuss the proposals in detail, or indeed whether or not she supports them. She did state there is the possibility that the final decisions could come before her for approval, but didn't make any guarantees. She stated: "Local people can be ensured that in all such cases, ministers take all the available information and representations into account before coming to a final decision. I think that is the proper and responsible way to run our health services." This was not entirely convincing,
Lib Dem health spokesperson Alex Cole-Hamilton said afterwards: "This vote sends a clear message to the health secretary that these damaging NHS closure proposals need to be called in by ministers and scrutinised by the Scottish Parliament." During the debate he had claimed it was "astonishing" that the issue was only discussed in parliament due to the opposition tabling a debate, and while recognising that "challenging decisions" needed to be made, called for Ms Robison to "enlist [MSPs] as champions" in redesigning health services.
It's extraordinary for anything to unite all the opposition parties in Holyrood, and this unprecedented (but not entirely unexpected) reversal for the government demonstrates the need to ensure it has the confidence of parliament. Some level of opposition support will always be necessary and the Greens cannot simply be assumed to offer it unconditionally. The outcome of the vote is not binding on the government, and inevitably uncertainty about the future of the NHS can unite across party lines in a way that other issues cannot. Perhaps it would be wrong to make too much of it - but the Scottish government was fortunate to narrowly avoid defeat (in rather bizarre circumstances) last week on its council tax proposals and this will be another shot across its bows. The Herald described it as "a bloody nose for the SNP", which seems to be overstating the situation, but the government will have had better weeks.
It's a good result in that it's sent a clear signal to the government that decisions affecting the NHS must be accountable and open. Whether the government acts on the vote is another thing, but I fully expect given the nature and sensitivity of the issue that it simply has to. Certainly, as a former Lib Dem member Gerry McGregor suggested, the result puts to bed the notion that the SNP government is effectively a dictatorship supported by the ever-compliant Greens. It's also positive to see the opposition parties working constructively to ensure democracy holds government to account - and for Labour to be showing a little of the kind of leadership we used to expect from them.