Official reports will today deal a devastating blow to the drive to close accident and emergency departments across Scotland.
The expert panel set up to scrutinise plans for A&E care in Lanarkshire and Ayrshire is to say health board arguments for cutting services are deeply flawed.
Criticisms include the use of foreign research which is up to 20 years old, the omission of important information when considering options and applying more weight to the opinion of managers than doctors. Even a calculation by the Royal College of Surgeons is found wanting.
Last night, Health Secretary Nicola Sturgeon said the reports "confirm the government's view" that the decisions to close two A&E units were "wrong".
The documents not only undermine the case for change in Ayrshire and Lanarkshire. They raise questions about the centralisation of hospital services across Scotland and beyond.
In the Lanarkshire report, seen by The Herald, the panel says: "Data from practice 15 to 20 years ago in other countries is now being used to justify reorganising care in NHS hospitals in Scotland, with effects that could potentially last for decades."
Arguments about the future of emergency services have been raging for years with thousands of people in communities from Caithness to Glasgow protesting to save services.
Plans to downgrade Monklands A&E in Airdrie, Lanarkshire, and Ayr Hospital A&E in Ayrshire to minor injury units were approved in 2006 by the last Scottish Labour administration.
When the SNP took office last May they said these A&Es must be kept, told the boards to draw up new proposals and created a scrutiny panel to examine them.
Both boards submitted proposals that still support schemes which cut emergency care.
NHS Lanarkshire has listed a plan where Monklands would lose intensive care, emergency medicine and surgery as the "preferred scenario".
NHS Ayrshire and Arran has backed a scheme which would axe emergency surgery and reduce the level of critical care at Ayr hospital.
However, the scrutiny panel, chaired by health economist Dr Andrew Walker, says there are "considerable strengths" to the established A&E structure.
It adds: "The panel's view is that the board has not made a convincing case for significant changes to emergency services."
Like other health authorities, NHS Lanarkshire and NHS Ayrshire and Arran argue specialist consultants who treat high numbers of patients get better results and they need to bring doctors together to reap these gains.
For some conditions - such as heart attacks and major trauma - the panel acknowledges centralisation might produce better outcomes. However, it concludes most patients would gain little.
The Lanarkshire report says: "The general case for change appears to be based on evidence that has little relevance to Lanarkshire in 2008."
Both boards quote a Royal College of Surgeons' report that says a population of 300,000 is required to support an emergency surgery department. The scrutiny panel says it finds "this figure was presented without being underpinned by a sound evidence base".
Ms Sturgeon said: "The next steps are for NHS Ayrshire & Arran and NHS Lanarkshire to carefully consider all the available information and agree preferred service proposals at their board meetings later this month."
Professor Bill Stevely, chairman of NHS Ayrshire and Arran, said they would consider the report. NHS Lanarkshire made a similar promise.
Why are you making commenting on The Herald only available to subscribers?
It should have been a safe space for informed debate, somewhere for readers to discuss issues around the biggest stories of the day, but all too often the below the line comments on most websites have become bogged down by off-topic discussions and abuse.
heraldscotland.com is tackling this problem by allowing only subscribers to comment.
We are doing this to improve the experience for our loyal readers and we believe it will reduce the ability of trolls and troublemakers, who occasionally find their way onto our site, to abuse our journalists and readers. We also hope it will help the comments section fulfil its promise as a part of Scotland's conversation with itself.
We are lucky at The Herald. We are read by an informed, educated readership who can add their knowledge and insights to our stories.
That is invaluable.
We are making the subscriber-only change to support our valued readers, who tell us they don't want the site cluttered up with irrelevant comments, untruths and abuse.
In the past, the journalist’s job was to collect and distribute information to the audience. Technology means that readers can shape a discussion. We look forward to hearing from you on heraldscotland.com
Comments & Moderation
Readers’ comments: You are personally liable for the content of any comments you upload to this website, so please act responsibly. We do not pre-moderate or monitor readers’ comments appearing on our websites, but we do post-moderate in response to complaints we receive or otherwise when a potential problem comes to our attention. You can make a complaint by using the ‘report this post’ link . We may then apply our discretion under the user terms to amend or delete comments.
Post moderation is undertaken full-time 9am-6pm on weekdays, and on a part-time basis outwith those hours.
Read the rules hereComments are closed on this article