Top-level departures from the board, hundreds storming public meetings, ministerial intervention - what's gone wrong in Fife? Colin Wright finds out

To lose one top health board member is an accident - to lose two seems like carelessness.

Thus might Oscar Wilde have described the situation at Fife health board.

Having said goodbye to general manager Pat Frost earlier in the year, the board has now seen off chair Charlotte Stenhouse.

Ms Stenhouse had not been long in the job. Drafted in from Kirkcaldy Acute Hospitals trust only two years ago, she had been replaced there by ex-minister Lord Ewing - who in turn resigned last May complaining about the running of the health service locally.

Ms Stenhouse made it clear she was pushed out by Scottish health minister Susan Deacon rather than having jumped, explaining: 'I very much regret the minister's view but I realise that if she has no confidence in me to deliver the Parliament's agenda for health in Fife then of course I must agree to her request and resign.'

Ms Deacon called for a 'cooling-off period on the board's proposals for public consultation to allow the new health board team to take a fresh look at the issues and how they consult with local communities'.

She went on to state that 'delivering and communicating changes in the way we deliver acute services is a challenge for everyone in the NHS in Scotland'.

She added: 'I am also aware that this has been a particularly difficult issue in Fife.'

The problem is that the board itself has had the communication problem.

It has been undertaking a strategic review since last year of all services in both the primary and acute sectors.

But it is the acute review which has generated the greatest controversy.

Even before it started, acting general manager Malcolm Murray said the board's preferred option was to locate acute inpatient and maternity services at Victoria Hospital in Kirkcaldy, turning Dunfermline's Queen Margaret Hospital into a specialist day-care centre.

He described the plan as 'the most logical and sensible step' and guaranteed 'that nothing will change until meaningful consultation has taken place with people in Fife'.

For Kathy McLean, Unison branch secretary at both Queen Margaret and the Victoria, this was a serious mistake. She argues: 'The board has made some very serious errors of judgement over the last few months.

'How can you have a consultation exercise which means anything if you begin it by stating your preferred option?

'There really is no way back from that position and it is this, in my opinion, which has caused the greatest concern among staff and the public.'

There is, she says, 'a feeling that whichever of the two sites becomes the day centre will be the loser - and as the board has already stated its position, many in Dunfermline are angered that a decision has been made without adequate consultation'.

In a parliamentary question, Dunfermline West MSP Scott Barrie asked Ms Deacon if she could confirm that no final decision had been made about acute services in Fife.

Ms Deacon replied: 'The Executive is aware that the health board has declared its preferred configuration for acute services.

'However, the health board will be reviewing its proposals in the light of the outcome of the options appraisal that has still to be completed, public discussion and formal consultation which is scheduled to commence in January 2000.'

Previous attempts at informal public consultation have dramatically broken down. One public meeting in Dunfermline had to be broken up as hundreds of people attempted to enter a building designed for 200.

The last meeting of the health board had, according to the local press, a 'sizeable police presence'. The health board's response was to hold no more public meetings.

A spokesperson explains: 'We have cancelled all public meetings but will continue with formal consultations over the coming months. The public reaction has been caused, we believe, by a lack of information about what exactly is happening and more announcements will be made in the new year to clarify the position, particularly in Dunfermline and Kirkcaldy, about what services will be available.'

Christine Johnstone, administrator with Fife health council, says: 'We did feel that the board's announcement about its preferred option did jeopardise any serious form of debate into the matter - and the public, in West Fife anyway, clearly feels that a decision has already been made.

'We are also disappointed that the board has cancelled the informal meetings after just two, since we believe they could have been a useful way of providing information on what the options were under the acute services review.

'We are happier that they are beginning to address these issues but believe that the public will never fully understand why, for example, the newer hospital at Dunfermline is not the preferred choice, without being given access to all the business plans which explain precisely why the board prefers Kirkcaldy.'

The health board is keen to emphasise that the acute review is part of an overall review of primary care, learning disability and other services.

For Unison, Ms McLean says: 'They are all interlinked. For example, the future of learning disabilities in some units is definitely connected to where the acute services are located, and until we know the answer to that question nothing else will be known.

'My own preference is either for a new hospital or for continuing the status quo with the two separate hospitals, neither of which seems to be an option.'