New Petitions

The next petition is PE1105, by Marjorie McCance, on behalf of the St Margaret of Scotland Hospice. It calls on the Scottish Parliament to urge the Scottish Government to guarantee retention of continuing care provision for patients who require on-going complex medical and nursing care as provided at the 30-bed unit at St Margaret of Scotland Hospice and to investigate whether arrangements for funding palliative care provision at hospices in the context of Health Department letter (2003)18 are fair and reasonable. We have quite a number of folk at the table. I welcome Marjorie McCance, Professor Leo Martin, Sister Rita Dawson, the constituency member for the area, and Cardinal Keith O'Brien. I thought that I was in trouble when the cardinal came in.Marjorie—you have three minutes in which to explain why you are where you are, and to tell us your concerns about broad palliative care. We will follow that with a question-and-answer session.

Thank you, Marjorie. I know that that was a tough shift for you, so well done. Do the other witnesses have anything to add?

Is the board looking to take away from the hospice the palliative care beds or the elderly care beds?

Did it give you an opportunity to tender?

What will happen to your current residents? Is the board looking to transfer them? Has it spoken to their families? My understanding is that if you transfer elderly people out of one home into another, a lot of them do not survive the transition very well, unless it is handled sensitively and they are moved in gradually, given time to become accustomed to their new surroundings and allowed to go back home at night.

I invite Des McNulty, the constituency member, to speak, because he has been involved with the campaign and the campaigners on the issue. I know that Nigel Don has asked some questions, but Des McNulty can perhaps clarify a couple of issues.

Before I respond to a couple of the points that have been raised, it is worth pointing out that Marjorie and others have collected more than 60,000 signatures for the petition, which is at the back of the committee room—I do not know whether Denis would like to show members the physical proof.

Is Denis your young, lovely assistant this afternoon? Did he not use to be in Equity?

Denis is the provost of West Dunbartonshire Council. We have strong cross-party support from not only that council but from people in East Dunbartonshire and in Glasgow, which the hospice also serves.There have been two consultation processes. The one in 2000 was a public consultation on proposals for a new facility at Blawarthill hospital. The proposal on which the health board consulted was for a complex of facilities to deal with a variety of needs: residential care needs, out-patient needs, continuing care and care for people with mental health problems. The generic consultation was on whether that would be a good idea. Many people thought that it would be good to have such facilities in Blawarthill, but there was no indication at that point that St Margaret's would be in any way affected. A further study, which was conducted in 2004 and published in 2005, was a balance of care report. It identified that there was a declining need for continuing care beds across the north of Glasgow, but an increasing need for residential care and specialist care for people with mental health difficulties. The most surprising thing is that in the face of evidence that suggested a particular shape for Blawarthill, the health board decided to make continuing care a significant component of provision at Blawarthill and to make no provision for other services, the requirement for which had been identified as increasing.There was no public consultation, as far as I understand it. The board did not consult St Margaret's about the process, although its decision will have a potentially profound effect on St Margaret's, which is being told that its continuing care provision must go and that it should contribute towards other provision, which the health board knew about but did not address in its reconfiguration of services. There is a question about the integrity of the board's decision about what to put on the Blawarthill site, given the conclusions of the 2005 balance of care report.There is also an issue about whether the health board has its numbers right on continuing care provision. The board argued for a big proportionate reduction in continuing care provision in the north of Glasgow—the reduction there is bigger than in other parts of Scotland. Given issues about delayed discharges and the evidence from St Margaret's of on-going demand for continuing care, the health board should be asked whether it got its numbers right and whether there is an opportunity to address the situation by acknowledging that we need the 30 beds that St Margaret's provides. That would be the simplest solution.The other solution is to ask the board to review its plans for Blawarthill, to ascertain whether it can put in place a service that meets requirements without affecting St Margaret's. Nigel Don asked what can be done; I have proposed two possible ways forward.The petition asks for a review of the arrangements for funding palliative care. The hospice movement is keen to preserve its independence. In 2003 it was agreed that hospices would receive funding of up to 50 per cent of agreed costs. In some ways, the agreement represented a step forward, because in the past hospices had not received such a proportion of the resource. However, the 50 per cent mechanism is a strange way of deciding funding, because as members can see from the additional information that was supplied with the petition, it means that health boards match what the hospices raise through fundraising efforts. All other NHS services are funded on the basis of a flat rate per patient—there is an idea of what care will cost and provision is made accordingly. In relation to hospices, however, funding is determined by the institution's fundraising capacity, which leads to significant differences in the amount per patient that hospices receive.There seems to be a fundamental inconsistency in such a funding mechanism, which puts much pressure on St Margaret's, given that it is Scotland's biggest hospice and West Dunbartonshire is one of the poorer areas in Scotland. Compared with hospices in other parts of Scotland, where there is less competition or a bigger funding base, St Margaret's is at a disadvantage and its capacity to maintain funding is reduced.The 50 per cent funding mechanism should be reviewed. It would not compromise the independence of St Margaret's if it were to receive 70 per cent or whatever. Indeed, the percentage approach is wrong; it would be better and fairer to provide an appropriate amount per patient.We should ask the board whether we can maintain the continuing care beds at St Margaret's alongside the palliative care beds, because all the evidence shows that that model works. Such an approach makes the best use of staff in St Margaret's, is strongly supported by the relatives of people who have been in St Margaret's and is very strongly supported by the local community that I represent and by neighbouring communities, as the number of signatures on the petition clearly demonstrates.

There are two options. I suspect that the health board is trying to reduce by too much the provision of continuing care beds in the north side of greater Glasgow. However, it will review the balance of care numbers, so it is feasible that another 30 beds might be required. If so, that would allow St Margaret's to continue, and the health board could continue with its plans for Blawarthill, if that was the best option.The other option, if more continuing care beds are not needed, is for the health board to reconsider the configuration of the proposed facility at Blawarthill. It is to be a newly built and newly staffed institution, so nothing would be disrupted by changing the balance of what is to be provided at Blawarthill, although making that change would have the great advantage of protecting and maintaining what is provided at St Margaret's.

An advert was placed in the Official Journal of the European Union to take the matter forward. I do not think that any building work is going on, but it might be due to take place relatively shortly. The health board will need to do some demolition and rebuilding on the site. I do not know where we are with the plans for that or the timescale, but there will be an opportunity before the facility is commissioned to make the adjustments that I have suggested.

I certainly agree with the second point. I do not think that it would be a big disruption to change the architecture, and the health board could be asked to consider that; the design should be under review anyway. The board should not build on the basis of a report that is two or three years old. When it finalises the design, it will have an extra three years' worth of information on which to base its decision.It is important to note that there were two consultations. The one that took place in 2000 was on the future of Blawarthill and what might be put on the site. A range of things was highlighted. There was almost a shopping list of different types of provision, including care for people with mental health problems, continuing care, extended residential care and out-patient provision.One of the attractions of the proposal, of course, is the ability to have a range of geriatric provision on a single campus. In principle, that is actually quite a good idea, but I argue that it was never anticipated that St Margaret's would be affected—that came out of the later consultation process. Because of what happened then, we might lose the excellent provision at St Margaret's and create provision that does not meet the requirements that the health board itself identified.I suppose that we are asking the health board to unpack its decision on Blawarthill in the context of wanting to maintain continuing care provision at St Margaret's. That would be a desirable outcome. The health board could, otherwise, continue with Blawarthill in the context of an increased number of continuing care beds in north Glasgow. Either option would be acceptable from St Margaret's point of view.

If there are no further questions from members, I invite His Eminence Cardinal Keith O'Brien to make some concluding comments, before we identify the next stage for the petition.

Thank you very much. I apologise for the noise, which came from outside the committee room.The testimony is powerful. Obviously, our purpose is to interrogate issues in detail. In this case, to clarify the issues, we will need to seek the views of the key players in the decision-making process. Given the finality of the decision, we will have to ask questions such as why we have arrived at where we are and whether there is still time to address the issues. We recognise that commitments on the provision of care for the elderly—or those with acute need—in the north of Glasgow may have been made, but we should still ask what opportunity the St Margaret's board has to raise issues with the Greater Glasgow and Clyde NHS Board directly and to lobby its members. Such questions would enable you to open up the debate further, to include the implications of decisions that have been taken and your concerns for St Margaret's.

I think that we have had a good opportunity to discuss the petition. Indeed, this is probably the longest we have ever spent with individual petitioners. That is not a criticism—I understand why we have done so; it has allowed Marjorie McCance to explain the reality of what is needed and to make clear the emotional commitment that family members and other individuals in the same situation have made.I am now open to members' suggestions on how we might progress with the petition.

I agree with those two suggestions, but when we write to the health board we should ask about the process that it follows on such matters. My understanding is that when health boards change provision, they have to carry out a consultation. I do not think that we can interfere with individual health board decisions, but we can find out whether the various processes have been properly followed, whether the health board carried out a consultation and whom it consulted. We should also raise with the Scottish Government how hospices are funded and provided for, as it seems that some are able to fundraise while others are not.

Do members have any other suggestions?

Perhaps we should also write to NHS Quality Improvement Scotland not just on palliative care but on the fact that, as I understand the petition, elderly care is being removed from the hospice with the suggestion that it care instead for people with addiction problems. I am not sure how that fits in with the operation of an organisation that provides palliative care or indeed with quality standards in Scotland.

Okay. We have a fair number of suggestions. Des McNulty, the local member, may have a helpful suggestion to make—as always.

I would like to be helpful. There are two issues in the petition, one of which perhaps needs to be addressed more urgently than the other. Hospice funding requires a systematic investigation and is a matter to refer to the Health and Sport Committee, if members agree to do so. That committee is the body that is best equipped to consider that issue in the appropriate depth and detail.The more urgent issue, from our point of view, is the future of continuing care. My understanding of the rules governing consultation is that there is a requirement to consult if a hospital is going to be shut down, but that consultation is not required for any other decision—even if the decision has considerable consequences, as this one might, for an organisation such as the St Margaret of Scotland Hospice. That is an in-principle issue that we need to refer to the Scottish Government. We need to ask whether the rules governing when a public consultation is required are adequate, bearing in mind the circumstances in this instance.The committee will want to ask questions of Greater Glasgow and Clyde NHS Board about its role and how it sees the issue being taken forward, but I want to avoid your getting exactly the same answers as we have already got in our extensive correspondence with it. Members who were downstairs earlier will have seen a long clothes-line carrying items of correspondence with the board. The issue is not that there has not been an exchange of information; it is that there is a difference of view. In our view, there is a strong case for retaining continuing care beds at the St Margaret of Scotland Hospice, and we would like your letter to the board to ask how that can be made possible rather than how it can justify its current stance.Ultimately, there is the possibility of addressing the matter to the Cabinet Secretary for Health and Wellbeing. The cabinet secretary has said in relation to other decisions—for example, regarding accident and emergency departments at Monklands hospital and elsewhere—that when a controversial decision have been made, she is interested in what the public have to say about it. In this instance, the public has spoken very loudly in favour of the St Margaret of Scotland Hospice; I hope that she will apply that principle in this case.

I will take comments from members and then allow Marjorie McCance to respond.

We are not entirely sure about the legal position of the decisions that the health board has taken in terms of its commitments to a pattern of care. I suspect that it might not be too late for a reconfiguration of services. As I said earlier, it is also possible that, if the health board goes back through its numbers and decides that it is scaling down continuing care too much, one option might be to allow the continuing care provision at the St Margaret of Scotland Hospice to be retained.

The petition asks a couple of specific things, but I think that the core issue lies in the implications of a decision not being thought through and the substantial consequences. The debate must be about whether you and the health board can engage in a much more constructive way, looking at the numbers, at the direction of provision and at the future, so that the economics of how you survive as a charitable institution are not jeopardised in the way that the trajectory might suggest. We need to try and get the health board engaged.We will collate our thoughts so that we can present the health board with the issues that have been raised with the Public Petitions Committee of the Parliament. We have asked the Health and Sport Committee to examine the longer-term consequences of how the funding of hospices in Scotland is allocated generally. The specific issue before us is the staging process that applies to St Margaret's and the implications of it. If that issue is not addressed, your evidence is that you will be unable to continue the current scale of provision, even if you do very different things to survive. We need to tease the matter out a bit further. The issue is also about the factoring that comes in at the health board end. I asked about representatives from a variety of local authorities making up the Greater Glasgow and Clyde NHS Board. I am sure that the people at the Glasgow end, or those from other parts of the board area, might be saying that anything that is gained at one end might have consequences for resources at the other end. We need to unravel that point. People are not daft; that is how they behave given the reality that they face. We need to identify how much time we have—and how much time Marjorie McCance has—to enter into dialogue. Let us have honest discussion and honest brokering between you and the health board. I have probably said enough on the matter—without getting into too much trouble. In fact, I am dealing with Greater Glasgow and Clyde NHS Board at the moment—Tom Divers will not talk to me next time I see him at mass, but that is life. I invite Marjorie McCance to make some concluding remarks about what she is doing.

Thank you very much. We have had a good opportunity to explore some of the fundamental issues that impact on St Margaret's. I know that it has been difficult for you to go through some parts of this process, Marjorie, but you have done really well—be proud of yourself. I say that to the other contributors, too. This has been a very good discussion. Let us hope that we can push the issue forward for you. Thank you for your time.