Current Petitions

The final petition is PE1105, by Marjorie McCance, on behalf of St Margaret of Scotland Hospice. The petition 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, such as that 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.Des McNulty, the constituency member for the area, is with us to discuss the petition. I acknowledge that he has survived the past one-and-a-half hours of the meeting. We have explored the issue and have heard from Des McNulty, campaigners and church representatives who have offered their support. We have also received further correspondence on the issue. Do members have any views on how to deal with the petition, which deals with a contentious issue?

We have had no real opportunities to get any formal response, subsequent to our previous contact. The campaigners have raised one or two issues with the health board that have not been resolved. Des McNulty might want to add to that.

The last meeting of the health board dealt with a proposal to withdraw, in effect, the beds from St Margaret's hospice. That proposal was due to be discussed before any meeting was held with the hospice to discuss the relevant issues. Fortunately, some of the lay members of the health board took the view that the decision was an inappropriate one for them to take at that time. Subsequently, there has been one meeting between the hospice and the health board, and another one is scheduled. People who are involved with the hospice and who use it are concerned about the fact that the health board seems to be intransigent in its decision to take forward a proposal that would not only remove continuing care beds from the hospice, where all the indications are that the care is excellent—indeed, better than that which is available elsewhere in the system—but jeopardise the ability of the hospice to provide continuing care and palliative care.The health board is the hospice's main funder; it funds all the continuing care and 50 per cent of the palliative care. If the health board removed two thirds of its funding, which would be a consequence of the removal of continuing care funding, the hospice would be placed in an impossible financial situation. Currently, continuing care patients and palliative care patients receive top-quality care. The alternative has not been demonstrated to be better—in fact, the evidence suggests that it could turn out to be significantly worse. The Cabinet Secretary for Health and Wellbeing set out a number of criteria on which she would base a choice on whether to intervene in a situation, including whether there was substantial community concern about a proposal, whether the proposal was not in the best interests of patients, and whether the proposal was seen to be irrational. She used that set of criteria to make the interventions in Monklands and Ayr. My view and that of the campaigners is that it is inconsistent to intervene in those contexts and not the situation at St Margaret's hospice. People feel strongly about the issue. When the petition came before the committee previously, it had about 60,000 signatures; there are now more than 90,000—perhaps 100,000. More than 400 people attended a meeting in Clydebank in March. In the modern age, that is a huge political meeting. People throughout the community, from all political parties, are saying, "This decision makes no sense at all." However, we do not seem to be able to get any purchase on the health board, which made the decision in the first instance; nor, regrettably, have we been able to get a response from the Cabinet Secretary for Health and Wellbeing on whether we can stop this nonsense and, rather than strip out something that works excellently and replace it with something that may turn out to be not so good, try to build around what is excellent in the system. That is what the petition is about. The issue is becoming increasingly urgent because the meeting at which the deferred decision is due to be taken is scheduled for 24 June. If there is anything further that the Public Petitions Committee can do to encourage the health board and the cabinet secretary to take an initiative that resolves the problem, that would be very much appreciated, certainly by my constituents. It would also be appreciated by constituents in other areas, because the hospice covers not just Clydebank but East Dunbartonshire, the west side of Glasgow and the surrounding areas. It is a well-used, well-known institution in that part of Scotland.

We cannot tell the health board what to do, but others have the power to do that. That issue is raised by the petition. There are three issues of fundamental importance to the petitioners. First, we still do not have an accurate response from the health board on specific issues of concern raised by the petition. As a matter of principle, the committee should say, "We're still awaiting clarity on your position." Secondly, we want to know the board's analysis of the proposals that it discussed with the hospice when it was trying to manage its way out of a decision—perhaps made in good faith—that is having an impact on the viability of the hospice. Thirdly, we want to know whether there are grounds for revisiting some of the issues.

That captures the issues well. Going beyond them, however, recent Scottish Executive directives on health governance talk about palliative care and about people being given the option of being looked after in hospital, in a hospice or at home. One impact of the proposal would be to wipe out the hospice option for continuing care patients. I do not understand the grounds for doing that. This is not just an administrative decision on the part of the health board. There appears also to have been a policy decision to separate out two categories that are difficult to separate out—those in continuing care, who are on average 48 days from death, and those in palliative care, who are presumably even nearer the point of death—by saying that one group will be fully funded and served by NHS facilities, and that the other will be provided for by hospice arrangements. An artificial barrier between the two types of care appears to have been constructed. I cannot believe that that is a considered policy view, but it seems to have been imposed by a particular policy decision. My view as a constituency member is that that is the wrong way of going about things.On few matters—including the asbestos issue to which I referred—is the community more united in querying a decision and saying that it is not right. That is why I am taking every step—the committee can be part of that—to ask whether such a decision should be taken on the basis of such evidence.

That is no way to speak about your man.

Do not start Des McNulty on that. Is it fair to say that people do not believe that the level of public consultation was anywhere near even that of a naive understanding of public consultation?

The legal position is that the health board must consult when it is to close a hospital, but the board would argue that it is not closing anything, because the facility that is in jeopardy is not under its control and is provided by the voluntary sector. The board is saying, "We will no longer require a service from you, small voluntary sector organisation. What happens to you is not necessarily our responsibility." That is the legal position. I am sure that the board would dress that up differently and say that it would put its arm around the organisation and look after it, but the reality is that the board is telling an institution that exists to look after the dying that it no longer wants that institution to look after half the number of dying people that it currently looks after.

That would be useful. It might also be worth saying in a letter to the cabinet secretary that we would be disappointed if a final decision were made before all the issues had been explored with the health board. I see no reason why we cannot say that.

We can summarise the key points that committee members and Des McNulty as the constituency member have raised. We can say that we still think that the concerns are unresolved and that we would be disappointed if a decision were made that militated against further exploration of the issues and against whatever else could be done. We will offer our good services to help that to proceed.I know that some meetings between the board and the hospice, which has expressed concerns, have been tense, to say the least. It would be useful for us to draw the cabinet secretary's attention to the fact that we are concerned that the matter is still unresolved.

Such meetings might have been tense if they had taken place, but I understand that only one formal meeting has occurred so far. There may need to be more meetings.I am grateful to committee members for their comments—the suggested route forward is helpful. However, I am keen that we should not lose sight of another dimension of the petition—the way in which the rate for palliative care is determined. Under the current system, palliative care hospices get 50 per cent of what are called the agreed costs of looking after a palliative care patient. Everywhere else in the health service, the system works on the basis of an identified cost. The cost of carrying out a procedure or looking after a type of patient is identified, and it is agreed that that amount will be provided, regardless of where people are in the country. The arrangement does not apply to hospices, which receive agreed costs that vary in line with their relative financial circumstances. The range of costs for palliative care patients can be very wide—costs seem to vary largely on the basis of the financial circumstances of the hospice that is looking after them. I see that as an iniquitous arrangement. It has been in place over an extended period, but it does not make sense and is not fair and just. I am keen that we should not lose sight of that strand of the petition when dealing with the immediate circumstances of the dispute between St Margaret of Scotland Hospice and Greater Glasgow and Clyde NHS Board.

We can raise the issue in our letter to the cabinet secretary. We will ask about both immediate decision making and long-term investment in and resourcing of palliative care and hospice developments in Scotland. I hope that the discussion has been useful. I thank members of the public who have concerns about the issue for their patience. I hope that we will be able to make progress on the matter. I am sure that people have other innovative ways of ensuring that their voices are heard. I thank Des McNulty for his evidence.