Current Petitions

PE1105, from Marjorie McCance, on behalf of St Margaret of Scotland Hospice, calls on 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 is provided at the 30-bed unit at St Margaret's hospice, and to investigate whether arrangements for funding palliative care provision at hospices across Scotland are fair and reasonable.Two members—Gil Paterson and the constituency member, Des McNulty—have expressed an interest in the petition. I call Gil Paterson.

Are you happy to go first, Des?

Absolutely.

I was deferring to age.

I was not talking about you, Gil.

No significant progress has been made thus far on costs. On previous occasions, I have explained to the committee that the costing model that applies to hospices in the voluntary sector, as opposed to NHS hospices—the NHS now provides a significant level of palliative care—is based on matched funding. In other words, the amount that the hospice raises for allowed expenditure is matched by the health board and through that—I suppose—the Government. The system generates significant inequities in the funding that is made available to hospices per bed.The justification for the present system is that it gives hospices the freedom to decide for themselves. However, the Clydebank and St Margaret of Scotland Hospice perspective is that that freedom is a freedom to reach penury. The situation is inappropriate and unacceptable.A health board's contribution to a hospice should be based on a realistic and transparent costing of palliative care and should be made per bed. The statistics appear to show that the funding that St Margaret of Scotland Hospice receives from NHS Greater Glasgow and Clyde is much lower per bed than that of many other hospices around the country. I see no fairness in that.I turn to the substantive issue that the petition raises of its treatment by the health board. Although meetings have taken place, NHS Greater Glasgow and Clyde has not engaged fully in discussions. It has not discussed the option of allowing the hospice to maintain continuing care or to put in place a refinanced system of the palliative care that is the hospice's mission. The health board seems to be trying to force the hospice to discuss alternatives that the hospice believes are inconsistent with the delivery of palliative care services, staff training and quality of care.The board has raised the option of residential nursing care, which leads to the question whether a palliative care dominated environment is an appropriate environment for someone who needs residential nursing care but who is fit and active and may have many years in front of them. A hospice is not a good place in which to provide residential care. Another option that the board has raised is for a specialised form of continuing care for people with mental health care difficulties. The hospice feels that it is not equipped to meet that need.However, that care need has been identified within NHS Greater Glasgow and Clyde, and the hospice questions why it is considered appropriate for it to deliver that care when the health board presumably is able to consider how that alternative might be provided. That is not fundamentally the hospice's problem. It wants to carry on doing what it does well and to be appropriately funded for it, but that is precisely the topic on which the hospice finds it most difficult to engage the health board in discussion.We are concerned that the geriatricians are apparently faced with a deadline for sending new patients to the hospice. I have raised that matter in general questions and health questions. Gil Paterson and Ross Finnie have also asked questions on it. No new patients are to go to the hospice after 1 April 2009, and patients' relatives are being told that there is no point putting their names down on a waiting list for the hospice because the health board has, de facto, taken a decision that no new patients will be admitted. However, the health board has not actually taken a formal decision about what should happen. That is a matter of considerable local controversy and has been raised with ministers. The deadline seems to pre-empt a decision that is not only wrong but has not been made. People are getting angry and upset about that new state of affairs.Let us take the health board's case at face value. It proposed to create a brand new facility at Blawarthill as one of three sites on the north side of Glasgow where continuing care patients would be accommodated. If the health board were to build a new facility there, it would at least be a state-of-the-art facility but—as I am sure Bill Butler will be able to confirm because Blawarthill is, I think, in his constituency—there is no new facility there now. Therefore, because it is withdrawing from patients the opportunity to go to St Margaret's hospice, which is a new facility that offers excellent care, the health board will potentially have to put patients into a dilapidated facility. Whatever the staff there do, they will not be able to provide the same care environment. The health board is falling short on its own plans. It is imposing a decision that has not yet been taken formally and which would have been predicated on the erection of a new facility that does not exist. It is also not dealing with the hospice in the way that would be expected.I will throw in another issue. One of the partners in the Blawarthill proposal was supposed to be Southern Cross Healthcare—a private sector provider of predominantly residential care. However, in the past few weeks, Southern Cross has been highlighted in the newspapers as having serious financial difficulties, so there is doubt about whether the proposal will proceed, certainly with Southern Cross. The danger is that the health board is forcing through an arrangement under which it would take a long time for a satisfactory outcome to be arrived at, even if we assume that a new facility at Blawarthill would be a satisfactory outcome.Despite the best efforts of the committee and local representatives, we are not making the progress that we want with the health board. I am due to meet the chair of the health board next week, and this issue is on the agenda. Several colleagues have sought meetings to discuss their concerns about what is going on, but we have not yet been allowed a meeting with the Cabinet Secretary for Health and Wellbeing. I do not understand how the Cabinet Secretary for Health and Wellbeing can intervene in car park matters but not in a key policy decision on the provision of continuing care.The health board, the cabinet secretary and others continue to restate that palliative care at St Margaret's is not under threat and that the decisions affect only continuing care. However, funding for continuing care amounts to about two thirds of the hospice's total funding from the health board. If two thirds of funding is removed, or is replaced with a substantially smaller amount—especially if that is associated with less appropriate or less integrated provision—the reality is that health care delivery by, and finance for, the hospice cannot be said to be unaffected.I remain very concerned. St Margaret's is a small hospice with a limited budget. It relies heavily on the good will of local people, which has been abundant for many years—the hospice has operated for 58 years. Its finances and its key function in the world are under threat, whatever the various authorities say.

Does Gil Paterson want to add to that?

Des McNulty spoke for only 10 minutes, so you are all right.

I thank both members for their comments; I gave them a lot of time to amplify the issues. We need now to get to the core of the petition.

The issue is serious and has been on-going for a considerable time. Des McNulty raised the general question that is mentioned towards the end of the petition document about funding arrangements for palliative care provision. On that basis alone, I certainly feel that the petition should be left open.As Des McNulty said, matched funding is the model that is used in the voluntary sector, but that model is inequitable. Des McNulty made the good point that the health board should contribute on a per-bed basis. If that does not happen, St Margaret's gets less.We should ask the Scottish Government whether it has any plans to re-examine funding of palliative care in the voluntary sector on the basis that has been outlined by Des McNulty. That would be reasonable.On the particular concerns about St Margaret's hospice and the 30-bed continuing care unit, I am sure that Des McNulty and others would agree that it is our job to act as honest brokers to find a solution that is agreeable to both parties. That has not happened so far. We should at all costs avoid—I am sure that we will—playing off one facility against another.As the member for Glasgow Anniesland, I have to say that the facility that has been proposed for Blawarthill is popular and has local support. It also has my support. We should not play the game of saying, "This proposed cut is worse than your proposed cut"—I know that we will not do so. Communities in my constituency have campaigned for a long time for a new facility at Blawarthill, and have been right to do so.Des McNulty made another point about the health board, which has still to make a formal decision but is saying informally through various channels that there will be no new admissions after April next year. If that is the case, the health board is wrong to have been doing that, so we should ask the Scottish Government to make inquiries.Finally, I have a suggestion about what the committee can do to reach a position at which all parties feel that they have arrived at a workable solution. We cannot direct a health board, but we could write to the Scottish Government and the NHS to express our concern and disappointment that no workable solution has been arrived at so far. In the absence of any constructive process, and in the interests of patients, both sides should at the earliest opportunity consider seeking independent mediation: their doing so would be fair, reasonable and sensible. The committee would be saying to the Scottish Government and the NHS board in question that they should get together and reach a solution that people can support as being fair and equitable.I have rehearsed my thoughts, convener. I hope that they are reasonable and will find favour with the committee.

I do not want to close anyone down, but will your contribution cover the same points, Robin?

A year today.

We have broad agreement on the direction of travel on the petition. If we take on board contributions from members who have an interest in the issue at a local level, and comments from committee members, we can pull this together into something. I am concerned that we cannot have reconciliation through negotiation and that the provision of palliative care in west central Scotland seems to be jeopardised. Further, a long-standing institution such as St Margaret's, which has contributed to the community throughout west central Scotland, is potentially jeopardised.

If I knew that, I would be putting on a lottery ticket on Saturday night. Essentially, we need to have the further debate that Bill Butler, John Wilson and other members have touched on, to consider how the figures were arrived at. The reason for the difference is probably that health boards have inherited different structures and different ways in which they calculate their budgets. There is an issue for those who run the systems. We need to be much better at identifying how consistently that is done across Scotland. Our consideration of the petition will help with that, because we will not let go of the issue—I assure members of that.I am conscious of time, Des.

I need only three sentences.

If you can fit your remarks into three sentences, I will buy you a Christmas present.

First, I do not think that the discussions between the hospice and the health board are taking place at the right level; we need to get the top people in the health board involved in finding a solution.

That is sentence 1.

Secondly, I strongly believe that Blawarthill and St Margaret's do not stand against each other; the debate is about the proper configuration of services at both institutions.Thirdly, we are drifting into the worst of all possible worlds, where patients will not be able to get into St Margaret's and there is no new Blawarthill, which is not good for patients or relatives.

That is another Christmas present that I need to buy someone. Thanks very much, Des. Gil Paterson will have the final word.

Okay. We have broad consensus on these issues, so let us keep pursuing them. We had already spent a fair amount of time on the petition and today the concerns that exist have been amplified. I hope that the visiting members appreciate the opportunity to make their views known to the committee, and I thank them for their time.