Current Petitions

PE1105, by Marjorie McCance on behalf of St Margaret of Scotland Hospice, calls on the Parliament to urge the 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 the Scottish Executive's health department letter HDL(2003)18 are fair and reasonable.Again, we have considered this petition on a number of occasions. Des McNulty has expressed particular support for the petition, so I invite him to say a few words.

I presume that members have before them the letter from Marjorie McCance to the convener. There were two issues in the initial petition. One involves the formula that governs how hospices are funded. Currently, hospices get 50 per cent of agreed costs towards palliative care. In practice, that means that some hospices get far more per bed than others, because it is the amount that the hospice can raise, divided by the number of beds that it has to raise money for, that determines the quantum of expenditure that it can look to claim 50 per cent of from Government.The case of St Margaret's hospice has highlighted a significant anomaly in the way in which the funding arrangement works. Nowhere else in the health service uses a match-funding system. By and large, the health service operates on a pay-for-care basis. In my view, the system that operates in relation to hospices leads to a fundamental injustice. The minister appears to have recognised that fact to some extent, which is why the Government agreed to set up a short-life working group. It was supposed to report by December but, of the three scheduled meetings, only one has so far taken place. The issue that has been raised by the petition has not been dealt with. The short-life working group has not completed its work, which means that, obviously, the minister has not had a chance to respond to its conclusions. That strand of the petition needs to be kept open until we get some further information about that and the issue is resolved. The other issue concerns NHS Greater Glasgow and Clyde's proposals to remove the funding for continuing care beds at St Margaret's, in the context of a consolidation of continuing care provision on the north side the river on to three sites. The contention of St Margaret's has always been that that consolidation should not necessarily affect it. There is no necessity for St Margaret's to be roped into that process. The health board could have made a number of different decisions about how it dealt with the need for continuing care. St Margaret's has a high quality of provision. We do not wish to set ourselves against any provision anywhere else, including Blawarthill, which is only a quarter of a mile away from St Margaret's. However, it seems that the way in which the health board has gone about this process has created a tension between those facilities, which is genuinely unhelpful. St Margaret's is looking for some security with regard to the continuation of the outstanding care that it currently provides—continuing care, sitting outside palliative care—and a sensible discussion that does not involve the health board saying, "We have made a decision, and you have to fit in with the arrangements, even though you have not been a party to the discussion." The hospice board and I have been seeking to create a genuine debate with the health board, but that seems to be extraordinarily difficult to do. The health board keeps coming back to the view that it has made a decision that St Margaret's has to go along with. St Margaret's, however, is saying that it would like to hear any reason, based on the quality of care or the management of continuing care, that makes removal of its funding a sensible way ahead.I remind members of the committee that the petition that Marjorie McCance submitted is the second-biggest petition that has ever been received by the Parliament, with more than 100,000 signatures—the largest was submitted in relation to the proposed changes at the Queen Mother's hospital, which was a highly sensitive issue of which members will be well aware.One of the issues that I and members across the political spectrum have highlighted is that what is proposed amounts to a significant change in provision. Previously, the Cabinet Secretary for Health and Wellbeing has said that, in cases in which there is significant public concern about such significant changes, she will investigate whether the correct decision has been made. She has not done so yet in relation to St Margaret's, but we would like to keep up the pressure on the minister to be consistent in relation to St Margaret's, in light of, for example, the decisions that she made in relation to Monklands hospital and elsewhere. We approached the issue on a genuinely cross-party basis in order to come up with a solution that was acceptable to the communities in Clydebank, the west of Glasgow, East Dunbartonshire and beyond, all of which believe that the approach that is being taken is wrong.I will end on a point that I have not made before but which is important. When the health board initially considered the provision of continuing care, it did so in the context of the boundaries of Greater Glasgow Health Board. Since that time, the Clyde area has been added to the health board's area. In the context of that new area, there might be a degree of flexibility with regard to the necessary numbers that would enable the much-valued and important provision of care at St Margaret's to continue as it is. I am sure that that would satisfy and delight everyone who is involved in the issue.

I think that a little more could be done before we close this petition. If the short-life working group had met on all of the occasions on which it had intended to, there might not be so much behind Des McNulty's suggestion on that particular element of the petition. However, given that it has not completed its work, we should continue the petition. We should ask when the short-life working group will complete its work and make its report. Once the report has been produced, we should consider what can be done with regard to what the petitioner has described as the inequitable or idiosyncratic funding of hospices.On the proposals to remove 30 national health service continuing care beds that sit outside palliative care, it might be appropriate to write to the minister and to Robert Calderwood to say that all that the board of St Margaret's is asking for is a discussion with the health board in respect of that proposal. Des McNulty made an important point when he said that the health board area has been enlarged since the provision of continuing care was initially considered, which means that there might be some flexibility with regard to this proposal, which is causing a great deal of anxiety and concern to many. On those bases, I think that we should continue the petition.

We will keep it open and explore the two or three points that members raised. I hope that we will get some satisfaction. It is a long journey. I also thank Des McNulty for his continued support for the petition.