Hansard

The petition has two strands. One is to do with the proposal by Greater Glasgow and Clyde Health Board to withdraw funding from continuing care at St Margaret of Scotland Hospice. The other strand is about the method of funding for hospices and the impact that that has on St Margaret's. I do not want us to lose sight of that point.The focus of the petition has been on the proposal to withdraw funding from continuing care. St Margaret's currently provides 30 beds for palliative care and 30 beds for continuing care. Even on the palliative care side, it is one of the larger hospices in Scotland. It is the oldest hospice in Scotland. The continuing care patients receive very similar care to that which is given to end-of-life patients. The skills involved in dealing with both types of patient are, in effect, interchangeable, which is why it makes sense to provide continuing care and palliative care in the same context.The health board indicated that it wished to discontinue the provision of continuing care at St Margaret's by April 2009. That has been hanging over St Margaret's for a considerable period—certainly for the past 18 months. It has caused a huge amount of anger and resentment locally, particularly among people whose relatives have been patients in the hospice, which is a well-known institution, not just in Clydebank but throughout East Dunbartonshire, West Dunbartonshire and a significant section of the western side of Glasgow.St Margaret's offers outstanding care—no one has said at any point that the care that is provided there is anything other than outstanding. In fact, I would say that it is a beacon for the type of care that people with such needs should be receiving.In 2001, the health board proposed that, in reviewing continuing care as part of a rationalisation from its point of view, it would build a new continuing care unit at the site of Blawarthill hospital, where the scope of provision was being altered. In 2005, there was a needs review—the balance of care review—which said that a smaller amount of continuing care was needed in the north side of Glasgow than had been needed previously. The health board decided that continuing care at St Margaret's was surplus to requirements, while continuing with its previously agreed plan to build the 60-bed continuing care unit at Blawarthill. Much of the debate has been about the logic of that decision and whether it was correct.To St Margaret's, it seemed entirely inappropriate that the care that it provided, which was not considered to be under any threat when the decision was made in 2001 to rebuild Blawarthill, should be the victim of the decision that NHS Greater Glasgow and Clyde took in 2005.The health board offered St Margaret's two options. The first was that it would become, in effect, a nursing home that would provide care facilities with a nursing component, funded by the local authority. The other option was that it would continue to receive funding to deal with national health service patients, but would become a specialist provider of continuing care for people with mental health problems.St Margaret's took the view that both those proposals were inappropriate in a hospice context. With regard to the first proposal, it felt that people who had a significant amount of life ahead of them would feel concerned about being cared for in a hospice, the prime purpose of which is to deal with people who are very sick or at the end of life. With regard to dealing with mental health patients, the hospice asked why, if NHS Greater Glasgow and Clyde had identified that need, it was not catering for it in its plans for Blawarthill, which has yet to be built, rather than telling St Margaret's that it should fill that gap.It is not for St Margaret's to decide what should or should not be put in place at Blawarthill. St Margaret's was concerned that its top-quality provision was viewed by the health board as being somehow dispensable. One question that arises is whether NHS Greater Glasgow and Clyde in a sense decided that it, and no one else, should provide continuing care—in other words, that such care should not be provided by a voluntary sector or charitable body—without making clear that policy intent. It has never stated that that is its policy, but that is the substance of what it has been trying to do.It is fair to say that there was a substantial public campaign around the issue. The petition gathered more than 100,000 signatures, which makes it the second biggest petition in Scotland since devolution—the larger one related to children's hospitals in Glasgow. It has been a significant campaign, and the health board has not managed to convince the public—or me, Gil Paterson or the other politicians who have been involved—of the rightness of its case.Last Tuesday, the health board met to discuss a paper on what to do about St Margaret's. The essence of the paper's recommendations was that continuing care provision should be withdrawn from St Margaret's in early 2012 rather than in April 2009 to reflect the realities of the situation. The new Blawarthill building has not been started yet—there is no logic in a potential transfer of patients from a high-quality, relatively new-build facility at St Margaret's to something that has not yet been built less than half a mile up the road.As part of its recommendation not to withdraw funding until 2012, the health board agreed to serve notice on St Margaret's that continuing care would be withdrawn from 2012. It appeared to me and to others that there was no logic in making that decision at that particular time or in the decision itself. Both points are important.Why decide three years in advance to withdraw care at a facility when one or more reviews could take place between now and 2012 that might affect that decision making? The health board seems stubborn to us. It recognised that its decision to withdraw continuing care from St Margaret's could not be achieved sensibly in 2009, but it still intends to go ahead with withdrawal in 2012.The health board has agreed to further discussions on expanding palliative care provision at St Margaret's, so the proposals in connection with the nursing home facility and the provision of specialist mental health care are in effect off the table. Future discussion will be about palliative care. Currently, match-funding arrangements apply to palliative care—the hospice would be reimbursed for up to 50 per cent of agreed costs for such care. The hospice is fully funded for continuing care with about £1.2 million, but the financial environment would be entirely different if the 30 beds for continuing care were converted into hospice beds and the hospice had to gather in from additional personal contributions 50 per cent—or 50 per cent plus a wee bit—of the funding for such provision. Great financial uncertainty is associated with that arrangement.The petition highlights the fact that the match-funding system creates huge discrepancies in the amounts of support from the NHS that hospices receive for hospice beds. St Margaret's receives £31,000 per bed per year, whereas the Scottish average is £86,000 per bed per year. Some hospices receive up to £200,000 per bed per year from their health boards and one hospice in the Highlands receives more than £300,000. Such huge variations in how hospices are provided for are intolerable.The committee should continue to pursue vigorously the funding implications because of the clear discrepancy. That discrepancy is not shown just by the figures from St Margaret's—some endorsement of the hospice's calculations has come from the Auditor General for Scotland. The figures that have been put into play are official and highlight an anomaly.The health board's decision about St Margaret's was wrong. Concerns were expressed about the conduct of the meeting at which the decision was made and about how the decision was made. However, now that a decision has been made, that can bring into play a role for the Cabinet Secretary for Health and Wellbeing, who is ultimately responsible. Until now, she has said that she could not become involved in the decision-making process, because the health board had yet to make a decision. The health board has now made a decision—I believe that it is the wrong decision. As an elected member, I will ask the cabinet secretary—with, I hope, the support and participation of elected members from other political parties—to review the decision and perhaps subject it to the independent scrutiny process that she has instigated for other decisions. The health board's decision meets the criteria for using that process.From previous consideration of the petition and—I hope—from what I have said today, the committee will be aware of questions about how such decisions are made and about the role of the Parliament and its committees in questioning how health boards reach decisions. On the face of it, it is illogical to decide to build a new facility to replace an existing facility that offers perfectly good and well-supported care. A lot of public concern is felt about the health board's decision and there are technical arguments against it.I personally think that there is win-win situation here for both Blawarthill and St Margaret's. If there is flexibility in the range of provision that can be provided at Blawarthill, it can be a perfectly sound facility and can complement St Margaret's, which can continue to do what it does very well. It is the rigidity and stubbornness of the health board in refusing to look at complementary situations that have caused such frustration among local people.