St Margaret of Scotland Hospice

– in the Scottish Parliament at 5:05 pm on 10th January 2008.

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Photo of Trish Godman Trish Godman Labour 5:05 pm, 10th January 2008

The final item of business today is a members' business debate on motion S3M-711, in the name of Des McNulty, on the St Margaret of Scotland hospice.

Motion debated,

That the Parliament recognises the outstanding care provided for terminally ill and frail elderly patients by the St Margaret of Scotland Hospice in the 57 years since its foundation; notes with concern the uncertainty faced by Scotland's largest hospice as a result of proposals to remove places for the care of frail elderly people with complex needs, and believes that NHS Greater Glasgow and Scottish ministers should be made aware of the very strong support that exists for St Margaret's in Clydebank and throughout the west of Scotland.

Photo of Des McNulty Des McNulty Labour 5:15 pm, 10th January 2008

Just before Christmas, nearly 200 people from my constituency and neighbouring constituencies came to the Parliament on a dignified demonstration in support of the St Margaret of Scotland hospice. For an hour and a half we sang carols, before a delegation from the hospice made a presentation to the Public Petitions Committee. I am pleased to acknowledge strong support from colleagues from all the main political parties for the case that we put before the committee on that day. Both at the carol service and at the committee meeting, we were joined by his eminence Cardinal Keith Patrick O'Brien, who spoke emotively in favour of St Margaret's being funded so that it can continue the outstanding work that it has been doing in Clydebank for the past 57 years. The cardinal, as a boy, was resident in Clydebank shortly after 1950, when the hospice was founded. I am deeply indebted to him for showing his support so publicly.

Although it is run under the auspices of a religious order, the hospice is a non-denominational unit, which has developed into a facility with 60 beds, comprising 30 continuing care beds for frail adult patients who require on-going complex medical and nursing care and 30 palliative care beds, which makes St Margaret's the biggest hospice in Scotland. The hospice believes that those two types of provision are complementary, and qualified and dedicated nursing staff care for both groups of patients. Relatives and patients are extremely satisfied with the care that is provided by St Margaret's.

The hospice is under threat because of decisions that were taken by Greater Glasgow and Clyde NHS Board, which have serious consequences for the hospice's financial viability and for the pattern of care that it provides. In 2000, the health board consulted on proposals for a new facility on the site of the former Blawarthill hospital. The proposal for the new facility at Blawarthill referred to

"a number of NHS beds for the frail elderly and elderly mentally ill people but also social care beds and other services".

That was in line with the current thinking, which was not to create new stand-alone national health service continuing care facilities. At that stage, there was no indication that any decision in connection with elderly care provision at Blawarthill would impact on provision at St Margaret's. However, a study of need for elderly care was subsequently commissioned. The Glasgow joint community care committee published the findings from the study in 2005. The report argues that there is a reduced need for NHS continuing care beds, which refers to the type of frail elderly patients who are cared for at St Margaret's, and an increased need for other forms of residential care, including care for patients with various forms of dementia.

Given that the earlier proposal on which the health board had consulted referred both to elderly mentally ill patients and to social care beds and other services, one might have expected those needs to have been reflected in revised plans for Blawarthill. Instead, however, the health board proposed to concentrate NHS frail elderly care for the north of Glasgow on three sites, one of which was to be a public-private partnership facility providing 60 NHS continuing care beds at Blawarthill, alongside sheltered housing and residential care.

According to the health board, public consultation is required where there is "significant service change" entailing the closure of a hospital site. The board's view was that there was no requirement for a formal consultation, despite the very significant impact of the 2005 decision on existing provision at St Margaret's. When the health board finally decided to talk to St Margaret's, the hospice was told that the board wanted to keep elderly care beds at St Margaret's

"but use them in a different way to meet the changing needs of our older population and ensure we are able to provide the range of services they require".

The evidence base on which the board is claiming that there is a decreasing need for continuing care beds north of the Clyde is highly questionable. The chart that was produced by the board in the balance of care report shows a reduction in bed numbers from 658 to 390 between 1997 and 2003, with a further reduction to 300 in 2004-05. The closure of the beds at St Margaret's would mean the number being reduced to 180 beds in north Glasgow, a level of provision that the board acknowledges would be sustainable only if the number of delayed discharges continued to fall. Any capacity for patients awaiting discharge will be required to be added to any model. Otherwise, according to the board, acute beds will become blocked.

The minister should be aware that a potential consequence of the removal of ring fencing from delayed discharge money is that it would invalidate the board's assumption. The board's argument that the need for continuing care beds in north Glasgow is declining at an astonishing rate is not reflected in any reduction in demand for the continuing care beds at the hospice, which has a 100 per cent occupation rate.

As I said earlier, the board could have adapted plans for Blawarthill in line with the evidence that it generated for its balance of care report, allowing St Margaret's to continue unaffected. Instead, the health board has intimated to the board of St Margaret's that funding for continuing care provision will be phased out, which the hospice estimates would reduce its income from public funds by £1.2 million. The health board has suggested that among the alternatives that the hospice should consider are becoming a provider of care for older people with a mental illness or becoming a care home with nursing. Either option would involve a significant reduction in income from the health board, which would jeopardise the viability of St Margaret's as an organisation and put at risk its provision for the terminally ill.

As I stand here, the hospice has to raise in excess of £30,000 a week to fund provision for terminally ill patients. Of its 30 palliative care patients, it has to fully fund 15. Unlike other hospices, St Margaret's has no financial reserves on which to draw. The unique ethos of the hospice is particularly well suited to the needs of continuing care patients who have life-limiting conditions. The changing needs of such patients can be met within the hospice without their having to be moved, other than within the hospice.

The hospice provides a model of care that is holistic and geared to the needs of patients, rather than fragmented by the categorisation and medical specialisation that dominates hospital provision. Many patients and relatives have drawn very favourable comparisons between the approach that is adopted at St Margaret's and their experience elsewhere.

The hospice board is, quite rightly, unwilling to abandon that integrated care model, to be forced to change the skills mix of its staff or to run the risk of altering its ethos in the absence of better planning and a more inclusive approach from the health board. Adapting services in the light of changing need patterns should not involve the sacrifice of outstanding care provision for both continuing care and palliative care patients as provided by St Margaret's.

I hope that the logical arguments as well as the emotional arguments for the retention of St Margaret's will be accepted, in line with the views of my constituents and those of other members here this evening. The cabinet secretary and the minister are welcome to come to St Margaret's to see for themselves what might be lost. I urge them to accept that invitation. However, above all, I urge them to knock heads together to ensure the right outcome, which in my view is the retention of the existing facility at the St Margaret of Scotland hospice.

Photo of Gil Paterson Gil Paterson Scottish National Party 5:23 pm, 10th January 2008

I thank Des McNulty for bringing this welcome debate to the Parliament and congratulate him on doing so.

St Margaret's is the oldest hospice in Scotland and has built up a fine record over the years. People who have had a direct experience of St Margaret's bear witness to its record. They will tell us of the dedication, professionalism, experience, love and compassion in abundance that the staff share with the individuals and families who require their services. That reputation for fine service is known to and appreciated not only by the people of Clydebank but far and wide across central Scotland and beyond. That reputation has developed from the way that St Margaret's goes about its business: it does it well, cost effectively and with great integrity.

Given that record and the public awareness of the fine work that St Margaret's carries out, I find it extraordinary that when major changes were going to take place that would have such a dramatic impact on St Margaret's, St Margaret's was the last to be told. In fact, it was never given the opportunity to be involved in any consultation whatever. It is clear that that is not right.

A major concern for me is the fact that the hospital that will benefit directly from the removal of beds from St Margaret's is Blawarthill, which is a PPP project. Blawarthill hospital was earmarked for closure but was saved after a campaign. Call me an old cynic but, on the face of it, the transfer of beds from St Margaret's to the PPP-funded new build at Blawarthill is simply a way of making that facility work.

That said, I believe that Greater Glasgow and Clyde NHS Board still has a duty to engage with St Margaret's, to take its legacy fully into account and to come to an agreement that builds on that legacy, so that others can rest assured that the fine service that it provides will be available for another 50 years and beyond.

At the risk of repeating myself, St Margaret's provides a service that is much needed and appreciated by the people of Clydebank and beyond. It would be worth the health board reconsidering the matter and discussing with St Margaret's ways and means of allowing the hospice to continue to make a full contribution to the community. The health board should recognise that it did not act properly as regards consultation. Surely it is not too late for it to put things right. St Margaret's has proved that it can do the job and do it well, and the health board should allow it to do just that.

Photo of Margaret Curran Margaret Curran Labour 5:26 pm, 10th January 2008

I, too, congratulate Des McNulty on securing the debate. We should recognise his contribution not just in lodging the motion for debate, but in pursuing the campaign in an assiduous and committed way, which included the organisation of a highly successful carol concert.

I declare an interest: sadly, the mother of my parliamentary organiser, Marie Kerrigan, died in St Margaret's hospice. As a close friend and colleague of Marie, I can testify to the comfort that it provided not just to her mother, but to Marie, her sister and her family, which was of great significance to them at the time, which they still remember and which they will, I am sure, remember for the rest of their lives. They have deep respect for the staff who provided them with such an important service.

Regardless of what is said in the many debates that we will have about health in years to come, I am sure that there is consensus in the Parliament on the significance of such services for people who are in critical need. My mother-in-law died in Hunters Hill hospice, so I am aware of the vital and sensitive services that hospices provide. I am sure that the minister, too, will want to recognise their importance in the provision of health services.

We will continue to have many health debates in the Parliament. I do not want to be divisive, but the Government says that it pays attention to public concern. I hope that in her response the minister will indicate how the public concern that has been expressed about St Margaret's is being addressed by the Government.

As Shona Robison knows, palliative care is a vital and growing issue in Scotland. All members will want to ensure that sensitive and appropriate services are provided to people who, it could be argued, are in their greatest hour of need. We will all require such services at some point in our lives. As I understand it, the evidence suggests that St Margaret's hospice provides high-quality services.

Everyone to whom I have spoken testifies to how much those services have meant to them.

Those of us who do not have the detailed knowledge of the situation at St Margaret's that Des McNulty and other members have must ask why a change is necessary. Why should services that are so valued by people be jeopardised? Why is the proposed shift being allowed to undermine an extremely important service? I ask the minister to address some of those issues in her response to the debate. Has she had, or does she intend to have, discussions with NHS Greater Glasgow and Clyde on the issue? Given its size and status, does she see St Margaret's hospice as an important part of the jigsaw of care in that area?

Can the minister provide support and indicate to St Margaret's that she will try to find a way through the issue? In other situations she has told health boards that she is not satisfied with their decisions. There have been words with NHS Greater Glasgow and Clyde on activities and consultations that the board undertook, so perhaps the minister could add St Margaret's to the list of issues to discuss with the board. It is important that the Government give campaigners a signal about possible ways forward.

I support not just Des McNulty and the campaign that he has launched but the staff of St Margaret's and residents of the communities around the hospice, who have brought a large petition to the Public Petitions Committee. Helen Eadie is a member of that committee and is carefully considering the evidence. The issue is of great public importance and it is incumbent on the Parliament to understand why it engages so many people so greatly.

Photo of Jackson Carlaw Jackson Carlaw Conservative 5:30 pm, 10th January 2008

I, too, am happy to congratulate Des McNulty, not just on securing the debate but on his sustained support for the St Margaret of Scotland hospice. There is no need for me to grandstand; Des McNulty is the constituency member and has comprehensively set out the arguments. As the constituency member, he is entitled to look to his colleagues in Glasgow and in the West of Scotland region for support—he and the hospice certainly have my support.

St Margaret's is an outstanding facility. Our hospices generally are outstanding. They share a commitment to our fellows in the final stages of their lives and discharge that commitment with warmth, compassion and understanding which, when it is encountered at first hand, is profoundly moving. The ability of the people who are dedicated to such a vocation to sustain their commitment in the face of the inevitable, continual fading of lives, is inspirational. When people find their way to St Margaret's, as did my wife's aunt in the final stages of her life—if that is deemed an interest, I declare it—there is contentment at last for them and for the families that they leave behind.

After 57 years of compassionate service, St Margaret's does more. St Joseph's ward deals with the terminal stages of life and St Margaret's ward offers 30 beds, which are always occupied, for the continuing care of older people who require complex medical and nursing care. Let it be said clearly—without in any way denigrating any other facility—that St Margaret's is a modern, welcoming, magnificently facilitated hospice that has an outstanding team that is led by the thoroughly committed—formidable, even—Sister Rita.

St Margaret's enjoys the wholehearted endorsement of its immediate community and the wider public. It is managed such that the national health service funding that it receives in respect of care for the terminally ill sustains more than twice as many beds as there are at the Prince and Princess of Wales hospice—another outstanding facility—which receives comparable funding. That is made possible by committed and professional fundraising staff.

Why is NHS Greater Glasgow and Clyde so belligerently determined on its strategy? Why do I —a regional member for the West of Scotland—find time and again that a consultation process that the board has entered into seems to be clumsy, predetermined or structured with a series of options that are designed to support the board's initial ambition? Is that why consultations are widely regarded as half-hearted and insincere, whether they are on the Vale of Leven hospital, the redefining of the role of health visitors, the rehabilitation of people with serious traumatic injuries, hospital car parking charges or the future provision of accident and emergency care? Margaret Curran made that point.

Why has the discussion on St Margaret's been so thin? Why does the board continue to promote the alternative uses for which Mr Divers persists in speculating that the 30 beds in the St Margaret's ward might be put, although they have been discussed and, by mutual agreement, found to be inappropriate? What sort of consultation is it when it is simply announced to St Margaret's that funding will be withdrawn? Where is persuasive evidence of a lack of need in the west of Glasgow for a facility that is permanently full? Des McNulty made that point convincingly. Why is it that Her Majesty the Queen found time in her schedule to tour St Margaret's but Mr Divers, who is determined to undermine the hospice, has not done so?

The board's reasons are perverse. Since May, I have spoken regularly in support of the complementary role that the independent sector can play in assisting with the speedy and effective delivery of NHS patient care. The Cabinet Secretary for Health and Wellbeing and I disagree on that, although I always emphasise the complementary nature of independent sector provision. However, in the case of St Margaret's, a not-for-profit facility is to be replaced by a private-sector alternative—so I find myself on the same side of the argument as Nicola Sturgeon in that regard. Moreover—and consistent with that position—Southern Cross, the independent provider, specialises in exactly the sort of nursing and residential care that the board has suggested be accommodated unsuitably with final-stage-of-life care at St Margaret's. The board could make use of Southern Cross in a complementary role elsewhere, without disrupting anyone.

For 57 years, all those concerned with St Margaret's—since its first house opened in Millbrae Crescent and since 1971 at its present site, which is now the subject of a £4.3 million investment—have, by their example of leadership, enjoyed the good reports, gratitude, support and wholehearted endorsement of those they have nursed and their families, and of the wider community. Their record deserves much more respect than the shabby treatment that is being meted out by NHS Greater Glasgow and Clyde. If the weight of public opinion and tangible public support is to mean anything, Sister Rita and all her team should expect St Margaret's to continue to do that at which it excels with confidence, into the future.

Photo of Ross Finnie Ross Finnie Liberal Democrat 5:35 pm, 10th January 2008

I, too, am extremely grateful to Des McNulty for securing the debate and pay tribute to hum for his unstinting efforts in the campaign. He deserves great credit for that. Des McNulty, Gil Paterson, Margaret Curran and Jackson Carlaw have made clear the record and history of St Margaret of Scotland hospice and why it should be retained in its present form. One begins to wonder why it has been necessary for Des McNulty to call the debate.

We are holding the debate because we are told by Greater Glasgow and Clyde NHS Board—better known as Glasgow and Paisley health board—that the process has been robust. According to the minister who will respond to tonight's debate,

"The Board of NHS Greater Glasgow and Clyde has determined through robust decision making processes, including comprehensive consultation arrangements, the arrangements for the planning and provision of continuing care beds for the future."

The cabinet secretary is entitled to come to that view, but she can be assured that it is not shared by anyone in the chamber tonight. Jackson Carlaw quite properly referred to a degree of cynicism about the ability of Greater Glasgow and Clyde NHS Board to take an holistic view of how we provide for care in that part of Scotland. It seems odd to us that if the board assesses care and long-term need—an assessment it claims to have made—and finds that there is a requirement for no more than 30 beds, that, having found a hospital whose record is impeccable and which has a standard and level of care that is beyond question, it should choose to provide those 30 beds elsewhere, without adducing one scintilla of reason or argument as to why it needs to upset the present arrangements that obtain in the hospice.

It is not entirely clear to any of us why the cabinet secretary, far less Greater Glasgow and Clyde NHS Board, should be interested in facilitating the development of the Blawarthill facility. If we have heard the cabinet secretary correctly, her objection is to arrangements that increase capacity through the private sector. However, as Jackson Carlaw said, that is precisely what is happening through Southern Cross Healthcare. We are not saying, "Keep this facility open because it happens to be there." Ours is a genuine, reasoned argument about the provision of the service, the number of beds that are required in that part of the west of Scotland, and the fact that they are currently provided for at a standard that no one has contested. No one has adduced one scintilla of argument as to why that arrangement should be changed.

If Greater Glasgow and Clyde NHS Board believes that there is a need for further provision, why has it not suggested that for Blawarthill? After all, Blawarthill is having to be reopened, restaffed and reprovisioned. There is ample opportunity to build from the ground up, and to develop the needs of Greater Glasgow and Clyde NHS Board, in Blawarthill, but the dedicated, experienced staff, the equipment and the beds are to be found in St Margaret's hospice.

The logic and evidence behind the case are overwhelming and not one scintilla of evidence has been produced on why the current arrangements at St Margaret's hospice should be upset. That is the message the chamber is sending the cabinet secretary tonight, and I hope that she will reconsider her belief that Greater Glasgow and Clyde NHS Board is correct in its present arrangements.

Photo of David Whitton David Whitton Labour 5:40 pm, 10th January 2008

All the previous speakers have given eloquent testimony in support of Des McNulty, and I, too, congratulate him on securing the debate.

I speak in support of the motion not only because Mr McNulty is the MSP for Clydebank and Milngavie, the constituency that lies next door to mine, but because the closure of the hospice would affect all those who live in East Dunbartonshire, including those in Strathkelvin and Bearsden, which I have the privilege to represent. They, too, took part in the carol service that Mr McNulty mentioned, which was held in support of the save the hospice campaign and which we enjoyed just before the Christmas break.

A lot of signatures have been gathered in support of St Margaret's—more than 60,000, in fact. That is due, in no small measure, to the efforts of one of Mr McNulty's constituents, Mrs Marjorie McCance, who lives in Milngavie. She and members of her family have worked tirelessly in support of the campaign and I pay tribute to their efforts and to the efforts of all those who were involved in collecting those signatures. I also pay tribute to the local newspapers, the Milngavie & Bearsden Herald and the Clydebank Post, which have been lending their weight to the campaign.

This week, in another newspaper, the Cabinet Secretary for Health and Wellbeing was quoted as saying that she would listen to the views and voices of local people before making decisions about health care provision. In correspondence with me on other matters, she has stated that she will not go back to decisions that have already been made and implemented. However, in this instance, as others have said, the final decision has not yet been made. All that I would say to the minister is that 60,000 signatures represent a very loud voice indeed and a very strong view. I daresay that there are many other voices—of people who are, sadly, no longer with us—who would have been willing to speak highly of the care and attention that they received at St Margaret's.

Mr McNulty has invited the cabinet secretary and the Minister for Public Health to pay a visit to St Margaret's. If they are not already planning to do so, I, too, urge them to pay a visit to the hospice to see for themselves the care that it offers to both the elderly and the terminally ill. They will find that there is a great deal of difference between an operational medical model for dealing with seriously ill patients and the personal style of care that is practised by Sister Rita and her dedicated team. They provide something that is difficult to put into words, but the praise and gratitude of those who have witnessed the care and attention that has been paid to their loved ones in their final days is a powerful testimony to the service to the community for which St Margaret's is rightly famous.

That kind of care and that level of service is not something to be changed just because the numbers do not add up. On this occasion, I am supporting Mr McNulty, Sister Rita and the St Margaret's campaigners, but I will also support the cabinet secretary and her minister if they decide that the decision on St Margaret's should be re-examined. After all, if we can review car parking charges, we can surely review a decision that will dramatically alter the care of the elderly and the terminally ill in this part of Scotland.

Photo of Shona Robison Shona Robison Scottish National Party 5:43 pm, 10th January 2008

I thank Des McNulty and congratulate him on securing the debate. I pay tribute to the many people who have been involved in the campaign to highlight the issues that are faced by the St Margaret of Scotland hospice. I am grateful to those who are present in the public gallery tonight for their commitment.

The presence of so many people from across the chamber and the level of the debate reflect the attachment that we have to the services that are provided to those who are vulnerable and who have particularly complex needs as they near the end of their lives. I know from the correspondence that I deal with, and from the recent presentation to the Public Petitions Committee, the level of support that exists among all those who are involved with St Margaret's.

Des McNulty's motion calls on us to recognise the work of St Margaret's and the strong support that the organisation has. I thank all those who are involved in the provision of palliative and end-of-life care for the fantastic job that they do.

In direct response to Des McNulty's request, the cabinet secretary is indeed visiting St Margaret's in the next couple of weeks to see at first hand the care that is provided there. I pay tribute to the hospice movement in Scotland more generally, because it is right that we recognise the special ethos of that movement and the values that hospices put into play, and their independence in doing that. We will continue to work closely with the Scottish Partnership for Palliative Care and the Scottish hospices forum.

St Margaret's is, perhaps, unique as an organisation, given the nature of the services that it provides. It clearly seeks to use its resources and skills in the best way that it can to meet patients' needs. Of course, as an independent organisation, it is for the board of St Margaret's to determine how it is run. We need to recognise that NHS Greater Glasgow and Clyde, in conjunction with its key partners and stakeholders, is responsible for planning and providing NHS services in ways that most appropriately meet the needs of the populations that it serves. In doing so, it needs to work together with its partners, stakeholders and providers to ensure the best possible standards of care.

Photo of Des McNulty Des McNulty Labour

Does the minister recognise that the hospice has, in a sense, been given a Hobson's choice? It has been told that it cannot continue doing what it has been doing so successfully, and that it must move to do something different—which is not, in its view, appropriate—just to suit an arrangement that the health board has made with a private provider. That does not seem to be right, and it does not seem to make sense in relation to everything else that the minister is saying.

Photo of Shona Robison Shona Robison Scottish National Party

It is important that we recognise that the hospice is not, in itself, directly affected by the changes. We are talking about the indirect impact, because of the overall funding and the way in which St Margaret's runs its services with the one fund. There is, therefore, an indirect impact from the decision; I will come back to that in a minute. The balance of care report, which has been referred to, was a review of the demand for, and the use of, different types of institutional care for older people. I am pleased to note that, although it was intended to repeat the review of that by the end of 2008, it has been agreed that the NHS continuing care section will be completed earlier than that.

That will involve updating the information on the demand for continuing care, and looking at admission rates and length of stay alongside projected population changes—some of the information that members have questioned during the debate. That will allow the projected bed numbers to be revised in the light of any changes in demand and length of stay since 2004-05, which was when a lot of that work was done—four years ago. NHS Greater Glasgow and Clyde aims to complete that work by the end of next month. I believe that that will provide a fresh opportunity for all key interests to find a way forward within the strategic approach that has been adopted. I have given a very clear message to NHS Greater Glasgow and Clyde that I expect it to redouble its efforts to reassure and encourage St Margaret's back to the table and into further discussions about future provision.

Scotland's health care challenges require us to continue to shift the balance of care towards community-based services. However, we need to recognise too that, for some people with particularly complex needs, it will be necessary to ensure the availability of the most appropriate services in the right setting with the best support. That is just as important for families and carers, too. Care of the frail elderly and care for those with palliative care and end-of-life needs are, perhaps, areas that most appropriately reflect our values for the NHS and for society more widely.

Implementing the action plan for "Better Health, Better Care" provides us with an opportunity to reflect our core values in the planning and provision of services for those who are most vulnerable in our society. As Minister for Public Health, that is what I expect from NHS boards and all those who are involved in providing services.

I reiterate that I look to NHS Greater Glasgow and Clyde and the board of St Margaret's, as a provider of services to the NHS, to work together so that the local communities receive services in accordance with their needs. They can be assured that we will give every encouragement to ensure that that happens.

Meeting closed at 17:50.