Kenneth Roy
There are two documents on my desk as I write this. One – a contract – is an indictment of public morality. The other – a report – is an account of human goodness. Together they tell us a lot about the values of modern Scotland. I will start with the report.
Kenneth Roy
There are two documents on my desk as I write this. One – a contract – is an indictment of public morality. The other – a report – is an account of human goodness. Together they tell us a lot about the values of modern Scotland. I will start with the report.
The Care Commission (the Scottish Commission for the Regulation of Care as it is formally known) recently inspected St Margaret of Scotland Hospice in Clydebank. The commission regulates around 15,000 services a year – from child-minders to private hospitals – and grades them from 1 (‘Unsatisfactory’) to 6 (‘Excellent’). Its visit to St Margaret’s was unannounced.
For ‘quality of care and support’, the commission gave the hospice the top mark. For ‘quality of staffing’ too, the hospice earned a score of 6. ‘The hospice provides extremely high-quality care and support for people who have advanced life-limiting conditions,’ the commission concluded.
There was nothing unusual about this outstanding assessment. St Margaret’s is accustomed to receiving the highest endorsement. But, for a more human perspective, it is worth looking at the views of the patients who were interviewed by the commission.
‘I feel safe here. The staff really know what they are doing. People think that hospices are miserable places, but that couldn’t be further from the truth.’
‘The staff are fantastic. I wouldn’t want to go anywhere else.’
‘This is a special place. It’s hard to explain and you wouldn’t understand unless you were a patient yourself.’
‘I have thought about it, but there really isn’t anything that could be done to make St Margaret’s Hospice any better.’
The commission also took the views of carers into account:
‘They don’t just look after my relative. They look after me.’
‘Nothing is a bother. The staff go out of their way to ensure everyone gets what they want.’
‘St Margaret’s is a very special place.’
The commission described these opinions as ‘extraordinarily positive’. Its own impressions were equally positive. It noted ‘the very high staffing ratios within the hospice’ – on the day of its inspection there were five trained nurses, a clinical nurse specialist and 11 nursing auxiliaries caring for 50 patients. It noted further that patients were being cared for ‘in a way that was genuinely respectful of individuality and preference’.
Under the standard heading ‘Areas for improvement’, the commission said only:
To continue
To continue. How simple the Care Commission makes it sound. And it should be simple. The phrase ‘world-class’ is used too carelessly, but Scotland really does have a world-class hospice, open to people of all religious denominations and none.
Why, then, does the public body on whom it relies for much of its income – Greater Glasgow and Clyde Health Board – wish to jeopardise its future? Why does it not echo the injunction of the Care Commission and tell the hospice to continue doing what it does so well?
Instead it has decided to withdraw funding for St Margaret’s continuing care beds for frail elderly people nearing the end of their lives, and to enter into a partnership with a private company, Walker of Leith, to build a new continuing care facility on the site of Blawarthill Hospital nearby. The health board wishes to convert these beds at St Margaret’s into a conventional care home, destroying the ethos of the hospice at a stroke. The hospice has consistently rejected this ‘option’ as the health board erroneously calls it – erroneous because it is the only offer on the table.
It is perverse. It is inexplicable.
In effect, the Scottish government has entered the speculative housing market on a site where terminally ill people are being cared for. Why would anyone in power think this was an acceptable thing to do?
The second document, obtained with some difficulty as a result of a freedom of information request, is the contract for the new development at Blawarthill. When SR began investigating this ‘land transaction’ last January, its terms were unknown. Now that they have reluctantly been made public, the deal looks even more extraordinary than we suspected.
A five-acre site – a public asset – has been sold by the health board to Walker of Leith for £2.8 million. By the time the developers make all the deductions to which they are entitled, the actual price will be as low as £1.1 million. Is that really all a five-acre site in the west of Glasgow is worth?
The next perplexing question is how, having done all they have to do, building a care home for Glasgow City Council as well as the continuing care facility for the health board, the developers will be able to recoup their investment. There appears to be no easy answer.
Except this. As part of the deal, they are entitled to build a ‘mainstream’ private housing development on the site. The number of houses is not stipulated in the contract, but there is an assumption that the sale of these houses will yield at least £8.5 million.
For every house sold above that figure, ‘the Scottish Ministers’ – the paymasters of Greater Glasgow and Clyde Health Board – will take 23% of the proceeds. In effect, the Scottish government has entered the speculative housing market on a site where terminally ill people are being cared for. Why would anyone in power think this was an acceptable thing to do?
There is, then, the question of how the patients are to be cared for. Not, it seems, by Walker of Leith, which claims no expertise in nursing and clinical services. The care will be provided by another commercial outfit, Southern Cross Healthcare, at a rate of £163.90 per bed per week based on 2007 prices. (Why not 2010 prices? That is one of the many mysteries of this document.)
The average cost of a place in a nursing home is around £30,000 a year. The deal at Blawarthill is worth only £8,522.80, plus any revision from 2007 prices. Southern Cross are not fools, so where is the rest of the money coming from – to pay for food, nursing, heating and lighting, medication, consultant and medical cover, laundry and linen, repairs and renewals? What standard of care will slightly more than £163.90 a week provide? And where is the profit for Southern Cross?
No doubt there is a rational explanation. I hope that Greater Glasgow and Clyde Health Board will provide it as soon as possible.
Even when the baffling economics are sorted out, however, there will remain a question of public morality. The Scottish government or the health board – it amounts to the same thing – stands to profit from the sale of private houses at Blawarthill, next door to the sickbeds of dying people, while the hospice which is being urged ‘to continue’ by another branch of that government wonders whether it has a future.
Where is the logic in all this? Where is the justice? Where is the humanity?
One day, perhaps, the cabinet secretary for health will seriously address these questions and not simply allow one of her civil servants to peddle the health board’s official line. Until she or her successor does so, we will go on asking them.
This article was reproduced with the kind permission of Kenneth Roy.
Read Kenneth Roy in the Scottish Review.