The inside story of how a hospice was saved and an injustice corrected

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by Kenneth Roy

In the closing weeks of 2009, I was asked if SR would become involved in the campaign to save St Margaret of Scotland Hospice. Of the campaign I knew nothing; of the hospice itself, the barest fragment of an anecdote. I was about to learn a great deal more.

All I had ever heard of St Margaret’s was a sad, amusing little story told by Murray Ritchie. A former colleague spent his last weeks in the hospice. Early one afternoon, a nurse came to his bed and asked if there was anything he would like. ‘Yes,’ Bob replied, ‘I would like a glass of dry white wine’. Murray spoke well of the care our dying friend received there. He was not alone. The Care Commission has consistently rated St Margaret’s ‘excellent’ in every department.
1. A lost cause?

When he first contacted me, the chairman of the hospice’s board, Leo Martin, was disarmingly frank. He said he could use an inquiring journalist who would be in it, as he put it, ‘for the long haul’. He asked me to look at the history of the NHS’s decision to withdraw funding for St Margaret’s continuing care beds – without which there would be a huge question over its viability. He said he could put many papers, reports and emails at my disposal. He duly did.

As I studied the mass of material forwarded by Leo Martin, my heart sank. It was a complex saga dating back 10 years; it would not be easy to present this material in a compelling way. Worse, it seemed that NHS Greater Glasgow and Clyde, the architect of the hospice’s present misfortune, was quite immovable; having made up its mind, it betrayed no hint of being in any mood to budge. I concluded that if the Scottish Review did take on this cause, it would be fighting a lost one.

Yet the injustice of the health board’s policy surely demanded some last-ditch resistance. The board had embarked on a scheme to replace the continuing care beds at the hospice with a new build, financed by private capital, on the site of the crumbling Blawarthill Hospital nearby. There, the beds of the frail elderly would be rented out for profit, their care put in the hands of a commercial outfit called Southern Cross Healthcare. The scheme made no sense. It was inexplicable.

The more I thought about SR’s approach to the story, the more convinced I became that there was no merit in joining an already substantial chorus singing the praises of St Margaret’s. The Care Commission’s glowing endorsements had made no difference. A petition signed by more than 100,000 people, the second largest ever to come before the Scottish Parliament, had made no difference. The support of influential politicians had made no difference. The only chink in the health board’s formidable armour was the nature of the Blawarthill deal: this was the point of greatest weakness, yet it had never been properly exploited.

2. Flaws in the plan

There was no time to waste. The missives for the redevelopment of Blawarthill were due to be signed on 31 January 2010. We came to the story with five days to spare, heading our long expose: ‘The land deal, the end of life, and the public interest’. We called it ‘the most controversial land deal in the history of the NHS in Scotland’ and, point by point, challenged its muddled thinking and the extraordinary cloudiness of the financial projections.

We made the most of our discovery that, when the plan for Blawarthill was approved by the health board and sent out for public consultation, there was no mention of the impact on the existing service being provided by St Margaret of Scotland Hospice; indeed no mention of the hospice at all. Had the members of the board been fully informed of the consequences of the scheme? Did they know what they were approving? If they had not been fully informed, if they did not know what they were approving, there seemed to us to be a strong case for challenging the legitimacy of the Blawarthill redevelopment.

Before we published these revelations, we alerted the first minister’s office – we wanted Alex Salmond to know personally what we were doing – and received an appreciative message back.

At health board HQ, however, the mood was not one of appreciation of the Scottish Review’s efforts. The immediate reaction of the PR department was to email all the board members with a dismissal of SR’s significance. Our story was described as ‘sensational’ and compared unfavourably with the mountains of positive publicity which a newspaper in the Herald group was about to facilitate for the board’s new health promotion campaign. The SR story was not picked up by any national newspaper or by the BBC. The head of PR at NHS Greater Glasgow and Clyde contacted his opposite number at the Scottish Government and confirmed that our coverage had had little or no impact.

3. The board’s errors of judgement

Of course I did not know any of this until much later, but I had already planned our next move. The following day, bypassing the PR department, I contacted all the ministerial appointees on the board with personal emails routed through the office of the chairman, Andrew Robertson. The terms of each email were identical: I put seven questions about various aspects of the deal and asked them to reply individually. If part of the purpose of this strategy was to unsettle a complacent management – as I suppose it was – it certainly had the desired effect. The management promptly made its first error of judgement.

Instead of forwarding the emails to their intended recipients, it sat on them, allowing an enterprising journalist from the Daily Record, who had spotted the seven questions in SR, to put them to the board himself. The board could safely ignore the tiny Scottish Review, but it would have been folly to ignore the Daily Record. The head of PR promptly answered the questions – but without consulting the board members. This failure of consultation was the second error of judgement, and it was to have serious repercussions.

Unknown to me when I started digging into the health board’s affairs, a senior member of the board, John Bannon, who had been awarded the MBE for his services to the NHS, had become increasingly concerned by the Blawarthill scheme. The management’s treatment of the Scottish Review, and what he saw as the cavalier handling of our seven questions, tipped him over the edge. Mr Bannon decided that he had had enough and spent the weekend writing a long letter to the cabinet secretary for health, Nicola Sturgeon.

The letter, headed ‘Scottish Review investigation’, was a stinging indictment of his own board. ‘I requested all facts, figures, tendering documentation…but I have been frustrated, indeed would go as far as to say that I was obstructed in my endeavour to get to the truth’, he wrote. Nicola Sturgeon at once sought a report from the health board on these serious allegations.

4. The Holyrood debate and its aftermath

A spark had been lit. All-party support for the hospice, always there but recently dormant, was re-ignited. During a debate in the Scottish Parliament on 11 March, SR was praised publicly for its investigative journalism and Nicola Sturgeon, in her closing statement, said she expected the health board to engage in constructive discussions with the hospice about ‘a range of options’ for its future.

At first these discussions seemed to be progressing well. But as soon as they ceased to be chairman to chairman and began to involve senior officers of the board, they ran into the sand. The ‘range of options’ was effectively reduced to one: the conversion of a significant wing of the hospice into a bog-standard care home – an option consistently rejected by St Margaret’s because it would have represented the destruction of the hospice movement’s ethos. Leo Martin felt he was getting nowhere. Contact between the parties became infrequent.

Meanwhile, however, SR had seized on another weakness in the health board’s plan for Blawarthill: the choice of Southern Cross to provide the care. Although the company looked buoyant at first glance, buoyant enough as recently as 2007 to allow a former chief executive to bank £6.6 million by selling 1.2 million shares, its underlying position was far from secure. A debt of £33 million, a share price in freefall, and a care record which in Scotland alone had provoked over a four and a half year period no fewer than 684 complaints, 373 of which were completely or partially upheld, did not strike me as the record of a company with which a major public body should necessarily be doing important new business.

These doubts were confirmed when, by a piece of good luck, I discovered that Southern Cross had hired the services of a Glasgow-based crisis management consultant. If Southern Cross was officially in ‘crisis’, why was it still the preferred bidder for the Blawarthill contract?

5. The hospice is saved

SR put these questions in a long piece headed ‘Intensive Care’. I emailed Dr Kevin Woods, the then head of the NHS in Scotland, informing him of all we had discovered about Blawarthill, including the state of Southern Cross. The letter was never acknowledged. After a delay of some months, the missives were signed: despite all the warnings, the health board committed itself to its foolish scheme. But the Southern Cross share price kept tumbling. Had no one noticed?

In the weeks running up to Christmas, rumours began to emerge from the health board that Blawarthill was in deep trouble. By the end of the year, the scheme was dead. As Leo Martin and Andrew Robertson met last Friday, the PR department was preparing a press statement: the notice to end the contract for St Margaret’s continuing care beds had been lifted. On Friday evening, Leo Martin emailed John Bannon and myself: ‘I wanted to place on record my utmost thanks to both of you for all the public and selfless help you have given to the hospice and for the strength it has afforded us’.

The hospice has been saved, although if I were Leo Martin I would be insisting on a watertight, long-term contract.

Tomorrow: The lessons that must be learned.