The broken window

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Kenneth Roy

Last winter the Scottish Review conducted a high-profile campaign opposing the decision of NHS Greater Glasgow and Clyde to withdraw funding for the continuing care beds at St Margaret of Scotland Hospice in Clydebank. This hospice wins top marks in every department from the Care Commission, and the concern over its future was the subject of one of the largest petitions ever presented to the Scottish Parliament.

 Kenneth Roy

Last winter the Scottish Review conducted a high-profile campaign opposing the decision of NHS Greater Glasgow and Clyde to withdraw funding for the continuing care beds at St Margaret of Scotland Hospice in Clydebank. This hospice wins top marks in every department from the Care Commission, and the concern over its future was the subject of one of the largest petitions ever presented to the Scottish Parliament. Yet, in the teeth of public opinion and hostile to any rational judgment, this unelected board proposed to replace the first-class provision at St Margaret’s with an unnecessary new build at Blawarthill hospital a few miles away, and to hand over care of terminally ill people to a commercial outfit whose track record might tactfully be described as patchy. The hospice, meanwhile, would be downgraded to the status of a nursing home.
     SR questioned many aspects of the 10-year history of the Blawarthill development, including the lack of proper public consultation over the final plan. The quality of our investigative work was praised in the Scottish Parliament. A member of the health board, John Bannon, broke ranks and bravely spoke out against his own board’s conduct. For a few weeks it seemed that sense and humanity might prevail. They didn’t in the end. The board persisted with its irresponsible scheme; Blawarthill is going ahead despite the severe recession and the financial pressures facing the NHS.
     Although our campaign failed to stop Blawarthill, indeed it was probably too late to stop it, it was not too late to save St Margaret of Scotland Hospice. We proposed that, when the continuing care beds were removed, there would be an opportunity to expand the hospice’s palliative care for the dying. This idea seemed to challenge official thinking on how people should be looked after towards the end of life; the chairman of NHS Greater Glasgow and Clyde, Andrew Robertson, indicated that he favoured the idea of people dying at home. In our view this is a wholly impractical proposition in many cases, although it would be possible in some. It also raises issues of individual choice.
     SR wrote to the Scottish Government inviting it to clarify official policy: specifically, whether it supports Andrew Robertson’s philosophy. Although our request was acknowledged, we are still awaiting a reply almost four months later. We are left to conclude that, on this important question, the Scottish Government does not actually have a policy.
     Nonetheless, on 11 March there was something of a breakthrough: a debate on the future of the hospice in the Scottish Parliament followed by a ministerial statement in which Nicola Sturgeon assured the house that she was committed to the hospice. She talked of a ‘window of opportunity’ in the prolonged negotiations between the hospice and the health board about the long-term funding of St Margaret’s. From Miss Sturgeon’s office on 31 March, SR received a written assurance in the following terms:
    
The Cabinet Secretary believes that, with co-operation and a willingness to discuss a range of options, NHS Greater Glasgow and Clyde and St Margaret’s will be able to agree a future model of service provision that will serve the interests of those served by the Board and allow the Hospice to continue its excellent work for many years to come. The Cabinet Secretary intends to monitor closely the progress made in these discussions.

We decided to suspend our campaign in the interests of giving Nicola Sturgeon’s ‘window of opportunity’ every chance; we genuinely believed that discussions would take place in a more positive spirit than before; we dared to hope that, by now, the health board would have given some assurance to St Margaret’s about its future funding. After three and a half months, the ‘window of opportunity’ looks suspiciously as if it is broken. The discussions have achieved little if anything. The future of the hospice is as uncertain as ever. There is a growing feeling of drift and bad faith.
     Earlier this week the health board approved a report on palliative care provision throughout its vast catchment area. Among the report’s key findings:

     in NHS Greater Glasgow and Clyde every year, there are likely to be around 3,800 people dying from cancer, and 6,800 dying from other causes, who will need palliative care in their last year of life;
     the palliative care needs of Greater Glasgow and Clyde are 60% higher than the national average;
     in some areas, including West Dunbartonshire where the hospice is based, fewer people have access to hospice care than in other areas.

The health board will now explore ‘how the relative lack of access to specialist palliative care beds in South Glasgow and West Dunbartonshire…might be addressed’. Of course there is a rather obvious answer to this question and it is surprising that it should require any further discussion: the answer lies, partly at least, in expanding the palliative care provision at St Margaret of Scotland Hospice.
     Yet, nowhere in this report is the hospice mentioned. Worse, there is a strong hint that any significant funding for extra palliative care is unlikely. Worse still, the health board now intends to embark on a ‘programme of further planning work’ lasting 12 months. That takes us to the summer of 2011, beyond which there will be a period of consultation and a decision-making process lasting several months more. By the time NHS Greater Glasgow and Clyde gets around to determining the future shape of palliative care for the 10,000 people a year who need it, funding for St Margaret of Scotland Hospice will have run out.
     So much for the new spirit of co-operation. So much for the cabinet secretary’s ‘close monitoring’ of the discussions. So much for the ‘window of opportunity’, a phrase carrying with it a sense of urgency and purpose. Did these undertakings ever mean anything? What fools we were to accept them at face value.
     The hospice is left to wonder. The dying are left to die.

Read Kenneth Roy in the Scottish Review.