Andrew Robertson
The board replies

On 27 January, we wrote to the chairman and other ministerial appointees on the board of NHS Greater Glasgow and Clyde with seven questions on the Blawarthill Hospital re-development and the subsequent withdrawal of funding from St Margaret of Scotland Hospice. We received the following reply from the chairman 22 working days later.

24 February 2010

Dear Mr Roy

Thank you for your letter of 27 January 2010, which has also been copied to all members of the board of NHS Greater Glagow and Clyde.
     Board members are free to respond to you individually if they choose. I am writing to respond to the seven questions you posed based on discussions at board meetings, and sub-committees, and from my own perspective of direct involvement in exchanges with representatives of St Margaret's of Scotland.
     I will address your seven questions in the order in which you posed them.

1. When the board approved the re-development of Blawarthill Hospital in late 2000 or early 2001, there was no suggestion in the board paper on which the board based its decision that the provision of continuing care beds on this site would impact on the continuing care already being provided by St Margaret of Scotland Hospice. Do you believe that the board should have been aware of this at the time of its decision or, if not then, at a much earlier stage than it did become aware?
The 2000/01 decision to redevelop the Blawarthill Hospital site with 60 NHS continuing care beds was made on the basis of our requirements for continuing care at that time. The proposed development of a campus style model, in partnership with other bodies, was deemed by the board to have significant merits. The public consultation which originally proposed the closure of the hospital made a strong case, fully supported by the local community, to provide a new range of health and social care services on the site. The subsequent plans for Blawarthill re-development were taken forward jointly with Glasgow City Council.
     In 2005, a further review of continuing care concluded that the 30 beds at St Margaret's were not required. In making the 2000/01 decision the board could clearly not be aware of the outcome of a review which took place four years later.

2. In view of the board's declared belief that there is 'a reducing clinical need for NHS continuing care' are you sympathetic to the logic of providing more continuing care beds at Blawarthill when this service is already being provided by St Margaret of Scotland Hospice?
There is no proposal to provide more continuing care at Blawarthill, the proposal is to replace the current 60 beds in 1970s accommodation in new-built, fit-for-purpose, single-room accommodation that meets the latest national standards and best practice.
     To be absolutely clear, the 60 continuing care beds that will form a part of the Blawarthill development are not new and do not substitute services currently purchased from St Margaret's of Scotland.

3. Are you satisfied with the length of contract between your board and the developer? Do you believe that the land should be disposed of with no agreement for the use of the facility beyond the first five years?
The decision to build in a five-year review period to the contract was ours and, therefore, we are entirely satisfied with it. The reason for doing this was to ensure that we will maintain a degree of flexibility to review the ongoing requirement for health and social care beds in west Glasgow. The review period does not entitle the developer to withdraw from the contract at the end of the five-year period.

4. What is your understanding of what will happen after five years?
Please see my previous response.

5. Were you aware that when the board approved the re-development of Blawarthill in late 2000 or early 2001, the plan approved did not include a private housing development on the site? Can you say why such a development became part of the plan and whether you approve of it?
The 2000/01 decision-making focused on the future health and social care services to be provided on site. As the detailed site planning has developed, in partnership with the city council, the potential to generate an additional receipt from partial housing development emerged. That element of the disposal has been properly endorsed through the required due property transaction process.

6. How many, if any, clinicians will be employed at the continuing care facility at Blawarthill?
The specific numbers will be finalised in due course but the 60 NHS beds, as now, will be fully staffed by NHS doctors, nurses and support staff, including cleaners and porters.

7. Why do you believe that, in all circumstances, the decision to withdraw funding from St Margaret of Scotland Hospice was the correct one?
Our primary responsibility is to commission the services our population require. The requirement for NHS continuing care has declined. We do not require the continuing care beds which St Margaret's provide and we have proposed options for the alternative use of the beds to ensure that St Margaret's have a secure source of income. St Margaret's will not consider alternative uses and it is that position which creates the risk.
     I, and others, have made it crystal-clear to the trustees of St Margaret's that we would work with them to identify any additional costs and challenges that they may face in the transition period and that we would provide appropriate support.
     I remain disappointed and saddened by the approach adopted by St Margaret's, and I am also disappointed in the way elements of the public debate have unfolded with the potential undermining of an important development in another community.

Yours sincerely

Andrew O Robertson, OBE LLB
Chairman

A member of the board, John Bannon MBE, responds point by point to Mr Robertson's letter:
 
(1) The 'balance of care' report is the document which the NHS board used to determine how many continuing care beds were required throughout the city. This report is still in draft form and was never ratified by any meeting of the health board. If the health board was of the view that it had far too many continuing care beds, why did it not say to St Margaret's to halt its plans for the new-build facility at the hospice. The board was well aware of the intentions of the hospice to build a new continuing care facility.
     Once officers of the board were of the view that there were too many continuing care beds and there would need to be a significant reduction across the city, why did they not have a public consultation period? This was a major change to services and the public had the right to comment on it just as it did in 2000.
 
(2) Where is the evidence to suggest that there are too many continuing care beds? This evidence was never laid before any meeting of the board nor was any value for money study, so how can the board, not officers, be assured that they are receiving value for money? Where is patient choice in all of this as patients have a right to be cared for in an appropriate setting whether that be at home, in an NHS hospital or a hospice but this decision denies them that fundamental right.
 
(3) If the five-year contract was the initiative of the NHS board why then did it never feature in any paper to any board meeting before the board reached a final decision. Does the board only plan services for a five-year period? What happens after five years if the board wish to continue purchasing a service from Southern Cross? Will Southern Cross be able just to set a price and the board will have no option but to accept it as there is no alternative provider in that sector of Glasgow?
 
(5) Why did you only work in partnership with Glasgow City Council when 40% of patients admitted to St Margaret's come from areas outwith the city of Glasgow? Why were other local authorities not involved at an early stage when we now see local authorities distancing themselves from the decison taken by the board? The only local authority which is fully supportive is Glasgow City Council but it has a vested interest as it will also be purchasing 60 beds on the Blawarthill site and is funding Yoker Housing Association to build the sheltered housing on the site.
 
(6) If the NHS board does not know at this late stage in the process its staff complement then how can it properly negotiate a price per bed with Southern Cross as staffing costs must be known before you reach a cost per bed per week.  
 
(7) What alternative proposals did the board put to St Margaret's Hospice, as the board paper only has one option and that is the continuation of the Blawarthill development, and once this is complete St Margaret's will lose its 30 continuing care beds? What client group is the board proposing for St Margaret's as this has never been mentioned in a board paper?
 
I would also like to know on what basis the board judged that there would be less need for continuing care beds when we have an ever increasing elderly population, many of whom will require specialist continuing care and who should have the choice of where that care is provided. The papers submitted to the board did not contain any cost benefit analysis or enough financial detail in order to allow board members to make an informed decison.

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