Close Encounters of the Third Kind- the Growing Dilemma of the Voluntary Sector

It's not a good time to be in the voluntary sector in health. Maybe it never is, but two stories have been rumbling on over the past few weeks, which illustrate the perils of being in this sector just now. One is the story of Kinloch Rannoch community, whose GP opted out and then retired in 2006. Tayside Health Board's solution to this, has been to attempt to bring in First Response, a volunteer service that specialises in on-the-spot defibrillation treatment, to replace the GP. Not surprisingly, this has met with a right royal raspberry from the local community. The second story is St Margaret's Hospice in Glasgow, which was asked by Greater Glasgow Health Board to admit a wider range of continuing care patients; not simply people that are at the end of their life, but those with complex mental health problems, and also nursing care patients.St Margarets has refused to do this, and is now looking down the wrong end of a £1.2million shortfall, as GGHB threatens to withdraw its funding.

What is interesting about these cases, is how each organisation has dealt with the NHS. There are three rules for a voluntary organisation that accepts public funding;
1. Know your remit.
2. Know the government's remit.
3. Do not let the two remits coincide, even if it means loss of funding.

First Response has a problem with its identity. It was set up by an RAF pilot, Scott Bateman,after the death of his father from a heart attack. The original idea of it, was to provide on-the spot emergency treatment from a trained volunteer to a patient, while waiting for an ambulance to arrive. They have a strong bias towards difibrillation treatment, and they tend to be centred round RAF posts, which are rural and the volunteers originally came from the RAF. However, things have changed as they have evolved.
First Response now recruit not just military personnel, but civilian personnel called 'community responders'.

First Response are acquiring their own set of vehicles; cars with markings almost indistinguishable from a paramedic's car. They are also setting up a scheme called 'Life Bikes' for operating in connurbations and rush hour traffic. This is a move away from their rural setting.

First Response have been granted the title of 'NHS Partner' and they display the NHS logo on their website.

I do not think that First Response is deliberately setting out to undermine the regular ambulance serices. But I think that the health boards have led them step by step into a situation where they will find themselves doing that, and it has happened because of their inexperience and because they were not clear enough on what their remit was.

By contrast, St Margarets Hospice in Clydebank has never allowed themselves to be mistaken for the health board. They know their remit; to provide specialist palliative care to the dying and judging by these minutes, they are not afraid to say so.

Palliative care comes under the quicksand banner of continuing care for the elderly. This can mean a dozen different things from a long term condition like Alzheimers, to cancer sufferers, to elderly with complex mental health needs. Their life span can be anything from a few weeks to a couple of years. What many hospices do to avoid confusion, is that they simply deal with cancer sufferers and neurological conditions such as Motor Neurone disease. St Margarets is different, because it will take people with other conditions as well, the proviso being that they are in the last stages of their illness.

Glasgow Health Board like other boards, has a problem with continuing care beds, and judging by the number of beds currently being discussed for the new Southern General, is going to have even more of a problem with these type of beds in the future. Hence their efforts to get the hospice to change its remit to what would amount to a nursing home. St Margarets has stuck to its guns, even although GGHB has threatened to remove funding. They have not allowed the health board to dump its responsibilities on them, and have not allowed themselves to become subsumed into a diluted version of professional services.

Perhaps the main difference between St Margarets and First Response, is age. St Margaret's has been going for 70 years; First Response has only been going for ten years. But it needs to heed the wake up call from Kinloch Rannoch if it is going to survive another ten. As for St Margaret's? Well, it's run by nuns. As Fr Jack probably didn't say; be afraid, Tom Divers. Be very afraid.

A Broken Trust- the Pamela Coughlan Case

Last November, the Scottish Health Campaign Network met with Andy Kerr to discuss various health issues. I was with them, and for that particular meeting I chose to ask a number of questions on mental health provision and care in the community. One of the questions I asked was; what was happening about the funding of people who were moved from continuing care beds in hospitals, into care homes in the community? The reason that I asked this question was because of the Pamela Coughlan case down in England, which became a benchmark case in health care.

Pamela Coughlan(above)was severely injured in a road accident some twenty years ago. She needed professional medical care, as well as help with feeding and dressing, which came under the title of personal care. At first she was placed in an NHS nursing home which specialised in long term care of this type. However, when plans were mooted to shut the nursing home and move the patients into local authority residential homes, Pamela was told that the funding of her care was no longer the NHS's responsibility. The social services were to provide funding and this would be means tested. Pamela challenged this decision in court, and to cut a long story short, she won. The court decided that the NHS trust had acted unlawfully and that they were responsible for the funding of Pamelas medical care. The social services would be responsible for personal care.

This issue is now coming to Scotland. In my own area, Lanarkshire, Kirklands hospital which catered for people with severe learning disabilities is closing. Hartwoodhill, which dealt with brain injury and psychiatric disorder, is closing. And the number of continuing care beds is being reduced. In short, there is a considerable number of people with significant medical needs being put into the community or nursing homes. But is the funding going to follow them?

Last week Frontline Scotland attempted to come up with an answer to that and they found that, like England, we are seeing a situation where people like this are being asked to fund their own care and they have no idea that the NHS should still be funding them. . This involves huge sums of money; medical care is more expensive than normal nursing care and the only way that the person can fund it is to sell their home. The buck for funding these people has been passed from the NHS, to local authority, to the person themselves and it's completely illegal. But because the NHS up here has not been challenged on this point, it is still following the old guidelines and hoping to get away with it. It's time it was challenged.