UNISON Response to
Greater Glasgow Health Board "Elderly Services: Proposed
Changes to Continuing Care"
3. Quality of Life : Frail and Elderly People
4. Hospital Closures - Recent History
5. Provision of Long Stay Care
6. Re-investment in Elderly Care
7. Morbidity and Re-admission
1.1 UNISON as the largest public sector trade union in
Scotland represents the interests of 15,000 members in all
sectors, which provide care for the elderly across the Greater
Glasgow Health Board Area. Our members are employed by three
NHS Health Trusts, Glasgow City and neighbouring councils
as well as the voluntary and private sector.
Our members whether in the traditional providers such as
the NHS, Local Government or in the voluntary/private sector
provide high quality care.
A significant number of them also provide care for elderly
members of their family who currently live in the community
and will undoubtedly be directly affected by any decision
that Greater Glasgow Health Board decides to implement.
This response is not intended as an attack on `alternative'
provision but as a direct response to the consultation to
close Cowglen and Blawarthill.
2.1 On the 18th of April, Greater Glasgow Health Board
considered the paper `ELDERLY SERVICES- PROPOSED CHANGES
TO CONTINUING CARE.'
The paper asks GGHB to,
- Note progress on jointly developing and implementing
new models of services to elderly people.
- Note the financial issues in elderly services.
- Consult on the closure of Blawarthill and Cowglen Hospitals.
As well as consulting on the closure of these facilities
the Board invited comments on how, if their closure plan
a) The long stay places should be provided.
b) Other related resources should be reinvested in elderly
UNISON would state that the method of consultation in this
exercise has been disappointing. We fully expected that
the Consultation would have flowed directly from the publication
of the proposals, but in fact it was delayed for a number
of weeks. Even then it was pressure from UNISON and the
local community groups that made GGHB set up public meetings
which were extremely critical of the plans to close both
Blawarthill and Cowglen.
3. QUALITY OF LIFE : FRAIL AND ELDERLY PEOPLE
3.1 UNISON are not convinced that the Health Board has
made the case for the closure of these facilities. UNISON
has consistently asked for, and been denied, data concerning
morbidity rates for the elderly in the community compared
to those in NHS care and for data concerning the levels
of acute admissions and re-admissions to hospital amongst
this patient group.
UNISON has also asked for data concerning morbidity amongst
elderly people who are transferred from one type of care
provision to another. To date this information has not been
provided and UNISON must therefore assume that this type
of basic information does not exist. This is obviously an
area of concern.
3.2 It may be that the data that the Health Board holds
concur with the verbal evidence obtained by UNISON in detailed
consultation with our members, patient groups and community
organisations. It is our belief levels of morbidity and
re- admissions for this group of people is unacceptably
It is the case now that there is just not the resources
or staffing in Social Care, Home settings and Nursing Homes
to take care of elderly and frail patients being discharged.
The evidence for this can be found in a recent report produced
by Help the Aged Scotland who express great concern with
regards the quality of medical and therapeutic care given
to people in Residential and Nursing homes.
This view is further supported in the Annual Report from
the Chief Inspector of Social Services, England and Wales,
who states that there is a " Crisis in Social Care"
due to poor recruitment and retention of staff, inadequate
training and resources. There is no evidence to suggest
that the position in Scotland is any better.
4. HOSPITAL CLOSURES - RECENT HISTORY
4.1 UNISON believes that it is wrong to view these current
closures in isolation; they come on a backdrop of significant
under-investment across the health service in Glasgow that
has lasted for more than two decades.
In 1995 Greater Glasgow Health Board proposed a reduction
in Continuing Care Beds across the Greater Glasgow Area
from 1438 to 964 by April 1998. Amongst the closures intimated
at that time was Cowglen Hospital whilst Blawarthill was
to see a significant reduction in beds.
At that time UNISON in its submission to the then Conservative
Secretary of State condemned the proposals as a "virtual
demolition of NHS Continuing Care in the Glasgow area".
UNISON believes that the current proposal amounts to the
same demolition today as it did in 1995.
IT WAS RIGHT FOR UNISON TO OPPOSE THE CLOSURE THEN IT
IS RIGHT FOR UNISON TO OPPOSE THESE CLOSURES NOW.
The 1999/00 Health Improvement Programme committed health
professionals in Glasgow to work jointly with Local Authorities
- Strike the right balance between institutional and community
care and between health and social provision enabling
people to live at home wherever possible.
- Achieve health and social services, which are integrated
and cohesive, involving pooled skills and resources.
- Improve the facility and range of services available.
UNISON does not believe that the balance has been struck,
the proposal by GGHB amounts to nothing more than `robbing
Peter to pay Paul.' The proposal to take care provision
from one sector and place it in another will not necessarily
improve the range of services available nor has that been
evidenced by the Board in its paper.
WITHOUT A PROPER AND FULL AUDIT OF THE CURRENT PROVISION
FOLLOWED BY SIGNIFICANT TARGETTED INVESTMENT, CARE OF THE
ELDERLY SERVICES IN GLASGOW WILL NOT BE IMPROVED.
UNISON believes that the statement that Blawarthill Hospital
is built "on the site of a Victorian hospital"
is misleading. It is accepted that the site once housed
a Victorian hospital. The current accommodation provided
for patients was not built in Victorian times. UNISON is
disappointed that GGHB in their consultation document appear
to have attempted to make use of the feeling that everything
Victorian needs to be replaced.
In UNISON's response to the last paper under the Conservative
Government in 1995 we were critical of plans for bed closure,
arguing as we did for an increase of 137 beds in the elderly
and frail sector in Greater Glasgow. The community groups
in this area were promised a further 30 beds on top of the
existing provision by GGHB in 1997. This was never honoured
although the closure of Knightswood Hospital went ahead.
Having committed themselves to the need for extra beds
in 1997, where is the Boards evidence to propose further
Blawarthill is an award winning hospital providing a high
standard of care in an area of Glasgow with an increasing
Elderly and Frail population. Instead of closing such a
facility it should be built on to ensure that the highest
level of patient care is maintained.
It should be remembered that in many cases this is the
fourth time that staff have faced closure of their workplace.
It is to the staff's credit that they have maintained the
current high standards, which have been recognised by the
patients and their families.
Whilst UNISON accepts that the fabric of Cowglen Hospital
may well be poor, it should not be considered in isolation.
The Scottish Health Advisory Service (SHAS) visit in 1998
commended the high standard of clinical care. UNISON is
disappointed that GGHB have decided to refer to the current
poor fabric as a primary reason for closure.
In 1995 the hospital was assessed by GGHB as being in an
adequate physical condition. At that time the Board spent
capital upgrading the fabric of the building.
UNISON believes that the building is structurally sound
and must question whether or not the facility has been deliberately
run down over the past five years. There has been some investment,
mainly from the community, more from the Health Board would
see an improvement in patient care at the site.
Whilst UNISON welcomes the move away from Nightingale Wards
in a general sense, we realise that for the majority of
elderly and frail patients with complex care packages there
is a benefit in the social interaction obtained in this
setting. UNISON is far from convinced that these patients
would benefit from a single room with en-suite facilities.
Many who are admitted or remain in both Cowglen and Blawarthill
are incontinent and require the care of nursing staff to
5. PROVISION OF LONG STAY CARE
5.1 Whilst supportive of the shift away from institutional
care, UNISON believes that there is a need to recognise
this practice in the past simply led to the privatisation
of continuing care.
UNISON believes that it is important not to confuse the
image of traditional institutionalised care with modern
hospital focussed health care. The levels of community support
and interaction with Blawarthill and Cowglen clearly evidence
the view of UNISON that health care facilities, like schools
should be seen as community facilities.
5.2 Local Authority provided residential homes will not
care for the most dependent elderly people. They currently
do not have the levels of expertise to provide complex care
packages. The result is that those who have a complex care
need find themselves being cared for in the private sector.
UNISON has already referred to the annual report of the
Chief Inspector for Social Services in England and Wales.
We believe that the concerns highlighted in that report
are transferable to Scotland and the GGHB area.
5.3 UNISON condemns the decision by GGHB to fund places
for the elderly in the nursing and residential sectors at
the expense of NHS beds. Across the UK NHS long stay beds
have been reduced by 38% whilst private nursing home beds
have increased by 900%. The picture in Glasgow is no different.
In 1995 there was 1438 NHS care of the elderly beds in Glasgow
with some 2153 private nursing home beds. In the year 2000
that figure is adjusted to depict 822 NHS beds and 2500
The current proposal, tabled under a Labour Government
will take the current 822 beds and reduce them to 582.
UNISON is concerned that the proposals put forward by
the Board could result in the most elderly frail in our
society being cared for in a less safe, less clinical environment.
5.5 Currently at anyone time up to four trained nursing
staff are on duty in the NHS environment, the ratio in private
nursing homes is somewhat less than this. The continued
use of untrained or semi skilled staff in the private sector
where profits are put before care does not fill UNISON with
confidence that those clinical standards will be maintained.
Further, evidence taken by UNISON in our consultation with
members and patient groups would support our view that the
patient journey for the elderly is far from smooth and that
whilst some private health care providers are professional
in their approach the monitoring system is not robust enough
to ensure the care and safety of the elderly.
6. RE-INVESTMENT IN ELDERLY CARE
6.1 UNISON is supportive of any commitment to re-invest
in elderly care, the mark of a civilised society should
be the care of its oldest and youngest citizens. UNISON
believes that the investment should take place now before
elderly frail people are transferred to a community setting.
6.2 UNISON believes that Glasgow Primary Care Trust is
already concerned that it does not have sufficient trained
District Nursing staff and that any increase in elderly
care provision in the community will have further significant
impact on the current staffing resources.
6.3 Occupational Therapist services are stretched to the
limit and UNISON believes in some areas have expended their
current budget provision. The result is that elderly people
are not receiving the essential aids and adaptations that
they require to be made to help them live in the community.
6.4 Reduced warden services across Scotland, which have
been replaced with `alarm pull systems' regularly fail.
In Glasgow this is particularly prevalent at `peak times.'
UNISON was concerned to hear that in some areas elderly
people are expected to purchase this service for themselves.
6.5 Services are already struggling to cope across the
city and other Local Authority boundaries.
Elderly people and their families are being expected to
pay for their care provision and yet there is no consistent
application of charges where these are deemed as appropriate.
Continued funding pressures on Local Government have resulted
in significant reductions in some essential services such
as meals on wheels and home help provision. As financial
pressures increase on Local Authorities and older people
are expected to pay for elements of their care package this
compounds the current problem of pensioner poverty. UNISON
is concerned that even if initiatives are put in place to
tackle pensioner poverty, the wealthier pensioners become,
the more of their improved income will be consumed by the
provision of care.
6.6 The Board attempts to justify its proposals by indicating
that a mixture of nursing home and residential home places
will replace the 240 NHS beds that will be lost. It goes
further in its justification by pointing out that by transferring
these beds into a non NHS environment could release up to
£6000 per patient from the DSS.
The proposal put forward by GGHB makes no comment on the
fact that the Local Authority is required to determine what
financial contribution the individual concerned can make
towards their own care costs.
A recent report by the Joseph Rowntree Foundation highlighted
that in many cases Authorities do not monitor an individual's
assets, so in many cases people were continuing to contribute
to the full amount when in fact they were entitled to state
6.7 The Macpherson report describes the current system
as designed around different bureaucracies, rather than
the needs of individual older people. Macpherson adds that
the system is characterised by its complexity and unfairness.
The number of different providers and funders of care, each
of whom have different management or financial interests
may work against the interests of the individual client.
The current system has no support in the community and
is not trusted by the elderly. Apart from the fact that
many of these people bought into a principle that promised
to provide care from the "cradle to the grave"
GGHB seems to be determined to ignore the fact that by transferring
care provision from the NHS to a social model elderly people
and their families feel let down, particularly when they
then are expected to pay for assistance and care.
UNISON believes that if the elderly are to stay in their
community, the role of advocacy should be developed locally.
Far too often it is reported that the elderly are not claiming
all of the benefit they are entitled to. New initiatives
can be complex and difficult to access at the best of times
without being a frail elderly person who is reliant on family
and care providers. Further if public bodies are serious
about being open and accountable they should be committed
to helping service users access them in a way that allows
them to contribute positively on issues that affect them.
UNISON believes that if the Government and local Health
Boards are committed to making Care in the Community a success
for those who rely on the service it is essential that investment
is made in the people who provide the services at the front
line. The difference between UNISON members in the traditional
public sector and the voluntary/ private sector is too great.
Work needs to be undertaken now to achieve a `coming up'
for those employees who are currently employed on cost cutting
terms and conditions.
If GGHB are serious about providing high quality care for
the elderly, they need to realise that high quality public
services are best delivered by well trained, directly employed
staff who put the needs of the service and the communities
that they serve first.
7. MORBIDITY AND RE-ADMISSION
7.1 UNISON has consistently asked for data concerning morbidity
rates for the elderly in the community/social care sector
compared to those in NHS care and for data concerning the
levels of acute re-admissions to hospital amongst this patient
group. UNISON has also asked for data concerning morbidity
amongst elderly people who are transferred from one type
of care provision to another.
To date this information has not been provided and UNISON
must therefore assume that this type of basic information
does not exist.
7.2 UNISON believes that without this basic analysis having
been undertaken GGHB's proposals amount to nothing more
that rough guesswork. We believe that this is not acceptable
in determining the future of care for the most vulnerable
in our communities.
8.1 There is a serious risk that the general public has
no confidence in Care in the Community. The concept of integrated
community care is not new.
UNISON has long argued that where care can be best provided
in the community, people should be given the opportunity
to stay in the comfort and familiarity of their own home.
It is our view that, that care should be provided by directly
employed public sector workers, who are paid a fair day's
wages for a fair day's work.
To do this will require a massive investment in Public
Services and a commitment from Government at all levels
and Health Boards that private provision is not necessarily
the best provision, especially in the care of the most vulnerable
members of our society.
8.2 UNISON can only condemn GGHB for their unashamed proposal
to pay for the short fall in Glasgow City Councils social
care budget by closing NHS beds. We believe that these services
should complement each other rather than at each other's
8.3 To date no evidence other than a financial benefit
has been put forward by the Board to support the view that
the hospitals at Blawarthill and Cowglen should close. It
would therefore, we believe, be fair to conclude that the
decision to effect these bed cuts is purely a financial
UNISON believes that there is overwhelming support for
the retention of the existing facilities and would urge
GGHB to listen to these views.
UNISON would recommend that;
a) GGHB retain the existing facilities at Blawarthill and
Cowglen, as there is little or no evidence to suggest that
the alternatives provide a higher standard of care,
b) GGHB undertake an extensive study of morbidity levels
and reasons for these deaths amongst the elderly and frail
people in the GGHB area,
c) That linked to the above study analysis should be carried
out to determine the levels of admission, re-admissions
and reasons for, within this patient group,
d) From the above study and analysis, a comprehensive targeted
investment should be undertaken across both the health and
social care provision in the Greater Glasgow area; and
e) GGHB should commit itself to the continued provision
of continuing care of the elderly at a level not lower than
the current provision.
JOSEPH S LYNCH