Howard Croft column: A deplorable levelling down of palliative care

The twelve bed Macmillan palliative care facility at Bridlington Hospital is to be replace by 'care in the commuity'.
The twelve bed Macmillan palliative care facility at Bridlington Hospital is to be replace by 'care in the commuity'.

I have over the past few months watched with interest the discussions and speculation in the press about possible changes in healthcare provision in the East Riding. Always with a sinking feeling that the twelve bed Macmillan palliative care (end of life) facility at Bridlington Hospital is doomed, and so it has turned out. It is to be replaced by “care in the community”.

You may remember from the eighties the shift from in-patient care for psychiatric patients to “care in the community”; the consequences for both the patients and the community were pretty catastrophic. The psychiatric hospitals were closed and the patients were turfed out into the community, many of them onto the streets, and many of the buildings were sold to developers for conversion into posh flats. The stated aim at the time was not to raise (and save) money.

Now as then – this has nothing to do with saving money we are told. So that’s OK then. But nor has it anything to do with optimising patient care during the final days/weeks of their lives. The idea that the level of service that is provided by a hospice, with its concentration of experience, expertise available round the clock, can be replicated for terminally ill patients scattered widely throughout the community is laughable.

As Mrs Joan Wormwell, speaking on behalf of the Pensioner Action Group (East Riding), is quoted in the Bridlington Free Press as saying, “There isn’t a sufficient number of district nurses to do that – you need special skills to support carers (in patients’ homes) and they don’t have the staff to do that”. Even if they did, end of life care requires not only specialist training, but also personal qualities and attitudes and temperament that not every district nurse is likely to possess. Anyone who has experienced a hospice in action, as I have, will have been impressed by this, not only in the doctors and nurses, but also in reception staff whose role is vital.

The words of the chief executive of the East Riding Clinical Commissioning Group, Jane Hawkard, are revealing. The people of Bridlington, she said, saw the unit at the hospital as the place to go for palliative care. That isn’t, she said, the case elsewhere. Well, quite; this is certainly the case in places where there is no hospice care, Malton for example, but in places where hospices are to be found, Scarborough say, with the admirable St Catherine’s hospice the expectation is the same. What we are seeing is a deplorable levelling down, rather than levelling up. We are also seeing, not just in the East Riding, the determined dismantling of the legacy of Dame Cicely Saunders, admired and emulated elsewhere in the world especially in America. We should be ashamed.

She goes on, “We want to work with that community to manage palliative care in the community, as in other areas. Macmillan (the charity) do support that direction of travel.” Ah, the foolish jargon of slippery officials! But at least she didn’t add “going forward”, perhaps unconsciously realising that she is pedalling backwards. Direction of travel is indeed apt, because she probably thinks of this not as a policy but “a journey”. I do wonder about the support of the Macmillan people. As retaining in-patient palliative care was not one of the options offered during the “consultation” I suspect that Macmillan recognised a fait accompli when they saw one.

A further insight into the official mind is provided by the following statistic: Bridlington Hospital had an average monthly intake of palliative care patients of 7.6 in 2016/17. Thinking of patients in terms of decimal points say it all. Had they said 91 patients over the year it would have been more sensible, but less appealing to their case. I’m surprised that they didn’t say “only a quarter of a patient a week” – case made.

People in Bridlington who are contemplating the inevitable would do well to hope for a quick and decisive coronary rather than a lingering end with cancer. Going forward. It’s only a journey, after all.