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Chamber and committees

Meeting of the Parliament

Meeting date: Wednesday, May 10, 2023


St Michael’s Hospital

The Deputy Presiding Officer (Annabelle Ewing)

The final item of business is a members’ business debate on motion S6M-08317, in the name of Fiona Hyslop, on the future of St Michael’s hospital in Linlithgow, West Lothian. The debate will be concluded without any question being put.

Motion debated,

That the Parliament understands that the land for the St Michael’s Hospital facility in Linlithgow was originally gifted by St Michael’s Church in the 19th century for the purpose of providing a hospital and garden for the community, and that, due to temporary demands to move staff elsewhere in the NHS due to illness absences, it is currently closed; recognises what it sees as the long history of St Michael’s in providing hospital services to the people of West Lothian, the Friends of St Michael’s Group’s hard work and dedication in supporting families with loved ones cared for at St Michael’s Hospital, and the invaluable local support and spirit of solidarity that the local community provides to all who use the hospital; notes the view that there will be an ongoing need for a health facility providing end-of-life and step-down intermediary care and, potentially, new support services to match increasing home-based care in the north of West Lothian; recognises what it sees as the strong community support for the retention of the hospital and the campaign to maintain hospital and health services there, including, it understands, the large number of people who attended the information evening on 7 February 2023 organised by the Friends of St Michael’s Group and addressed by West Lothian Health and Care Partnership, which, it considers, saw a willingness from all to identify the best future needs for patients and families and the role that the hospital could play; understands that West Lothian has a growing population that is already well in excess of that of the City of Dundee, and also has one of the highest proportions of older populations; acknowledges what it considers the continuing challenges in securing and resourcing staffing for any expansion of care at home, and the ongoing pressure on caring families; notes the West Lothian Health and Social Care Partnership’s consultation on the current closure of St Michael’s Hospital and its community bed review, and further notes the calls on the partnership to take a strategic view in favour of using the physical, social and community assets of St Michael’s for the benefit of the growing population in the north of the county.


Fiona Hyslop (Linlithgow) (SNP)

I thank all those members, across parties, who signed my motion, allowing me to bring this important debate to the chamber. I also thank my constituents and the Friends of St Michael’s Hospital, some of whom are in the public gallery this evening, for their work on the campaign.

St Michael’s is a community hospital that provides end-of-life care, respite and step-down intermediary care, and it supports patients who are waiting for care packages or for placement in a care home. It is situated in Linlithgow, in the north of the county, and it supports patients from all over West Lothian.

St Michael’s hospital is the only national health service facility of its type in the north of West Lothian. The land for the hospital was owned by St Michael’s church and gifted to the health authorities at no cost in 1854, on the stipulated condition that it would remain land for a hospital facility and a garden for the people.

I understand that the former Conservative Secretary of State for Scotland Michael Forsyth MP confirmed to David Steel—not our former Presiding Officer, but his father, who was minister of St Michael’s at the time—that the land would revert, with the buildings on it, to the kirk session if it ceased to be used for the purpose for which it was given.

In August 2021, the West Lothian health and social care partnership integration joint board took the decision to close St Michael’s temporarily, using emergency powers, under pressure from short-term staff shortages across the NHS. A decision was taken to move patients and staff to Tippethill community hospital in Armadale, which allowed staff to be reassigned to St John’s hospital in Livingston. St Michael’s hospital remains closed.

In June 2022, a report to the West Lothian integration joint board contained two recommendations: that either St Michael’s should remain closed or a public consultation should be held with all relevant parties to review future bed-space requirements at the hospital. If the minister is told that there were few patients previously, that is because the IJB did not refer them.

In February this year, West Lothian health and social care partnership held a public information meeting, which was organised by the Friends of St Michael’s Hospital, on the future of the hospital. Hundreds of people attended that standing-room-only public meeting in the kirk hall, and the health and care management were left in no doubt about the importance of St Michael’s hospital to the community. Many of those who attended the public meeting had relatives who had been cared for there.

The IJB then launched a review of bed capacity with a consultation, citing moves for care at home. The review is due to report next month. However, the same IJB has since announced that it wants to outsource care at home and six care-of-the-elderly residences in the future. Taken together, that all points to an IJB that wants to own no community properties for elderly care and that exists simply to contract out home care services. That is not on. We need the public provision of quality care, and the certainty of a home for older people in our county and community hospital care when they need it.

I implore the Minister for Social Care, Mental Wellbeing and Sport to look carefully at what West Lothian IJB is doing in removing public facilities with stealth tactics over a number of years. We know that the IJB’s finances mean that it has to make savings, but we also know that it holds significant reserves. With such drastic action planned, now is the time to allow the IJB to release reserves in order to support care for our elderly population.

When I raised the need for step-down care and facilities such as St Michael’s—and specifically St Michael’s—with the First Minister in October 2021, when he was Cabinet Secretary for Health and Social Care, during questions on his winter planning and social care statement, he agreed to “stress” the need for community-based elderly nursing care and respite in the north of the county as a priority “with local partners”.

My constituency of Linlithgow is the largest in Scotland by population. West Lothian as a whole has a growing and an ageing population. It is forecast to have the fastest growth in pensionable-age population in Scotland over the next 25 years, with an increase of 44 per cent, which is twice the Scottish average. In addition, there are no hospices in West Lothian, which means that, without St Michael’s, families in West Lothian who require end-of-life palliative care to support their loved one will have to travel for almost an hour, to St Columba’s in Granton in the north of Edinburgh or to the Marie Curie hospice in south Edinburgh.

The IJB has previously used statistics that underreport the scale of population growth in neighbouring Winchburgh. Given the high price of property in Edinburgh and major population growth in Queensferry and Kirkliston, joint provision with the west of Edinburgh for elderly care at St Michael’s would surely make sense. There is a clear moral and needs-based argument to keep the site for health purposes, but there is also possibly a legal argument, if the health board thinks that it will sell lucrative land for housing, that the land might revert to church ownership.

The Friends of St Michael’s Hospital is a dedicated and committed group of volunteers, and I thank them for their work and their support and care over the years for patients and their families. They were a lifeline to the families of those who were staying at St Michael’s, and they provided emotional support to many. They also provided financial aid to families who needed that extra help—they paid for taxis and other public transport to make sure that patients got to see their loved ones when they were at their most vulnerable. As the local MSP for Linlithgow, and on behalf of all patients and families who have benefited from care at St Michael’s in the past—as patients and families will, I hope, in the future—I thank them.

We know that there are continuing challenges in securing and resourcing staffing for any expansion of care at home, and we recognise that senior managers at West Lothian health and social care partnership have been clear that no decision has been taken about St Michael’s and have made commitments to maintain the fabric of the hospital, pending their review. However, I reiterate my call to the partnership to take a strategic view in favour of using the physical, social and community assets of St Michael’s for the benefit of the growing population in the north of the county.

It is clear that there will be an on-going need for a health facility that provides end-of-life and step-down intermediary care and, potentially, new support services to match the increase in home-based care for a rapidly growing elderly population in the north of West Lothian. The strong spirit and solidarity of local people who support the retention of the hospital exist because of the extraordinary nature of the way in which St Michael’s hospital and the Friends of St Michael’s Hospital have cared for their loved ones and their families. St Michael’s hospital must be retained to benefit the communities and the families who depend on it.


Sue Webber (Lothian) (Con)

I welcome the chance to speak about the future of St Michael’s hospital, in Linlithgow, and I thank Fiona Hyslop for bringing the debate to the chamber. Like her, I believe that local health services are a vital part of our local communities and, as we know, St Michael’s hospital has served the community for many years. However, the current situation demands that we take a hard look at the hospital’s viability and its role in meeting the healthcare needs of the community.

St Michael’s was first shut in August 2021, in response to acute staffing pressures that were created by Covid-19. That is a clear indication that the hospital was struggling to provide the level of care that was needed. It is important that it was a temporary closure, and it was done using emergency powers.

In West Lothian, we have a growing population that is well in excess of that of Dundee, and we have one of the highest proportions of older people. West Lothian needs a healthcare system that can meet the needs of the community now and in the future. As Ms Hyslop said, West Lothian has the fastest-growing population of pensionable age, with a projected increase of 44 per cent—twice the Scottish average. I, too, put on record my support with regard to the concerns about the data that is being used in relation to population growth across West Lothian.

The importance of the hospital to the local community cannot be overemphasised. I draw parallels with what is happening elsewhere within the NHS Lothian boundary, with the Edington hospital in East Lothian. That hospital remains closed as a result of very similar issues, so the situation with St Michael’s is not simply an isolated incident in West Lothian.

Supporting, developing and protecting our workforce is vital and, in order to ensure that that happens, there will need to be active talent management and succession planning across NHS Lothian, in addition to recruitment and retention initiatives. That is key to keeping our local services in the communities open and thriving. Although I acknowledge the campaign to maintain the hospital and the health services at St Michael’s, we must take a view that considers the future needs of patients and families in the area.

West Lothian health and social care partnership’s consultation on the current closure of St Michael’s hospital and its community bed review was an important step in understanding which direction needs to be taken. When I visited St Michael’s last year, it was clear that the building was not in a good state of repair and that it would need significant investment to restore it to what would be expected in order to meet the standards that are required for modern healthcare. However, the Scottish National Party Government’s funding decisions have resulted in the West Lothian IJB needing to save an eye-watering £17 million. Any decision to close St Michael’s hospital must therefore be accompanied by a clear plan to ensure that the healthcare needs of the community are met in a way that is sustainable, effective and equitable.

Unfortunately, there is a funding shortfall in NHS Lothian relative to other health boards under the NHS Scotland resource allocation committee formula. In the 2022-23 financial year, that equates to approximately £14 million. That alone is a huge challenge, but, over the past decade, that equates to more than £100 million. If we are to continue services in the community across the Lothian region, that must be rectified, with reference to the changes in population in West Lothian specifically.

In conclusion, although the history of St Michael’s hospital is important, we must prioritise the needs of the community and ensure that we have a healthcare system that can meet those needs in the future. I urge my fellow members to work together to find a sustainable and effective solution that meets the healthcare needs of the people of West Lothian.


Gordon MacDonald (Edinburgh Pentlands) (SNP)

I thank my colleague Fiona Hyslop for securing this members’ business debate. I point out that my wife is a district nurse in West Lothian.

As Fiona Hyslop outlined, St Michael’s is the only hospital facility of its kind in that part of West Lothian. If it were to permanently close, patients and their families would be forced to use other sites, such as Tippethill House hospital in Armadale or one of the two respite and end-of-life centres in Edinburgh—St Columba’s hospice in the north of the city and the Marie Curie hospice in my constituency of Edinburgh Pentlands. I have visited the Marie Curie hospice at Fairmilehead on many occasions and I recognise the dedication that the staff have to provide compassionate end-of-life care. However, the hospice has only 20 in-patient beds—a situation that is increasing pressure even without the proposed closure in West Lothian.

The Friends of St Michael’s Hospital group has been unwavering in its support for the families of its patients, with regard to both emotional support and financial assistance. As Fiona Hyslop highlighted, the group has paid for many family members’ taxis from different parts of West Lothian to the hospital—something that I am not certain that other hospitals would be in a position to offer, particularly if the journey were into Edinburgh, which is obviously more costly.

It is not just about the financial cost but about the time that is taken to travel and the ease of travelling, especially at peak times, given the congestion on the A71 into Edinburgh or, indeed, on the city bypass. It is especially difficult for people without a car who rely on public transport, given the recent cuts in bus services across West Lothian.

The closure of the St Michael’s facility, which is forcing patients to other ones such as the Marie Curie hospice or St Columba’s hospice, is already creating a huge stumbling block with regard to the patients’ most basic need of spending time with their family and friends. How do those family members and friends—especially the elderly and vulnerable—get to the hospital to visit their loved ones, given the transport issues that I mentioned?

The proposed permanent closure is happening at a time when West Lothian has a growing older population, which means that the need for access to healthcare facilities will only increase. Hospital sites such as St Michael’s will be in demand, from use as a step-down facility to relieve delayed discharge to provision of respite and end-of-life care. That is not to mention the fact that diverting patients elsewhere—indeed, out of West Lothian—reduces not only the availability of local healthcare but the number of jobs that are required to offer a fully functioning service.

On the suggestion that West Lothian patients could be moved to the city hospitals, I note that, in the 10 years to 2021, Edinburgh’s population grew by 10 per cent to 526,000 and that it is expected to grow by another 26,000 by 2028. Edinburgh’s 75-and-over population is projected to see a 25 per cent increase in the period to 2028.

I believe that the closure of St Michael’s would be a retrograde step and that it should be paused until we understand the impact of the National Care Service (Scotland) Bill, which is proceeding through Parliament. I believe that stripping services at this point would be reckless.

Fiona Hyslop has raised the issue previously, and I know that she will continue to raise it in Parliament and with NHS Lothian and other stakeholders until a positive outcome for both the community hospital and the people who need to access its facilities now and in the future is secured.


Foysol Choudhury (Lothian) (Lab)

I thank Fiona Hyslop for bringing the motion to the chamber so that we can discuss this important issue. In January, I wrote to the chief executive of NHS Lothian to express the concerns of my constituents, who were worried about the lack of end-of-life care at their nearest hospital—St John’s hospital.

I also addressed the lack of GP surgeries in the area and the fact that the possible closure of St Michael’s would be catastrophic if no alternative palliative and respite care services were made available. Constituents were also concerned that that might lead to nurses retiring earlier, adding to the overall pressures on the NHS.

The original purpose of St Michael’s hospital was to provide a service for the local community, and that was thanks to the amazing dedication and commitment of the Friends of St Michael’s Hospital group. For so many of my constituents, St Michael’s hospital is not only vital for providing hospital and crucial end-of-life care but acts as a community hub, supporting families with loved ones who are being cared for at the hospital.

The SNP has been in power for the past 16 years, yet the state of the health and social care sector has deteriorated due to chronic underfunding and mismanagement. Local government and the integration joint board in West Lothian have been starved of resources and left between a rock and a hard place. St Michael’s hospital is just one example of the current crisis in health and social care in West Lothian.

Many members might be aware of the public meeting last evening about the privatisation of care homes in West Lothian. More than 200 local residents turned up to express their concerns about the future of social care in West Lothian and the local residents who rely so heavily on it. I attended the meeting on behalf of my Lothian Scottish Labour colleagues, and there was clear frustration and anger about the insufficient resources and funding for health and social care. That is a result of cuts, made by the Scottish Government, which are putting councils under pressure.

It is important that all Lothian MSPs meet together now to discuss how we can get extra resources and funding allocated to health and social care in West Lothian and in Lothian generally and how we can move forward and tackle this crisis. A cross-party approach to that is essential.

Once again, I thank my colleague Fiona Hyslop for bringing attention to the issue, and I look forward to meeting with my Lothian colleagues soon, to deal with the crisis in health and social care in West Lothian.


The Minister for Social Care, Mental Wellbeing and Sport (Maree Todd)

I thank Fiona Hyslop for bringing the debate to Parliament. I am grateful for her commitment to championing the role of St Michael’s hospital. I am also grateful to the Friends of St Michael’s Hospital, and similar groups across the country, that work hard to support those who benefit from community hospitals.

As others have said, St Michael’s hospital was originally gifted by St Michael’s church in the 19th century for the wider benefit of the community—a principle that endures today. Caring for individuals, whether they are our loved ones or members of our wider community, is a fundamental shared responsibility of us all, personally and as a wider society. I am committed to ensuring that we do that by providing those who need it with the utmost care, dignity and respect.

I pay tribute and place on record my thanks to all the individuals and teams who make that happen right across the country, from our unpaid carers to our social care staff, allied health professionals and clinicians. We are all indebted to the teams who provide care right across our health and social care system.

We all know that the best bed for us to be in is our own bed. When that is not possible, being close to home is extremely important for the individual and their family. Ensuring that people are cared for in the right place at the right time is absolutely at the heart of everything that we do, and community hospitals play a vital part in that. They provide care closer to people’s homes that is personalised, holistic and patient centred.

Our community hospitals, including St Michael’s, can provide a wide range of services, including non-acute in-patient services, rehabilitation services and palliative care. They form a crucial element in facilitating service integration locally, functioning as an integrator of services and as a locale for the development of a single point of access to services.

Palliative and end-of-life care spans a wide range of professionals and sectors, with clinical and social care being delivered in acute hospitals, community hospitals, hospices, care homes and people’s own homes. The Scottish Government is committed to ensuring that everyone who needs it can access seamless, timely and high-quality palliative care.

We are developing a new strategy to achieve the highest standards of care up to the end of life. We will develop a strategy that reflects what matters to people who are experiencing serious illness, dying and bereavement. We are reviewing the information and evidence that we have about people’s experiences of palliative and end-of-life care and bereavement to inform our strategy going forward. That will contribute to a holistic, integrated and multidisciplinary approach, which will ensure access to palliative and end-of-life care wherever and whenever it is needed, and which has the person and their families and carers at the centre.

As we seek to ensure that our services reflect the changing needs of patients and wider society, we must harness advancements in technology such as home health monitoring, community alarms and the Near Me service. We are constantly looking to develop clinical and care pathways to prevent people from being admitted to hospital.

For example, our hospital at home programme is an innovative approach to providing hospital-level care for patients in the comfort of their own home. We know that it assists with the recovery of patients as well as alleviating pressure on acute sites, emergency departments and the Scottish Ambulance Service. Hospital at home currently provides levels of virtual capacity matching that of St John’s hospital in West Lothian. I am pleased that we are continuing to fund the expansion of the programme by providing Healthcare Improvement Scotland with a further £3.6 million in the current financial year to support more than 150 additional virtual beds.

Innovations linked to the advance of technology, such as the hospital at home programme, enable health and social care partnerships to be more creative and pragmatic when designing future service provision. The design of those services must always put the patient at the centre by working with them and for them to provide the best level of care to suit their needs.

However, it is really important that decisions on how services are delivered are made at a local level in consultation with those who use services to ensure that local needs are met in the best way. I am aware that the consultation regarding St Michael’s is on-going and I do not want to influence the outcome of that consultation in any way. My officials will continue to engage with West Lothian health and social care partnership as the consultation progresses, and they stand ready to provide support where appropriate. More generally, we will also continue to work with partners and people with lived experience to make sure that our social care services work for everyone.

On the point about population levels expanding, I am comfortable with my officials reaching in to the HSCP and making sure that it is using the most up to date and relevant data on population level as part of its strategic planning, if that would be helpful.

On funding, the door is always open to NHS boards to discuss funding with Scottish Government health officials. Sue Webber raised the NRAC formula, which is always contentious. On the point that Foysol Choudhury raised about local authority funding, the real-terms increase of £376 million, or 3 per cent, to local government applies. West Lothian is therefore getting £405 million to fund local services, which equates to £17.5 million to support day services.

I am not sure whether the minister is aware that West Lothian Council received an 8.9 per cent uplift in the current financial year, which is second only to what the city of Aberdeen received.

Maree Todd

I was not aware of that, but it is a good point to make at this juncture.

Funding is undoubtedly challenging, and I share the concerns of the IJBs and HSCPs. However, the Government has to balance finite resources and make tough decisions. The Scottish Government has an open-door policy when concerns need to be raised.

I will conclude where I began. The cornerstone of our health and social care system is the people who work tirelessly day in and day out to support individuals. I am grateful to them all. I am also grateful to communities such as the Friends of St Michael’s Hospital for their dedication to providing care to individuals and their families.

Meeting closed at 17:25.