Tayside Project
The final item of business is a members' business debate on motion S2M-3558, in the name of Shona Robison, on the Tayside project. The debate will be concluded without any question being put.
Motion debated,
That the Parliament commends Marie Curie Cancer Care for joining forces with NHS Tayside, Dundee City Council, Perth and Kinross and Angus Councils and the Scottish Ambulance Service to deliver the first Scottish project of the Delivering Choice Programme in Tayside, which aims to look at the problems in palliative care provision in the region before developing a strategy to deliver the best possible palliative care and end-of-life care for patients in the area, allowing them to be cared for in the place of their choice; notes that Tayside has specific problems in this area, with 75% of the admissions to the cancer centre in Ninewells Hospital being for palliative care, and that over the three-year project issues like this will be tackled, and believes that the findings of the project should be utilised in other areas of Scotland to inform palliative care policy so that everyone in Scotland can benefit from this ground-breaking project.
I thank those members who have stayed for the debate and I pay tribute to Marie Curie Cancer Care for providing members with important information for the debate about its crucial work in developing the first Scottish project of the delivering choice programme in Tayside. The project aims to look at the problems in the provision of palliative care in the region, before developing a strategy to improve end-of-life care for patients in that area and, it is hoped, across Scotland.
Nothing is more certain than the fact that each of us, one day, will come to the end of our lives. Although that is inevitable, we in Scotland do not like to talk about it much. The 2003 Scottish partnership for palliative care study showed that 70 per cent of people thought that there was not enough discussion in our society about death and dying. I agree.
Today's debate is about how we can ensure that, where possible, people can exercise some control over their death, particularly over where it occurs. Research has shown clearly that three quarters of us would choose to die at home, with 90 per cent supporting the dying person's wishes. However, in Tayside at present, 75 per cent of admissions to the cancer centre at Ninewells hospital are for palliative care, much of which could be given in the person's home given the right back-up and resources. Yet we know that the difficulties that are associated with supporting our dying loved one at home can be immense. Moreover, research has shown that the vast majority of us do not believe that we will be able to cope with providing the care for that person so that he or she can exercise their choice. Today, around only 25 per cent of people with a terminal illness are able to exercise their choice to die at home; in Dundee, that figure is just over 21 per cent. Too many people are denied that choice and end their lives in a hospital bed in a busy ward. Although hospital staff try to be as sensitive as they can be to the needs of the terminally ill, hospital wards are not designed to be places of peace and tranquillity where terminally ill people and their families can spend quiet, quality time together.
Despite those figures, Dundee and Tayside are fortunate with the services that are available to support people in the choice to spend their last days at home with their loved ones. In fact, the people of Dundee and Tayside are more fortunate than people in many other areas of Scotland. We have the specialist palliative care unit at the Royal Victoria hospital, and several beds in the community hospitals are designed for palliative care. In the near future, units will open in Perth and Forfar to provide palliative care services. There are also several day-care units in Dundee, Perth and Stracathro, along with the highly regarded symptoms control clinic. Moreover, we are well supported by Marie Curie and Macmillan nurses, who are able to support the primary care team in meeting the complex needs of dying patients and their families throughout the area.
Dundee and Tayside have excellent resources, but more must be done to ensure that all those who would like to end their days at home are able to do so. Achieving that will require a number of changes. Services need better integration; doctors and nurses need to know more about the palliative care services that are available in the community; and, importantly, flexible services need to be available when and where people require them. In particular, 24-hour access to nursing care in the person's home is extremely important to prevent carer crisis or late-night admission to hospital due to lack of symptom or pain control. Carers must be assured that services are available, otherwise many of them will not take the risk of being left unable to cope at home with a terminally ill person in distress.
I will quote from a real-life case study. Eilidh and John went through the process of John dying at home. Eilidh said:
"During his illness John spent ten days in a hospital setting. These ten days were the worst of his illness. All he wanted was to be at home. I wanted to have John at home but only if I knew I would have the right support."
That is the key for many carers—they have to be reassured that the support will be available.
Additional resources might be required to ensure that services are established, and the outcome of the Tayside project will be crucial in determining the level of resources that might be required. In the long run, things might balance out, given that, as research by Marie Curie shows, every £1 that is invested in palliative care at home saves £2 in acute services.
The debate should not be driven by money. It should be about what is best for the terminally ill person and their family. I quote Eilidh again:
"Being able to have John at home provided a sense of normality to an otherwise totally abnormal situation. Our children could come and go and see their Dad for short periods of time at regular intervals during the day. John was much more secure and orientated in his own surroundings and I could sleep when he did rather than sit in a chair by a hospital bed."
Perhaps that says everything that needs to be said about the benefits of someone getting their choice. As has been stated previously, the majority of patients have expressed a clear preference to remain at home, properly supported, for as long as possible towards the end of their life. If we were all to exercise our preferred choice, that would entail a threefold increase in demand for services, from 25 per cent to 75 per cent. Despite the level of service that is available in Dundee and Tayside, that target would be very difficult to achieve in the short term. Nevertheless, the target is worth while and achievable and the Tayside project will go a long way towards helping us meet it.
The Tayside project, which is the first of its kind in Scotland, was launched just last month by the Minister for Health and Community Care. Its aim is to develop service models that meet the needs of, and ensure the best possible care for, palliative care patients and which improve equity of access to services. The project will be subject to an independent academic evaluation, which will include the economic impact on health care services of more patients receiving palliative care at home as opposed to in hospital. Once the project findings have been evaluated, it is intended that they will be disseminated to other health and social care providers, thus sharing best practice throughout Scotland.
I would like some assurance from the Deputy Minister for Health and Community Care that, should a need for additional resources be evidenced by the Tayside project, those resources will be forthcoming so that the necessary changes to services can be delivered, not just in Tayside but throughout Scotland.
The Tayside project provides a great opportunity for us to show that, with the proper support and information, people throughout Scotland can have confidence in their abilities to look after their nearest and dearest in their final days, weeks and months. I am delighted to welcome the project, and I am confident that it will enhance the services that are available to people with a terminal illness, better enabling them to exercise their right to choose how they spend their final days.
I thank Shona Robison for bringing this subject to the chamber. It gives us all a chance to promote and support the excellent work that is undertaken by the Marie Curie Foundation, which provides high-quality nursing totally free, giving terminally ill people the choice of dying at home, supported by their families.
Cancer is the United Kingdom's biggest killer, claiming the lives of more than 150,000 people every year. At any one time, a further 1 million people are living with the disease. I doubt whether there is anyone who does not have a family member or friend who has suffered, or is suffering, from some form of cancer. The key question must be how we support the sufferers.
Marie Curie Cancer Care's chosen emblem—that welcome burst of the springtime yellow daffodil—exemplifies the spirit of hope and renewal that is so much part of its work. Its slogan, "Devoted to Life", highlights the positive nature of its work.
The Tayside project, which is the first of its kind in Scotland, goes to the heart of the matter—the choice of available palliative care. Research has shown, and my conversations with friends and family confirm, that most people would prefer to die in dignity at home, surrounded by familiar faces. To offer that choice, with the necessary provision of the most up-to-date palliative care, is the aim of that worthwhile project.
The choice of Tayside, with its mix of urban and large rural areas, highlights some of the problems that face patients, families and friends, such as the enormous costs of making the necessary visits to treatment centres. Families often have to make huge sacrifices of time and money—albeit willingly—to support patients by accompanying them for treatment and visiting them if they become in-patients. Those costs were highlighted recently. They are often much more than travel costs, as family members must sometimes give up full-time employment to be free to accompany or care for the patient. The centralising of specialist services means that those costs can be beyond the means of some, so spiralling debt becomes the overriding legacy.
This welcome project can help to alleviate some of the extra unwelcome worries at such a difficult time in a family. It has a part to play in reducing extra stress for families, which has a consequent benefit to the patient that goes beyond the medical support that is given.
I was struck by the comments of Marie Curie director Susan Munroe, who spoke at the project's launch in December about the need to treat terminally ill patients as individuals and not as people who are fitted into a system. Such dignity at the end must be available for all terminally ill patients, but flexibility of choice must also include the choice of a change of mind if circumstances dictate, for whatever reason. At the end, hospital may be a necessity, so real choice, without any pressure from hospitals or staff, is paramount.
I congratulate all the partners in the project and hope that the resources will be available to match the vision and compassion that are at the heart of the initiative.
I am pleased that Shona Robison secured the debate, because it is important to raise awareness of this innovative project, which the Marie Curie Cancer Care charity has spearheaded. I was involved in the launch last year of the Scotland supporting the choice to die at home campaign, but I confess that until I picked up on Shona's motion, I knew little about the delivering choice programme in Lincolnshire or Tayside. The project is extremely important and could make an enormous difference to the terminal care of many people if and when it is rolled out throughout the country.
As Shona Robison said, death is an inescapable part of life. It is just as important to give people the best possible care through the process of dying as it is through the rest of their lives. By relieving pain and suffering and giving the terminally ill a sense of worth and well-being, good palliative care not only helps the patient to face up to the inevitability of death without fear, but helps relatives and carers to cope with the impending loss of a loved one and to be comforted in their eventual bereavement by knowing that death was made as comfortable as possible. If death can occur in the setting of the dying person's choice, that is of even greater comfort to those who are involved and looking on.
Before speaking to Susan Munroe of Marie Curie last summer, I confess that I had not realised that a very high percentage of people wish to die at home or that few of them achieve their wish. If the work that is under way results in many more people being granted their dying wish, that will be a wonderful outcome.
By aiming to develop round-the-clock models of patient-focused service that satisfies local needs and gives patients and their carers the best possible care and support, and by providing a choice of place of death and good co-ordination of the agencies that are involved in terminal care, the delivering choice programme could become a role model that has an enormous impact on terminal care services and, in time, leads to patients fearing much less the process of dying, which I hope would allow the population to become less afraid of talking about death. Again, I agree with Shona Robison that we do not discuss the issue often enough.
The thought that has gone into organising the project's three phases is impressive. The development of models of service and their incorporation into local provision following a proper assessment of local needs and of the current state of services and then the testing and evaluating of those before the project is handed over and the findings are disseminated should contribute in a unique way to palliative care throughout Scotland and, in due course, should benefit people throughout the country.
I have seen at first hand the wonderful work that is being done in Dundee's Roxburghe House, Aberdeen's Roxburghe House and the children's hospice in Kinross. Those hospices and the other existing and planned palliative care services in Tayside can only benefit from the collaborative work that is being undertaken by Marie Curie Cancer Care, NHS Tayside, the Scottish Ambulance Service and the Tayside councils.
Marie Curie Cancer Care is to be congratulated on its innovative approach to improving the well-being of the terminally ill and their carers. I look forward to hearing about the success of the project in due course and—I hope—of its roll-out not only to my home area of Grampian, but throughout the country. I thank Shona Robison for bringing the Tayside project to the Parliament's attention and wish the project every success.
I congratulate my colleague Shona Robison on securing an important debate in the Parliament.
It was my pleasure to attend the launch of the delivering choice programme in Perth in December. I record my appreciation of the Minister for Health and Community Care's attendance at the event and of his enthusiastic support for the programme.
At the launch, the minister commented that if there was a part of the country in which he would have expected a dynamic initiative to deliver such a new programme, it might have been Tayside. Tayside now has the good fortune to have a health board that is much more engaged with our communities' priorities and that goes to considerable expense to serve and support the people of the area. I record in the Official Report the appreciation of many of us of the work of Peter Bates, the chairman of NHS Tayside, who was recently honoured in the new year's honours list for his service to NHS Tayside. Despite his own health challenges, he has made a formidable contribution to transforming Tayside's health care services.
The minister said that the board, the Tayside area and the partnerships that exist with the local authorities—Dundee City Council, Angus Council and Perth and Kinross Council—that work with organisations such as Marie Curie Cancer Care are determined to bring innovative services into place. That is how I would characterise the significant contribution that has been made.
At the launch, I was struck by the sheer undiluted enthusiasm of the clinicians and nursing staff for ensuring that the programme is successful and by their delight in having the opportunity to contribute to improving the quality of life and—conversely—the quality of death of the people whom we have the privilege to represent in the Parliament.
On one of the minister's previous visits to my constituency, we attended an event to unveil the new Lippen Care hospice in the Whitehills health and community care centre in Forfar. That hospice has been created by the voluntary fundraising efforts of a range of different individuals under the Lippen Care umbrella. Through talking to patients in the hospice, who appreciated their surroundings and circumstances, the Minister for Health and Community Care and I were given an understanding of the tremendous service improvement that has been made for every individual who has the opportunity to benefit from the service.
At the launch of the project, I was struck also by the commitment of the nursing staff to take the hospital service and the hospice service directly into the homes of the individuals concerned. It does not matter whether a household is in the centre of the city of Perth, adjacent to where the launch took place, or in the most isolated farmhouse in the most rural part of my constituency in highland Perthshire or the Angus glens. The same service and support—and the same dignity—can be offered to each individual in their own household, because the nursing staff are so motivated to make a contribution to the circumstances and conditions of the individuals who require the service.
The introduction of this programme, the evaluation that will take place in due course and the impact that the programme will have on the constituents that I am privileged to represent in this Parliament will be a model service and should be rolled out to everyone else in Scotland, so that the same range and quality of care that are available to my constituents are available to people in every other part of Scotland.
I thank Shona Robison for bringing the debate to the chamber. Like John Swinney, I attended the official launch of the project last month, and it was good to be at the start of such an innovative and inspiring project.
The subject matter is delicate, but anyone who has been in close contact with someone who is dying from cancer will respect the wishes of those who want to leave this world and help them to do so in their own homes, surrounded by their relations, neighbours and belongings. Both my parents died in institutions; I wish that that had not been the case. At present, only a small percentage of the population is able to choose where they spend their final hours, which is unsatisfactory. That makes the Marie Curie Cancer Care project admirable in producing a scheme for which there is a demand.
It is of secondary importance, but I am pleased that the project should be financially effective. As Shona Robison mentioned, a report by Professor David Taylor estimates that in the medium to long term every £1 invested in the appropriate provision of care at home will release £2 in hospital services.
Normally when something new comes along it is accompanied by some negative aspects, but that does not seem to be the case with this project. It will, however, place a hefty burden on the staff of Marie Curie Cancer Care. People who require palliative care are often very demanding in their needs, and those who provide that care will also have to travel to deliver it.
I particularly welcome the fact that the project covers areas where transport to hospitals often leaves a lot to be desired. If someone lives out in the proverbial sticks, it can be difficult for their friends and relations to visit regularly. The project will allow visitors to continue to take their well-travelled routes without having to make major expeditions to major hospitals. As a local councillor who is used to dealing with complaints about public transport to hospitals, I am aware that that is a big plus.
Another plus is that the project should mean that there is parity of support throughout the area regardless of whether someone lives in the back of beyond or the centre of a major city. That will remove any allegations that there are favoured and neglected areas. In fact, I fear that the only complaints that might come my way will be ones from other parts of the country that will not benefit from the proposed coverage.
I wish the project well and I hope that when it proves to be successful it will be used as a template to be rolled out throughout Scotland.
I congratulate Shona Baird on bringing the subject to the Parliament to debate. I also congratulate Marie Curie Cancer Care, with which I had a long association during my previous job as a general practitioner—my practice was about half a mile down the road from Marie Curie Hunters Hill. Most of the patients in our health centre had the choice of dying at home, and we had a wonderful team-working relationship with Marie Curie and the local hospital. We could get people into hospital when they required to be there, and get them out again as quickly as possible to keep them at home.
If district nurses, general practitioners, health visitors and many members of the family are involved, I assure members that it is quite an enjoyable experience to look after someone who is dying at home. It fills the heart with pleasure when things are right. It is not as miserable as one might expect when visiting someone who is dying if they are in the heart of their home with their family around them and their family can go back and forward to visit. When my sister-in-law died, she was able to be at home with her nine-year-old daughter. We were all with her.
I have undying respect for Macmillan nurses and general practitioners, who are so often forgotten.
We do not need to have a pilot to demonstrate that palliative care is not available in certain places. We know that it is provided well in certain places, but that provision is patchy. The aim should be to ensure not only that we get patients into the community, but that there is a free flow for patients between the community and their home. I had experience of one patient who was dying at home but for whom the situation was getting out of hand. Neither the patient nor his relatives were able to cope. For the few hours that he had left, Marie Curie Cancer Care took him into hospital and the day was saved. The fear went out of the patient when they got him into hospital. The ambulance came as fast as possible, he was admitted and the few hours that he had in the peace of the Marie Curie hospital were wonderful. It reminded me of my early days in hospital, when I was a newly trained doctor, but hospitals have changed and have become very busy places.
When we think about palliative care, we should remember that people working in primary care with patients at home are not the only ones who need to learn about how to look after pain relief. It is important that people working in accident and emergency departments are also taught about pain relief. Patients who suffer from cancer have to go into hospital for other emergency procedures, but somehow that message does not seem to be picked up. Patients hang about in casualty departments for longer than we would imagine—sometimes for a few hours—before they get the comfort that they deserve. Let us face it—life is precious to all of us. Our last few days are more precious than anything, and we want to spend them in comfort.
Another area of concern is nursing homes. Often the workforce in nursing homes includes such a low number of qualified people that the homes become scared when people reach their dying hours, so they want to shift them back into hospital. It is important that Marie Curie Cancer Care manages to incorporate nursing homes into community provision.
The extended family benefit exceedingly from the provision of palliative care. We have mentioned the cost of that provision, which is great. Sometimes people have to give up their job in order to be at home, which has an enormous impact on the family. We should help people to work out their finances and make things easier for them. The situation is especially difficult for people who live in places such as Kinloch Rannoch. Although we had problems—the Macmillan nurses were always keen to help out, but sometimes there were not enough of them to do night work—it was relatively easy for us. How do people in very remote areas manage? Kinloch Rannoch is an excellent area of Tayside in which to figure out how everything will work.
I will tell the chamber about one experience that I had. About four months before she died, my sister-in-law had to be admitted acutely to one of our hospitals. Although we did not know it, she had a very virulent form of breast cancer. We were up all night, and she was taken in at about 5 or 6 in the morning. At 7 o'clock, when I went to visit her, I was appalled to find that she did not have a special mattress or appropriate pain relief. That was in a prominent hospital in the city. I asked the nurses, who were standing around the nursing station, whether she could have a special mattress. They said that they were sorry, but that it was in the store and they did not have the key. There are pockets of sadness when we see that no one in their busy life has thought fit to do a simple thing such as getting a proper mattress for someone who cannot move a millimetre one way or the other because they have spinal secondary tumours. We had to ask for my sister-in-law to be reassessed by a doctor.
When my sister-in-law came to die a few months later, we had a fortnight of absolute magic, thanks to a very attentive general practitioner who came in twice a day, Macmillan nurses, district nurses and others. The whole family were there, and I would not have missed it for all the world. Perfect palliative care is worth its weight in gold, as it allows people to have special time—sometimes the special last hours—with their loved one. We must remember that patients are in and out of a world of their own and that sometimes they have only a very small amount of time to spend with their family, which is precious.
I thank Shona Robison for lodging her motion and wish the project well.
I congratulate Jean Turner on that moving speech.
It is excellent that Shona Robison has put this subject on the Parliament's agenda. I congratulate Marie Curie Cancer Care on forcing society to discuss the subject while it is well. It is unfortunate that the subject is a bit of a taboo—it should not be. It is important that we discuss palliative care before we need the services; we do not want to have to start lobbying when it is not the most appropriate time to do so.
My expertise is not in palliative care. As a midwife, I represent a profession that is present at the start, rather than the end, of life. However, some of the cultural issues around choice are common in birth and death and there is commonality when it comes to addressing the overmedicalisation of both. We need to have a discussion about the normality of birth and death in society, so that we can deal with them in a mature way.
I have long been a campaigner for choice in birth and I support the right for choice in death. Again, in common with birth, there has to be genuine choice in death. That choice should not be made by accident, through lack of resources or as a result of either cultural or institutional pressure. We have an awful long way to go before we get genuine choice.
There are fears that because of the funding structures in some areas, pressure might be applied when authorities see a chance to divest health and community services of responsibility for resources. The worst possible scenario is of a patient dying at home, among family and carers but without the appropriate resources and with all the stress, worry and fear that that entails.
I support the Tayside project, but it must be undertaken in tandem with the allocation of appropriate resources. I am delighted that there have been developments in Tayside. I would like the programme to be rolled out and I would like to find out what the impact is and how satisfied the relatives, carers and patients feel.
When Susan Munroe came to see me about the Tayside project, I accidentally expressed a personal worry about lack of resources. We must address the fears of not just the relatives and carers, but the patient. The patient might want to choose to die at home in an ideal world, but they might fear the burden that that would place on their carers and relatives if the necessary resources were not there, particularly if there was a crisis during the night and no 24-hour nursing support. In that situation, and in the absence of adequate resources, I would be very worried about placing such a burden on my relatives. We need to provide the security and the confidence for people to be able to make a genuine choice.
Palliative care services should not have to rely on charitable funding. The work of Marie Curie and Macmillan is absolutely wonderful, but should we live in a society in which that kind of care and provision of dignity in death rely on the rattling of cans? We should be ashamed of that. We need a massive shift in society and Government, so that society takes collective responsibility for ensuring genuine choice at birth and death. Rather than the burden being placed on patients at the end of their lives, on relatives, and on carers, we should all share it proportionately. Usually those relatives and carers are out rattling the cans thereafter, as a result of their experience. That is not acceptable.
I welcome the debate, which must continue. I am glad that Shona Robison has brought the subject to the chamber and I am sure that today's debate will not be the end of it.
As Carolyn Leckie said, the debate is about providing choice for people when they are at their most vulnerable. I have long been an advocate of increasing the choices that are available to citizens in all aspects of their lives. I support this initiative, which allows freedom of choice on where and how people will spend the final days of their lives.
Every person should have the right to die with the dignity and respect that human beings deserve. They should be able to do so with the people whom they love around them and in the place where they feel most comfortable. The initiative will provide positive assistance to people at the end of their lives. I thank NHS Tayside and Marie Curie Cancer Care for their work in pioneering this service in Angus and Tayside.
I like the co-operation and teamwork that are inherent in the proposal, which combines the skills, infrastructure and experience of three councils, Marie Curie Cancer Care and the ambulance and health services in Tayside; it uses their combined resources and personnel to create a 24-hour service care model at the local level.
The Tayside project has been established to address specific problems. The proposal in no way detracts from existing provision but complements and adds to existing services. From personal experience, I know about the tremendous work that is done by the staff of Roxburghe House in creating a caring, friendly and comforting environment and providing the highest quality of care. However, Roxburghe House is based in Dundee, not Angus, as is most of the specialist care that is available in the area. Although Lippen Care in Forfar, Stracathro hospital, Cancercare, the Tayside primary health care team, palliative care networks and community hospitals provide valuable services, the simple fact of the matter is that people in Angus have to leave their homes and local communities to get this kind of care.
It naturally follows that family members have to travel to where their loved ones are being treated in order to be with them. Such transportation difficulties only add to the emotional strain involved. Although those journeys may not seem much of an issue to the healthy, young and fit, for the senior citizens in Angus who are probably most impacted by these issues, the Tayside project is a major breakthrough. Elderly partners who have to travel from a village in Angus or Perthshire to Dundee find those journeys not as easy as they sound. The project will make a great difference in enabling them to spend as much time as possible with their loved ones.
Angus Council predicts that the number of people aged 75 and over will increase to almost 17 per cent of the population between 2000 and 2016. It also says that the numbers of people aged 60 to 74 will increase by nearly 24 per cent during the same period. That is a huge increase in the number of people who could, in the future, benefit from the pioneering service that we are debating tonight.
Under a successful Tayside project, many of the terminally ill would no longer have to leave their homes and communities, nor would friends and families be forced to travel far to be with them in their final days. In the familiar surroundings of their own homes, people will benefit and gain comfort from high-quality palliative care.
This pioneering three-year project is good for individuals, good for families and good for communities. I thank my parliamentary colleague Shona Robison for securing the debate and pay due tribute to all the organisations involved. I welcome the delivering choice programme and wish it every success.
I congratulate Shona Robison on securing the debate. I also thank all the members who contributed in such a positive way to the debate on this important topic. Andy Kerr's involvement in the launch of the Tayside project is a mark of the Executive's recognition of the value of the approach that the project is taking and the work that it is doing.
Palliative care as a concept was pioneered through the voluntary sector, which is still heavily involved in the provision and development of such care, particularly for patients with cancer. That is entirely appropriate; it allows us to mobilise in support of health care the compassion and experience of health service professionals and of the families and others who have a knowledge of the patient's experience.
Marie Curie Cancer Care is one of the oldest and best-known of the organisations that work in this field. I understand that it opened its first hospice at Hill of Tarvit near Cupar in Fife in 1952. Therefore, it is fitting that Marie Curie Cancer Care, in its UK-wide campaign to assist more people to be able to end their days at home, has chosen Tayside as the site of one of its pilot projects.
As members have said, Marie Curie Cancer Care has signed up an impressive list of partners, including Tayside NHS Board, the three local authorities—Dundee City Council, Perth and Kinross Council and Angus Council—as well as the Scottish Ambulance Service. That coalition of interests fits very well with the principles of palliative care, which are to address the physical, spiritual, social and psychological needs of patients, their families and their carers and to do so through partnership.
The project has an interesting focus on increasing the opportunity for people to spend their last days at home. I accept that some people who would choose to die at home are not able to do so. However, the reasons for that are complex. Making support available around the clock will be a big help, but it is not the whole story. It is important that I say in response to some of the points that were made in the debate that resources should not be the key in this matter. We should recognise that being able to provide patients with choice is important.
I will not respond to Shona Robison's request to sign blank cheques, but we will consider the conclusions of the Tayside project very carefully indeed.
I agree with the minister that resources are not the key driver in the issue. However, there may be a need to invest to save. An upfront investment in areas of Scotland that do not have well-developed palliative care services may be required if we are to shift the balance in relation to where services are provided.
Marie Curie Cancer Care makes the interesting proposition that one of the benefits of the Tayside project is that it could be cost-neutral because of the invest-to-save aspect to which Shona Robison refers. That will be a feature of the project at which we will look very closely indeed in our final assessment.
We heard several very moving speeches about people who are reaching the end of their lives, and the project is about how services can be provided to individuals who are in that position. The responsibility of health care providers is to ensure that those services join up. We try to do that in all parts of the public sector, but the sensitivities of cases in this area are self-evident.
It is also self-evident that it is easier to join up services when they are provided in a hospital or on a similar site, because the journey from patient to patient is shorter. Therefore, it will be harder to provide such services at home. It is important that when we carry forward such home projects we take on board the logistical challenges involved and realise that they are different from those involved in providing care in a hospital.
Many of us may want to spend our last days at home, but we must recognise the position of families—that point was made in the debate. Families will not always know what the final journey will look like; they may not always know to whom to turn or when. In such circumstances, a Marie Curie nurse can make a real difference by reassuring families and by knowing whom to contact and what to say if further support is required.
While recognising the innovative nature of the Tayside project, it is important also to recognise that palliative support already exists in various parts of Scotland. For example, there is a managed clinical network for palliative care in Forth valley. In many parts of Scotland, hospices provide support for out-patients and in-patients. We have made it clear to NHS boards that they must provide 50 per cent of hospices' agreed costs by April of this year. However, it is important to stress that hospices want to retain their independent status. The 50 per cent funding will be provided in a way that allows us to respect the wishes of those who are involved in providing hospice services.
NHS 24 offers out-of-hours support and has developed arrangements to get access to special patients' notes so that it can deal quickly and effectively with terminally ill patients. However, I am happy to acknowledge that the provision of dedicated Marie Curie nurses takes the service a step further. With the project, people in Tayside will know that, if they choose to die at home, they will be able to call on direct support when they need it. We should be proud of the ability of voluntary organisations to innovate and expand the frontiers of health care in such a way.
It is also worth saying that such a project fits well with the principles that are set out in "Delivering for Health", which we published a few weeks ago, to make health care available as locally as possible at whatever stage in a patient's life and to respond to patients' needs on their terms. If the project is successful, it could transform the options available to people when they choose where to see out their last days.
However, we must leave the door open to people to change their minds. By definition, the process of dying is often not easy and is not always what patients and their families expect. A patient may decide to die at home but find that they or their family simply cannot cope. Even with the best support from Marie Curie nurses, that can happen, and a patient or their family may decide that they need the support and back-up services that are provided in hospitals or hospices. As Shiona Baird said, we must ensure that, if patients change their minds, that decision is not considered a failure of care or of the family. We must also ensure that no stigma is attached and that the health service is able to respond quickly.
We have rightly focused on cancer, but it is important to say that we must also make sure that we address the needs of terminally-ill people who do not have cancer. In palliative care, they can sometimes be overlooked, partly for clinical reasons—it is less easy to predict the course of death—but partly for cultural reasons, in that we tend to pay a good deal of attention to the situation of cancer patients and not realise that palliative care goes beyond that. I hope that the Tayside project will help us to take those aspects on board and broaden out beyond the care of cancer patients to the whole range of palliative care.
I also look forward to hearing about the findings of Marie Curie projects elsewhere in the United Kingdom. Tayside has urban and rural areas and therefore the project will be instructive for us all, but I suspect that there will also be lessons to be learned from elsewhere, and I look forward to them. Whatever the outcome, I have no doubt that we will be able to take away important messages that will improve the quality of care that is available in Scotland.
As I said a few minutes ago, it would not be appropriate to talk at this stage about future roll-out throughout Scotland. We need to let the three-year project run its course, prove the value of its work and give us results on which we can make balanced judgments. However, the prospects are good. I give one final assurance that, should obvious and early lessons emerge from the project in the course of its three years, we will expect health boards to take those emerging findings on board and act on them.
In the meantime, like other members, I take the opportunity to wish Marie Curie Cancer Care every success with the development of the project in Tayside.
Meeting closed at 17:59.