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From May Marie Curie will no longer be delivering end of life care services in Fife.
The reasons they outline are in my view of great concern and would suggest that there is a cost cutting exercise taking place by Fife Health and Social Care Partnership. The Partnership has issued a tender for home services which have incorporated palliative care, and Marie Curie do not believe that the proposed contract would deliver the appropriate levels of quality care that is needed. I hope anyone reading will agree that we should not be cutting the cost of delivering end of life services.
The Health and Social Care Partnership is ultimately accountable to both NHS Fife and Fife Council. This is why I have written to every councillor in Fife asking them to raise questions on this deeply serious concern.
The full text of the letter from Marie Curie is below:
Dear Alex,
I hope you are well.
I wanted to let you know about a development in Fife in relation to our direct services which we deliver there in partnership with Fife Health and Social Care Partnership. Earlier this year Fife Health and Social Care Partnership issued a tender for its support at home services for adults and older people, which includes its palliative care services. Marie Curie currently provides these services through our Fast Track and managed care services.
When I emailed you last month in relation to our Helper service I had mentioned that we were hoping to be able to be in a position to respond, however, we have taken the difficult decision not to submit a bid to this tender for the palliative care services lot.
We are concerned that the proposed contract might result in a reduced quality of care for people with palliative care needs and their families in Fife.
Our decision not to bid is underpinned by our experiences as the current provider of palliative and end of life care in Fife through our Fast Track and Managed Care services. We believe that the economic values applied in the tender are unrealistic and restrictive for a number of reasons:
- With the maximum hourly rates quoted, and no margin for extending these, we do not believe appropriate levels of quality care can be provided to achieve these objectives.
- The rates quoted would not allow Marie Curie to retain a sustainable, highly trained and experienced workforce that could deliver on the ambition of the tender objective.
- The level of risk transferred to us in terms of the financial structure, rates and payment does not align with the delivery and performance requirements of a specialist health provision.
We support Fife Health & Social Care Partnership’s quoted tender objective ‘… to ensure that individuals have access to support that aspires to the highest level of quality and promotes the right of each individual to direct their own support’.
We recognise that the partnership has incorporated palliative and end of life care into a much larger contract dominated by social care. We understand the potential efficiency of this approach, but whilst there is interconnectedness between social and palliative care, we would caution against delivery approaches being generically commissioned and delivered. We also believe that this approach to commissioning palliative care services in Fife does not reflect the ambition of strategic commissioning and third sector collaboration that is at the heart of the integration agenda.
When it comes to palliative and end of life care, the impact of insufficient services extends beyond the patient. Patients failing to access palliative care or sufficient palliative care for their needs are at greater risk of unnecessary, unplanned hospital admissions including emergency admissions. People are more likely to die in hospital than in the community or in their own home, putting greater pressure on acute services. It can also have an immediate and long term impact on family members who may have to provide the main caring role. Without adequate support from services families are at increased risk of being overwhelmed by that role and the possibility of the care breaking down. This can have a significant negative impact on how they are able to cope with bereavement and grief.
Marie Curie’s commitment to the provision of palliative care in Fife remains but we believe the current contract poses too high a risk and would not reflect the high quality of care that we currently provide. It would also not enable Fife to achieve the ambition for palliative care set out in its Strategic Plan 2016-19.
Should the Partnership be unable to award a contract through this procurement we would welcome an opportunity to discuss how we could continue to support people with palliative and end of life care needs across Fife.
We are contracted to provide nursing services until the end of May 2018, and will continue to provide our nationwide information and support service in Fife, as well as campaign and research activities.
Kind Regards,
Richard Meade
Head of Policy and Public Affairs, Scotland
Marie Curie
