Reasons Or Excuses?

The Marie Curie board seem determined to close down this particular hospice without any discussion.  They have put forward many different reasons for the closure, but when examined closely they all look more like excuses:

It's In Our Strategic Plan

This one first cropped up in the letter sent to local Marie Curie supporters:

"The charity has recently published its new strategic plan, which includes a commitment to double the number of people being cared for at home at the end of life by the Marie Curie Nursing Service."
Sara Jane Woods, Regional Fundraising Manager
Letter to Supporters 26/11/2008

What they somehow managed to overlook is the commitment in the same plan to "increase the number of patients using our hospices by 50 per cent", which is not going to be helped by closing Harestone. In fact, throughout the strategic plan, for every statement in support of home-based care there is an equivalent one for hospice-based care.
For more examples see Selective Quotation.

It's What Most People Want

Marie Curie are fond of quoting the result of a 2004 survey which found that most people would prefer to spend their last days at home, then using this to justify closing Harestone to pay for it.  For example:

A spokesperson for the charity said: "Research by the charity shows most people in the UK would wish to die at home if they had a terminal illness. As a result, the charity is considering a restructure of its services in Surrey which could see the closure of its Caterham Hospice site."
www.thisiseastgrinstead.co.uk 01/12/2008
quoting from the original Marie Curie Press Release

It is no surprise that most people would prefer to die at home.  But were the people in the survey asked to consider how practical this would actually be?  They certainly weren't asked whether they thought hospices should be closed down to pay for their care at home, and yet this is the bizarre conclusion reached by the Marie Curie board.  For more on this see That Survey.

They also emphasise the Delivering Choice Programme when promoting care in people's homes.  But where is the choice for those people in East Surrey who prefer or need the care that only a hospice can provide? Marie Curie has abandoned them.

We'll Double The Number Of Nurses

This one needs very close scrutiny.

"Our aim is to double the number of Marie Curie nurses working in the local community."
Rachael McCormack , Public Relations Manager
Quoted in www.thisiscroydontoday.co.uk 03/12/2008

What exactly is meant by 'Marie Curie nurses working in the local community'?  The Harestone nurses who already work in the community are going to be made redundant so how could the total number of nurses be doubled?

Susan Munroe chose her words more carefully:

Susan Munroe, director of nursing and patient services at the charity said: "If we are able to invest more in the local Marie Curie Nursing Service, we believe we will be much better placed to help more people achieve their wish to die at home."
www.thisiseastgrinstead.co.uk 01/12/2008
and The Caterham Independent December 2008
quoting from the original Marie Curie Press Release

What needs to be pointed out here is that the Marie Curie Nursing Service (MCNS) is actually a national service which currently provides night nurses to local people, but does not include the Harestone ward nurses.  And not all MCNS staff are Registered Nurses; some would be Healthcare Assistants who are not able to give pain relief injections etc..  So when the MCNS service expands, even if the number of MCNS nurses available locally were doubled or trebled by using ex-Harestone staff it would still leave something like half the current nurses redundant.  Closing Harestone will not result in more nurses serving the local community, but that is not clear from these statements.

Harestone Hospice Beds Were Underused

In-patient beds at the Harestone Drive hospice were shut three years ago following a sharp drop in admissions and were replaced as an interim measure by four beds at the North Downs Hospital.
Caterham County Border News 04/12/2008
quoting from the original Marie Curie Press Release

This is factually correct but is perhaps the most misleading statement of them all. The reason the number of admissions dropped is that the Harestone team were treating more patients out in the community - in their homes and in nursing homes - just as Marie Curie had instructed them.  Notice their use of the words 'beds' and 'admissions', rather than 'referrals' and 'patients' which would be the true measure of the number of people being cared for.

In fact the drop in admissions was a sign of success not failure. See Victim Of Success.
The article continues:

The charity has already announced that those beds, which have been occupied for less than 50 per cent of the time, would close this week.

North Downs Hospital is fine as a place to stay following an operation but it was never designed to be a hospice.  For example:

• the Marie Curie rooms were next to the car park
• there was no garden or peaceful place for people to relax in
• there was nowhere for relatives to talk or grieve in private.

The ward lounge was available but had to be booked in advance and was often busy with staff meetings etc.  Discussions with distressed relatives sometimes had to be held in their cars. Staff at the hospital weren't used to dealing with large numbers of grieving relatives and this could also make things difficult on both sides.  These problems were all highlighted but nothing was done about them.

Given all this it is little wonder that many people took one look and decided not to use the hospice after all.  This is what caused the empty beds, which of course were still being paid for.

We Can Help More People

"...we need to ensure the care provided by the charity reaches the greatest number of patients possible. "
Thomas Hughes-Hallett, Chief Executive
Response From Thomas Hughes-Hallett 15/12/2008

That is the attitude of a board focussed on figures, not people. Care should be directed where it is most needed and that can mean a hospice or therapy room as well as a patient's home.

That approach takes no account of the vulnerability, needs and individual circumstances of patients. According to the board, if Marie Curie can treat three people at home, people who may be well off and already have the support of family and friends, then that is more important than supporting one old lady who lives alone in a small flat with no-one but visiting nurses to help, who would be much better off in a hospice.

The board's strategy places more importance on keeping the numbers up than considering the needs of a child who has lost their mother to cancer, has no other family, and no one to help them through their loss apart from the support they receive from Marie Curie specialists.  They value quantity over quality and can't see beyond their list of targets.

The Closure Is Long Overdue

All that tells us is that the board have wanted to close Harestone for years.  It still doesn't explain why.

Is It About Money?