An adult placement scheme for residents of a long-stay hospital that is due to close has provoked controversy, writes Colin Wright

Plans to close a long-stay hospital and send patients with learning disabilities home to live with healthcare staff have sparked vociferous criticism from unions and politicians in Scotland.

Lennox Castle Hospital, in Lennoxtown, is due to close in 2002 and Greater Glasgow Primary Care trust, which operates the unit, is going ahead with its adult family placement scheme. It will try to place some of the 200 patients still resident in the hospital out into the community among former staff members.

The trust says this is one option which would benefit both the patients and some of the 650 hospital staff who are facing redundancy. A spokesperson for the trust says: 'This is still an option we are looking at and initial information has been sent out to several members of staff, some of whom have expressed an interest in going further with the placement.

'Obviously this would only be used where it is most appropriate for the patient and where the situation is agreed with all agencies involved.'

The trust estimates that around 20 to 30 patients may be placed in this way.

Mark Feinmann, joint general manager for learning disabilities with Glasgow city council, is one of the authors of the plan. 'This scheme is a tried and tested procedure and one that has proved successful elsewhere in the country, ' he says.

'It is most definitely not 'patients for sale' as some people have been claiming.'

Mr Feinmann says there are three components to the scheme.

Respite care would be provided 'on a yearly basis' to help staff 'get away for a period from the patient'. Patients would be entitled to daycare. And a charity which assists with transfer of patients into the community, will be paid£20,000 per case to help.

The charity, PSS - formerly Liverpool Personal Services Society - will 'assess the individual taking the patient, provide support for them and help them in giving advice on providing care', Mr Feinmann says.

He insists that 'the only payment made to the person taking the patient' would be social services benefits which 'could be between£10,000 and£15,000'.

Mr Feinmann adds: 'This is a well-established, well-respected approach to placing patients in the community and is one of a number of options which we have.'

Claiming the scheme was 'similar' to dealing with children in local authority care, Mr Feinmann adds: 'You wouldn't place a child in a home for fostering without adequately assessing the needs of the child and the competency of the people taking that child. It must be difficult if you have seen your child who was placed in a hospital now being looked after in someone else's home, but this is part of the future pattern which we as a council believe will become a more common practice.'

The response from Joe Lynch, Unison's professional officer for the Greater Glasgow area, is one of disbelief. 'We have grave concerns about what might happen if these patients are put out into someone's home. We very much doubt that they will receive the level of care that they will require or that any one person could provide one-to-one 24-hour care for them.

'The facilities that are offered within an NHS setting cannot possibly be matched in someone's home. Many of these patients would be too terrified even to leave the building. You have to wonder whether someone would be able to cope with a patient who is both physically disabled and incontinent within their own home. And the answer is no.'

Mr Lynch describes the benefits payments as 'irrelevant' because however much carers earned, patients would still be getting a lower level of care than before.

He admits the union has 'lost the battle' to keep the hospital open, but warned: 'We have great concerns about this system of placing patients in the community in what may prove to be an inappropriate setting.'

Social care budgets may be 'unable to cope with this level of placement', he adds.

The trust has also come under attack from politicians. Conservative health spokeswoman Mary Scanlon says: 'This really is a matter of very serious concern and I am going to raise this matter with the health minister.'

Ms Scanlon says the move would require much more support than had been suggested. 'If you place someone within a family it is not just one individual who needs to be experiencedit is the whole family who need to know how to respond to the needs of the individual.

'Where is the accountability for this individual's treatment, where is the continuity of care, and what experience and what qualifications do the people taking these patients home have?'

The scheme costs 'more to fund than a qualified nurse would cost' and risks 'exploitation' of patients, she says.

'I also believe this smacks of desperation on the part of the trust and it beggars belief that at the beginning of the 21st century this method of distributing people out into the community should be regarded as acceptable.'