The imminent disappearance of health services for the homeless from Cowgatehead has yet to feature in objections to the massive India Buildings hotel development.

Fears of the detrimental effect of yet more hotel development on the Old Town continue to grow particularly in response to the India Buildings/Cowgate development which goes to the Planning Committee on 25th May. Most civic organisations, resident groups and scores of individual residents have objected to the plans which threaten still further the viability of community life in the city centre.

The scale of the development is called into question, as is its negative impact on the Central Library, but the fact that it impacts on some of the most vulnerable members of our community, those affected by homelessness, has not yet been highlighted.

Referring to the Cowgate Access Practice, a spokesperson for the Council’s property department confirmed that:

The sale of the assets (Cowgate Free Church] is conditional on planning permission being obtained for the proposed hotel development for the larger site (which includes India Buildings). The NHS occupy the property by way of a monthly tenancy and no notice of termination has yet been issued. Such notice will be issued should planning permission be granted and will coincide with an agreed date for the completion of the sale to the developer. NHS has identified a short term relocation option and are actively pursuing a long term solution.

It appears that the short-term relocation is scheduled for the basement of the Spittal Street Centre (the Needle Exchange) and the impact of this temporary relocation on the quality of service to the homeless is of concern to practitioners. (Those same practitioners are reluctant to speak out for contractual reasons.)

Caring services are part of our Old Town heritage

The poor have always found refuge in the Old Town, in the Cowgate and Grassmarket in particular – including long-term and temporary residency.

The Cowgate Access Practice, still known locally as the ‘Skin Clinic’, has been in operation for over 40 years. It offers everything a GP practice offers, connecting clients to the full range of health professionals. More importantly, it does this from one location with up to thirty staff available at different times of the week for consultation: the GP, dentist, chiropodist, psychotherapy and a full community psychiatric nursing service. It not only provides access to health care, a lifeline to the most vulnerable people in the city experiencing extreme trauma in their lives, it also serves as a way of gauging the changing face of homelessness and social inequalities in the city.


Part of the Old Town’s heritage, much longer than any significant level of tourism in the city, homelessness services, once removed will find it difficult to return to the city centre given the soaring cost of property and the Council’s policy of maximising capital receipts on publicly owned land.

Legislative changes and cost-cutting

Apart from the controversial hotel development, the advent of Community Health Partnerships is also a factor in the changing face of homeless services – and cost-cutting is one of its drivers. The latest newsletter from Council Leader, Andrew Burns, confirms this.

The Edinburgh Health and Social Care Partnership has been formed to deliver these services.... in collaboration with the private and voluntary sectors and community organisations. These changes are driven by a mixture of legislation and the need for cost savings in both the Council and NHS Lothian. The partnership approach allows for more creative ways to deliver services to meet the needs of Edinburgh's citizens. In Edinburgh, the focus remains on quality of service, clearer pathways for service users, and colleagues working collaboratively to reduce bureaucracy and duplication.

The latter, an integrated health and social care service, should be good news for the city and its citizens but the first evidence of this initiative in practice could be the closure of a known place of refuge and care in the Old Town. The Edinburgh Community Health Partnership claims that it ‘actively involves the public, patients and carers in the redesign and development of community health services’. This should mean that consultation on these developments has been widespread but there is little evidence that this is the case.

The importance of the co-location of services

In providing for vulnerable groups, the physical co-location of services is considered key to successful delivery and that is what’s currently under threat. The Cowgate facility is the closest thing to ‘home’ that most of its users have: a place they consider safe, a source of care, comfort and medical help, a place to identify with. With many of the users being transient returning to the city cyclically, the location of the service is important. It’s also important that the varied services on offer are provided in the one place.

However, City of Edinburgh’s Chief Social Worker confirms that the City and NHS are committed to full co-location of services:

Arrangements for relocation [of the Cowgate Practice] are being made by the Integration Joint Board for Health and Social Care. It is anticipated that this will be an interim arrangement, as NHS Lothian, the City of Edinburgh Council and the Integration Joint Board are all fully committed to developing an integrated service, to include housing support, social work and health for people who are homeless in the city centre. These plans are well underway and include the intention for full co-location.

It would be welcomed if ‘plans’ and ‘intentions’ were openly shared and discussed instead of reported in council committee papers that are difficult for the lay person to decipher.

Economic development and inequality

As our society becomes ever more unequal there is no sign that the Council is pursuing economic policies other than those that continue to work against the most disadvantaged in the city. The sale of the India Buildings/Cowgate site, seeking the highest market price rather than wider social or environmental concerns, will have direct effect on our neighbours who depend on it.

One of the two main responsibilities for the Edinburgh Community Health Partnership is ‘to address inequalities in Edinburgh for NHS Lothian’. It is hard to see how the fate of the Cowgate clinic fits with this responsibility.