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Miss Widdecombe: On a point of order, Madam Deputy Speaker. It will not have escaped your notice that at the Committee stage of the Bill none of the amendments were discussed, and that that stage included only forthwith votes on stand parts. Is that really what is meant by parliamentary scrutiny, Madam Deputy Speaker, and will you, as the guardian of the right of the House to hold the Executive to account, please examine the proceedings today with a view to ensuring that they can never be repeated?
Madam Deputy Speaker : Order. I have to inform the right hon. Member for Maidstone and The Weald (Miss Widdecombe) that the timing of the debate was very much in the hands of the House itself, as it had agreed to the allocation of time order.
Hospice Movement
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Stringer.]
7.15 pm
David Taylor (North–West Leicestershire): I am especially pleased to have secured this debate on the future of the UK hospice movement in the light of recent closure announcements affecting four of the 20 homes run by Sue Ryder Care, including the hospice at Staunton Harold hall in my constituency.
I shall outline the history of the hospice movement in the United Kingdom, the problems that it has traditionally encountered and the inherent limitations of the over-reliance of the national health service on the voluntary sector to deliver what is now an essential element of public health care. My speech will draw on the research of the National Council for Hospice and Specialist Palliative Care Services and Help the Hospices. I am grateful for their assistance.
In 1967, the voluntary sector, tackling a gaping hole in state provision, founded St. Christopher's, Britain's first modern hospice at Sydenham. Prior to that, what we have come to know as palliative care might occasionally have been provided in the patient's own home, but availability was patchy and remained so for some decades.
The lives of most people will be touched by cancer, either their own or that of a relative or friend; my life was, two decades ago. A searing memory comes back unbidden of a family member who contracted myeloma and of how we were all traumatised by the terminal phase of that bone marrow disease. It was an awful period for our family, with a prolonged physical and emotional agony that might have been relieved had hospice care been available.
The growth of the hospice movement has offered the chance of equity of access to provision but, for reasons that I shall detail, it remains restricted in its ability to expand and to provide an increasing number of beds. Even with the limitations of the voluntary sector, that vital, magnificent and enduring movement can still provide 70 per cent. of all in-patient care, 87 per cent. of all day care, 44 per cent. of all home care and 81 per cent. of all out-of-hours care.
Voluntary contributions created and sustained the first hospices and remain the financial life blood of the majority of them. The voluntary sector continues to run two thirds of all hospices in the UK. Although the need for state provision of palliative care was eventually acknowledged, the growth of NHS contributions to voluntary sector hospices has been agonisingly slow, although it was at least ring-fenced until the early 1990s.
The removal of the separate status of hospices in health authority budgets has, I fear, led to the closure of charitable hospices.
Mr. David Drew (Stroud): Does my hon. Friend agree that the greatest problem is that there is a disparity between what is given by health authorities and trusts and that that has a disproportionate effect on hospices?
David Taylor: I certainly agree with my hon. Friend, whose Adjournment debate on this topic was a seminal one in the last Parliament. He makes a valid point, as I hope to show later.
In the late 1980s, the right hon. Member for South–West Surrey (Virginia Bottomley), in her capacity as a Health Minister, stated:
- "The Government's objective is to work towards a position in which the contribution from public funds available to voluntary hospices and similar organisations matches that of voluntary giving. This will provide a clear basis on which to plan ahead."—[Official Report, 15 December 1989; Vol. 163, c. 847W.]
Mr. David Lepper (Brighton, Pavilion): Does my hon. Friend agree that the situation faced by the Martlets hospice, which serves the Brighton and Hove area, is not uncommon in that it still relies on annual funding from the primary care group and therefore cannot plan ahead, as it could if it were given three-year funding?
David Taylor: I thank my hon. Friend for making that point. Indeed, I shall make a similar point later. The three-year planning horizon is illusory for many hospices.
Children's hospices receive state funding of only a meagre 5 per cent. on average. If we are to safeguard the widespread provision of palliative care, the need for a national strategy for the funding of voluntary hospices cannot be stated strongly enough. The restoration of their separate status would prevent the perpetuation of the present almost annual negotiations with health authorities, primary care groups and primary care trusts for emergency supplementary funding. Left unaddressed, the disparities in the statutory funding of hospices and the resulting unevenness of geographical provision will worsen.
The voluntary sector's role in providing hospice care has been invaluable to successive Governments in taking the burden of responsibility off the NHS. That has led to a culture of complacency towards palliative care in the NHS and its Treasury paymasters, in which health authorities seem to regard it as a late call on tight budgets, not as one of the first claims. Unsurprisingly, palliative care is still viewed as the preserve of the voluntary sector, providing significant volunteering opportunities to those with personal experience of nursing terminally ill relatives.
That tacit arrangement continues to characterise hospice and palliative care provision in the United Kingdom, and it is to the eternal credit of the volunteers and professionals working in the sector that, despite a future shot through with uncertainty, they continue to provide environs of dignity and respect and an incomparable quality of care to those coming to the end of their lives. I am not saying, however, that the NHS should always incorporate hospice or palliative care facilities in hospitals even if appropriate sites are available.
Sir Teddy Taylor (Rochford and Southend, East): Does the hon. Gentleman agree that one of the problems,
under Governments of either party, is that when there is a substantial increase in spending, such as a staff pay rise, every part of the NHS gets the money except the hospices?
David Taylor: I must have left my draft speech on a photocopier, because I shall come to that very point later. NHS inflation, especially in relation to nurses' pay, is a serious problem. Coherent guidelines for local health authorities and PCTs need to be formulated so that local health authorities are encouraged—or, in new Labour-speak, incentivised—to improve their perception and usage of hospice services.
I understand that the National Institute for Clinical Excellence is in the process of creating such guidelines for the budget holders, but that they are not due to be published until the middle of next year. Will the Minister please confirm the planned publication time scale?
Furthermore, the psychology of the service and environment provided by the voluntary sector often has important advantages for the patient over NHS provision, where beds are typically found for palliative care in a hospital or, at least, on an adjacent site. Even if practical, NHS provision does not offer psychological or psycho-social sanctuary to terminally ill people in the way that hospices have traditionally done. The voluntary sector can offer a curative distance, alleviating the emotional agony of terminal illness. The Government are to be applauded for acknowledging that intrinsic advantage as they promote and encourage partnership between the NHS, voluntary, independent and charitable sectors.
In my constituency, the life of the Sue Ryder Care hospice at Staunton Harold hall is drawing to an early and unnecessary end, speeded by the action of its landlords, the Ryder Cheshire Foundation. A 31-year lease on that historic building, which is in the most picturesque and tranquil setting, is being surrendered under pressure from the foundation, as part of its need to realise assets. Hard-nosed boardroom attitudes enter by the front door, and agency funding and caring staff have left by the rear.
However, the foundation is not the only guilty party in this sad saga. Poor co-ordination between the various NHS bodies leads to a successor range of small palliative facilities attached to hospitals that will struggle to approach the quality of care that is the bedrock of Staunton's reputation. The 20,000-plus signatures on the petition handed in at Sue Ryder Care's head office in London bore testimony to the high esteem and affection that local people have for the Staunton Harold hospice.
A magnificent care home closes. Despite an energetic fight by William Fantham, Helen Fawcett and their fellow KOSSH campaigners, a treasured hospice is to be lost—one on which local communities had become very reliant and to which they have become most attached. The national charitable sector is the smallest presence in the palliative care network with just 17 UK hospices and it is very vulnerable to the sort of circumstances that have sadly stolen the jewel from the Leicestershire hospice crown.
Although I welcome the £50 million pledged to palliative services in the NHS cancer plan and the opening up of the new opportunities fund to the voluntary sector, the allocation process highlights what has traditionally hampered the sector in the expansion of its progressive care practices: the disparate and improvised nature of its
statutory funding. That leads to a perennially precarious situation. Hospices can go for months not knowing their long or even short-term prospects for survival, with the spectre of closure and the removal of patients from their beds always hanging over them.Although late funding is often found from one source or another, the supposed three-year length of the contracts with the health authorities is rarely the case in reality. Such is the frugal nature of NHS contributions. It is a cruel irony that, in some years, hospices are often saved from closure by the deaths of former patients and/or their relatives.
In January 2001 in England, not including children's hospices, there were 449 hospice or palliative care beds available in the 36 NHS units compared with 2,074 beds in the 127 voluntary "units". Logically, this would be respected as an exemplar of best practice and value for money and the state would recognise the success of this palliative care model by embarking on a national strategy to guarantee its funding. But there is little logical about the disproportionate emphasis on handling a slow inflow of tax revenue that has masqueraded as modern government for the past 20 years.
Post-Staunton provision in North-West Leicestershire is obviously a priority for the local primary care group. I believe that four beds in Coalville community hospital are already earmarked for palliative usage. Good as that is, it illustrates the improvised nature of palliative provision. Staunton Harold's capacity was latterly 12 beds, supplemented only by a handful of other voluntary hospices
Unfortunately, that situation of insufficient beds and sites is replicated all over the country. Lord Hunt said recently that the NHS was mapping existing services to identify and tackle geographical inequalities. I welcome that, but it must not be an excuse for delay nor a disincentive to the voluntary sector if little extra funding is to be available in areas with high community involvement.
In summary, existing state funding is inadequate to provide even a very basic level of universal palliative care. Despite the welcome £50 million for specialist palliative care in the NHS cancer plan, local hospices trying to access this funding via the cancer networks cannot find the way in to the foggy maze that confronts them. This cloud of uncertainty over finance also embraces strategic planning as the NHS seems unwilling to spell out its core palliative care responsibilities. That is at the heart of the present crisis.
We need a national strategy and framework for palliative care. Hospices need to know what the state accepts as its responsibilities and that the Government will commit to fund them. With a more realistic taxpayer contribution to costs, charitable fundraising can focus on the piloting and expansion of progressive care and treatments.
Communications between Government, their agencies and the voluntary sector have been improved a little by the national compact, but the startling lack of awareness about it by the Department of Health has seriously impaired its dealings with the voluntary hospice movement. Properly joined-up government could and should change such cynical reactions into more constructive relations.
There is a tremendous fund of good will towards the voluntary and charitable hospice movement from the generous British public, but their ability to underwrite the costs of this crucial service has been stretched too far. Collecting tins, charity shops and cake stalls can only do so much. National taxation, whether hypothecated or not, needs to pull its weight. Warm words from Government are not enough. We need action—and now.
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