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7.29 pm
Mr. Andy Reed (Loughborough): I am grateful to my hon. Friend the Member for North–West Leicestershire (David Taylor) and my hon. Friend the Minister for giving me the opportunity to speak briefly in support of my hon. Friend the Member for North–West Leicestershire. We have worked closely together on the matters that we are discussing.
I want to speak specifically about children's hospices. The Rainbow hospice is a fantastic children's hospice in my constituency. It suffers from the sort of problems that my hon. Friend described. I know from my visits to it that it rightly calls itself a place of rest on a long and difficult journey. Rainbow provides respite and terminal care in the hospice and at home for children who suffer from conditions that mean that they will die before reaching adulthood. We need to remember that that is what hospices are about.
One problem is that Rainbow has to cover Derby, Leicestershire, Lincolnshire, Northamptonshire, Nottinghamshire and south Yorkshire. Although it helps families to cope with life-shortening conditions such as Batten disease or life-threatening conditions such as cancer, working across such a wide area is extremely difficult.
I want to concentrate briefly on Rainbow's wonderful work. As my hon. Friend said, fundraising has become increasingly important. The hospice has to raise more than £1 million simply to remain as it is. It is lucky in being able to raise 10 per cent. of its income from health authorities and others. That is above the national average, but it shows the enormous amount of work that such a hospice has to do. Although it produces wonderful glossies and can rely on the good will of people in my constituency and throughout the east midlands, so much effort is put into fundraising that one feels that more of it should be directed at the excellent care that is provided at Rainbow.
As I said, Rainbow has to deal with all the health authorities in the counties that I mentioned. I have always supported PCTs, but I fear that even more work will have to be done to ensure the continuation of funding to Rainbow. I appreciate that the Minister and the health team have been considering innovative ways of providing health care in the future, but they should consider the excellent work that is happening not only at Rainbow but in the constituencies of the majority of hon. Members who have stayed for the debate. It is a testament to the work of hospices that so many hon. Members are in the Chamber.
I repeat that there is no agreed national strategy about funding voluntary hospices. They negotiate with health authorities, PCGs and PCTs, which means that there is a wide variance. The Government rightly emphasise an end to the postcode lottery for many other aspects of the health service. I hope that the Minister can end the postcode lottery that appears to be happening in our hospice movement.
More PCTs will make matters harder. From parliamentary questions that I have tabled in the past, I know that health authorities receive an element of funding for hospices. However, not all of them necessarily use the allocation to fund their local hospices. The further away one travels from Leicestershire, the greater the difficulty of convincing health authorities in, for example, south Yorkshire that they should contribute to the work of Rainbow hospice in Loughborough.
I make a simple plea to examine the funding of children's hospices seriously, end the postcode lottery that appears to be happening in my area, consider developing a national strategy to bring the best and worst authorities closer together and assess the impact of the move to PCTs on the amount of work that hospices will have to do to secure their current level of funding.
7.33 pm
The Minister of State, Department of Health (Jacqui Smith): I congratulate my hon. Friend the Member for North–West Leicestershire (David Taylor) on securing a debate on such an important subject as the future of the hospice movement. I am aware of the specific anxieties that he raises about the Sue Ryder home at Ashby.
The hospice currently receives 50 per cent. funding from the NHS for its services. That is above the national average of 30 per cent., which my hon. Friend rightly mentioned. The closure is due to the termination of the lease by the Ryder Cheshire Foundation rather than the lack of NHS support, but we do need to ensure the continuation of services. To that end, I understand that there has been a constructive discussion between the home and the NHS to work out some options that have been debated by interested parties and will be considered by the cancer network management board in November.
As my hon. Friends said, the hospice movement is a success story. As a result, we are world leaders in palliative care. It was the hospice movement that first demonstrated the importance of ensuring that those nearing the end of their lives, and their families and carers, receive compassionate and skilful care. That good practice, which began outside the NHS and is still, as my hon. Friends rightly highlighted, predominately provided by the voluntary sector, is now acknowledged as a service that should be available to all who require it. That of course extends beyond those who need it for cancer services.
There are large variations in the provision and funding of specialist palliative care. Hospices have tended to be established in areas where the general public have been generous. That has enabled centres of excellence based on clinical practice, teaching and research to be established. Unfortunately, it has also resulted in patchy provision and wide variations between regions.
We have issued guidance to the NHS for palliative care strategies to be in place to meet the needs of the local population, and we are committed to tackling those inequalities in access to specialist palliative care services for patients.
My hon. Friends rightly ask for action. Let me explain what we intend to do to ensure that palliative care is adequately funded and the inequalities addressed. The
national council estimates that total expenditure on adult palliative care services is about £300 million, of which about £170 million is provided by the voluntary sector and £130 million by the NHS.The NHS cancer plan sets out our intention to invest an additional £50 million in specialist palliative care by 2004, which will match, on a national basis, the investment by the voluntary sector. That will also enable the NHS to make a realistic contribution to the costs that hospices incur in providing agreed levels of service. We will monitor the information from the service delivery plans and financial frameworks, which will help to provide a transparency for the level of investment made in reaching that target. We intend to ensure that that happens.
In addition, a further £70 million has been committed by the new opportunities fund to palliative care projects in England. Of that, £22 million has been allocated to adult community palliative care, building on the living with cancer programme, but extending to conditions other than cancer. Merely increasing investment in specialist palliative care, however, will not necessarily address the inequality of provision. We need to know the current level of provision and what is required to meet the needs of the local population.
Sir Teddy Taylor: Will the Minister give way?
Jacqui Smith: No. The hon. Gentleman knows that time is limited.
That is why we have put in place a series of measures. We have commissioned the National Institute for Clinical Excellence to undertake an evidence-based review of palliative care services as part of the supportive and palliative care service guidance. The guidance will benefit the voluntary sector and help decision making about service delivery. I can confirm that initial findings will be available from summer 2002.
We have required all 34 cancer networks to develop costed strategic investment three-year plans for palliative care. My hon. Friends made an important point about the certainty of investment. The plans will be based on current provision and local population needs and will form part of the cancer network service delivery plans. Those plans will inform the wider NHS planning process through the health improvement programmes and the service and financial frameworks for 2002-03.
For the first time, comprehensive data on the current provision of palliative care at a network level will be available. Networks will be able to see where the inequalities in specialist palliative care service provision are and plan services to address that, and as a consequence enable more realistic support for voluntary hospices. That will also enable hospices to plan strategically with cancer networks and identify their own business strategies, putting an end to short-term planning.
I must stress, as did my hon. Friend the Member for North–West Leicestershire, that we recognise the importance of ensuring that the needs of voluntary sector providers are fully reflected in network investment plans. In some instances, hospices may find it difficult to know how best to influence the process, which is why we have made available central funding to support voluntary hospice and palliative care providers in working effectively with cancer networks in the development of
plans. All networks are participating in the programme, funded by the Department and led by the National Council for Hospice and Specialist Palliative Care Services. I agree with my hon. Friend that we must recognise the vital contribution made by the voluntary sector and engage it realistically and properly in NHS planning. We must support the sector to enable it to make its contribution.My hon. Friend the Member for Loughborough (Mr. Reed) rightly drew attention to the Rainbow children's hospice. I am grateful that he set out the important work that it undertakes. It is a tribute to the many voluntary organisations that identified the help most needed. Their staff, supporters and well-wishers often have a special appreciation of the care that is required, which is often gained through deep personal experience.
Children's hospices have made a remarkable contribution to the care and support of dying children and their families. Fortunately, most children will grow into adulthood without experiencing a serious illness, let alone a life-threatening one, but some children are not so fortunate and develop conditions that may lead to an early death. It is important that in the NHS of the future these children and their families have high-quality support services and that coverage is extended so that equal access to a range of options is made possible.
Provision has been made for funds for children's hospices to come from the NHS. It is a matter for local discussion and agreement and is based on the local health needs assessment with the health improvement programme, which is the general funding mechanism for services. Voluntary health care providers, such as hospices, must be viewed as important players in the planning and provision of services, and should be involved in the development of health improvement programmes. That involvement should help to lead to more structured funding streams.
I recognise the concern that has been expressed about the development of primary care trusts and the role that they play. The year 2002-03 will be one of transition, with PCTs at different stages of development. They are increasingly making planning and investment decisions on behalf of their local communities. As key players within cancer networks, PCTs will have agreed to and contributed to the development of the network service delivery plan. That will be crucial. We shall soon be issuing national guidance on the new arrangements for the
2002-03 planning process, and allocations will soon be announced to Parliament. As I have said, PCTs will be involved in the cancer network planning process that I have outlined.Each region now has a children's "lead" and is surveying the provision of children's palliative care services against demand, engaging voluntary and statutory sectors. We expect this work to secure a far better strategic fit of services to local needs and to achieve a range of options, and to afford greater equity of access for all people.
As I mentioned earlier, a further £70 million has been committed by the new opportunities fund to palliative care projects in England, of which £48 million has been allocated for children's palliative care to support programmes providing at least one of the following: direct services in the community to children with life-threatening or life-limiting illness—24-hour care; respite care services, which are either home-based or hospice-based; and bereavement services that are home based, community based or hospice based.
My hon. Friends have rightly said that the founders of the hospice movement, through dogged persistence, careful research and tireless fundraising, helped others to see that care was possible and at the heart of good clinical practice. As a Government, we have set out a challenging agenda for the support of palliative services for adults and children. We are committed to delivering this agenda, and we must work in partnership with the hospice movement if we are to do so. I give my commitment that that is the Government's pledge.
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