Select Committee on Health Written Evidence


Memorandum by Saint Michael's Hospice (OB 9)


  We were delighted to hear that the Health Committee has decided to inquire into Palliative Care. Independent voluntary hospices like ourselves make a major contribution into such care, and whilst Help the Hospices and the National Council for Specialist Palliative Care Units provides a forum for our views to be aired, it is inevitable that aggregation of information and generalisation dilutes the situation which exists in some areas.

  Saint Michael's Hospice provides specialist palliative care to the 165,000 people of the Harrogate District through a number of services including a 10-bed Inpatient Unit, 12-place Day Therapy Centre, Bereavement Support, and Lymphoedema Clinic. Over recent years our paymasters have changed from the North Yorkshire Health Authority, with whom we had a good rapport, to the Harrogate Primary Care Group, then the Harrogate Primary Care Trust and now the Craven, Harrogate, and Rural District (CHARD) Primary Care Trust. Despite our best efforts, we have no contract or service level agreement in place, and only in recent months have we established a meaningful dialogue with the CHARD PCT. It is against this background that this submission is made.

  Our comments are framed against the committees' terms of reference.


  We believe there is equity of service across all adult age groups. However, we serve a large rural area, and whilst Inpatient facilities support all areas, day clinics do not. In particular the lack of ambulance transport for Day Therapy and Lymphoedema has proved problematical. Until last year we were denied any ambulance services and now they are currently funded from the Government's £10 million package awarded last year. It is not clear whether this funding will continue, or if these costs will be deducted from future grants.


  We are subject to inspection by the National Care Standards Commission and we also participate in Quality by Peer Review. The latter involves a three day inspection/audit by three or more independent hospice specialists and really provides a worthwhile barometer to quality in every aspect of hospice work, including governance, management of staff and volunteers as well as clinical practice and patient care. On the other hand the NCSC inspection is but a few hours, superficial and in the main only looks at compliance with legislation.


  We provide specialist palliative care and as such meet the needs of those eligible for our services—only on rare occasions do we have a waiting list for any service. We believe there is an unmet need in our region for domiciliary general palliative care, due to a lack of suitable nursing home places.


  Comprehensive practices and procedures have been set up to ensure financial and clinical governance. Standards have been set for all patient and most other areas. Some contracts exist with NHS providers for support such as Chaplaincy. Where necessary links have been established to provide external support/supervision of solo practitioners.


  There is a general shortage of suitably qualified and experienced nursing staff, which is now causing problems with vacancies at senior staff level. The quality of staff training remains excellent. Retention is not an issue, but the replacement as an ageing workforce reaches retirement is of concern, as are the national struggles with the recruitment of senior clinicians.


  By minimising waste, purchasing wisely and operating efficiently, we believe that our services are provided in an extremely cost effective manner. Even so excluding the recent Government initiatives, last year only 25% of our £1 million running costs were met by NHS funding. Indeed, a recent capital project to provide new Day Therapy facilities and modernise all inpatient rooms, which cost £1.1 million, received not one penny of NHS funding and a bid to the National Lottery was rejected. As a consequence our reserves now stand at just £600,000 which barely represents six months' running costs and is too low for comfort. The generation of charitable funds continues to be difficult, despite the best efforts of our paid and voluntary staff.

  The Government's special allocation of £50 million for specialist palliative care was distributed on a per capita basis and the CHARD PCT received £188,000. After funding other projects, just £39,000 was available to Saint Michael's Hospice; from our perspective, the greatest problem was the varied interpretation of "specialist palliative care" within the NHS.

  We believe that in many ways we are a victim of our own success. It is clear that we are a long way down the priority list for NHS funding, and as long as we remain afloat by our own efforts, the situation will not change. However, the pressures on charitable funds are such that this situation may not prevail. Indeed, we have had attempted to match NHS Agenda for Change proposals for our staff, but resultant increase of over £200,000 in staff costs has meant that we will not be able to introduce the full range of benefits that NHS staff enjoy.


  The National Service Frameworks, Cancer Plan and NICE recommendations have had little impact on our work. However, the Yorkshire Cancer Network is developing its strategies and will I am sure inform and influence our work in due course. On the other hand, the raft of health and safety, and employment legislation has had a significant impact on administrative costs.


  Saint Michael's Hospice has grown over 14 years to be a major health care provider. Over this period costs have risen from £300,000 to over £1 million, with very little help from NHS sources. We are very proud of the high standards of care we achieve as evidenced by the audits, inspections and numerous letters of appreciation. However, without sustainable funding from the NHS, our future may well be threatened.

  We would be delighted to welcome any, or all, of the Select Committee to Saint Michael's Hospice for a face-to-face briefing and to see at first hand the quality of care being provided by the voluntary sector.

February 2004

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