APPENDIX 9
Memorandum by Saint Michael's Hospice
(OB 9)
INQUIRY INTO
PALLIATIVE CARE
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.
EQUITY IN
THE DISTRIBUTION
OF PROVISION
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.
QUALITY OF
SERVICES AND
QUALITY ASSURANCE
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.
MEETING THE
NEEDS OF
USERS
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.
GOVERNANCE, STANDARDS
AND NHS LINKS
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.
WORKFORCE ISSUES
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.
FINANCE
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.
GOVERNMENT POLICY
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.
CONCLUSION
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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