Memorandum by Hospice in the Weald (PC
Hospice in the Weald (HITW) a registered charity
with nearly 25 years standing, and a voluntary provider of specialist
palliative care and support services, would like to make the following
submission to the Select Committee. It is hoped that the comments
made are viewed as constructive and supportive to the work of
the Committee and will provide a helpful insight into the issues
which are preventing the development of palliative care in the
UK and the contribution the voluntary sector can make to supporting
1. Provision of servicesHITW provides
a comprehensive specialist palliative care service. The initial
focus of support is provided by a team of Community Nurse Specialists
(CNS). Liaison with Acute Hospitals, Consultants, GP's and District
Nurses is an essential part in ensuring a joined-up service. Patients
are visited in their homes, community hospitals and nursing homes.
Emphasis is placed in addressing the needs of the patient and
their carers. The changes in demographics and life expectancy
means that more people reaching the end stage of their life need
help and support from outside the family. The wishes of the patient
are paramount. However, whilst initially patients may prefer to
die at home, this situation changes as the patient's condition
1(a) Comment: The belief that patients can
mostly be treated at home is overstated. Increasingly patients
are able to visit the Hospice for day therapies and symptom control.
It is then that the patient and their families realise that the
patient would be more appropriately cared for in a Hospice, as
compared to home or an acute hospital.
2. Equity of ProvisionThere is considerable
variation of service provision around the UK. This situation has
occurred due to variations in statutory funding and the difficulties
of recruiting skilled nurses in certain geographic areas.
2(a) Comment: There is a need to encourage
greater levels of co-operation and support between Hospices and
NHS Hospitals. Secondment of nurses from acute hospitals and district
nurses to hospices would benefit both the hospitals and the hospices
with skills being passed on.
2(b) Comment: Greater emphasis needs to
be given to encouraging and supporting nurses coming back to the
profession. HITW would welcome the opportunity to be part of the
educational programme by providing a clinical work placement at
the hospice. Including the provision of mentorship and supervision.
2(c) Comment: HITW would like to teach palliative
care to pre-registered nursing students, working in conjunction
with teaching establishments. HITW would also support post-registration
3. The current Hospice nursing recruitment
crisis has been made more difficult by the treatment of nurses
wishing to rejoin the NHS Pension Scheme after a career break.
Currently nurses can only rejoin after a break not exceeding one
year unless they are joining an NHS establishment. This makes
nurse recruitment at hospices less attractive as they are unable
to join the NHS Pension scheme after a prolonged break.
3(a) Comment: Hospices should be eligible
to take up membership of the NHS Pension Scheme in the same way
that staff of General Medical Practices were able to do since
4. Financial constraintsThe levels
of statutory funding provided to hospices varies dramatically
across the Health Economies. PCT with inherited deficits are required
to reduce these deficits at the expense of addressing current
funding issues. Most statutory funding is based on past negotiations
and therefore does little to take care of existing needs of a
4(a) Comment: Statutory funding should be
based on the provision of assessed core services and the core
costs associated with these services. This would ensure that hospices
provide a cost efficient service to its community and would enable
adequate budgetary and planning of service delivery to take place.
5. AdministrationMany hospices find
that they are being burdened with unnecessary legislation and
reporting, whilst facing additional costs imposed from Central
Government. NI contributions, cost of CRB checks, NCSC registration
fees have all produced increases without additional state funding.
The recently announced increases in the NHS Pension contributions
are being supported by extra Government funding but the basis
of calculation will result in a shortfall of funding compared
to the actual cost increase.
5(a) Comment: A fairer contribution to hospice
funding to meet these additional costs is essential, otherwise
a cut back in services is unavoidable.
In conclusion of this submission I would like
to emphasize that independent hospices generally and my Hospice
in particular are totally committed to working with our NHS colleagues
to support the healthcare system. However, the funding situation
is in serious need of review to ensure that the vital palliative
care services provided by hospices are not undermined. If this
situation is not addressed there will be a fall back on the NHS
to support more terminally ill patients and this would not be
cost effective or appropriate.