APPENDIX 47
Further letter from Professor Mike Richards,
National Cancer Director, Department of Health to the Clerk of
the Commitee (PC 18C)
Thank you for your letter of 31 March asking
for further evidence from the Department of Health for the Committee's
Inquiry into Hospices and Palliative Care. This request follows
on from the submission from Greenwich and Bexley Cottage Hospice,
in which the hospice stated that it had not received its approved
allocation from Greenwich Primary Care Trust from the £50
million central budget for specialist palliative care.
The Department of Health, through the National
Partnership Group for Palliative Care (NPG), has asked the voluntary
hospice representative bodies that are members of the NPG, to
keep us informed of any local concerns regarding the allocation
of funding to the voluntary sector from the £50 million central
budget for specialist palliative care. To date we have been made
aware of only two localities where concerns have been raised—Greenwich
and Swindon; both of these were raised directly with the Department
by the local hospices concerned.
The concerns all relate to the use of slippage
arising from the £50 million central budget. On 6 October
2003, we provided cancer networks with the following advice on
this:
"We have had enquiries from a number of
networks about whether the slippage from your allocation from
the £50 million central budget for specialist palliative
care can be carried forward.
We are advised that, as your PCTs will know,
the NHS has freedom to carry forward underspends. Generally this
is managed either at national level via the end year flexibility
system or via internal brokerage. Where a sum has been allocated
for a specific purpose (as with the central budget allocation
for specialist palliative care) and there is an underspend against
that particular allocation in year, PCTs are able to manage the
underspend using these mechanisms. For example, any 2003-04 underspend
against the palliative care allocation could be used by the PCT
to fund additional expenditure on other programmes in 2003-04
with an equivalent amount being added to 2004-05 palliative care
funds from other PCT resources. If the PCT is projecting an overall
underspend the SHA will advise how this is to be managed.
Precisely how slippage is managed at PCT level
to allow the palliative care funds to be carried forward remains
a matter for local agreement. You should discuss the details with
your SHA/lead PCT. Ministers will, of course, wish to be assured
that the full central budget has been used for specialist palliative
care, the purpose for which it is intended."
All cancer networks expected to see some slippage
in the first year of the £50 million allocation. Many have
seen this slippage increase, mainly as a result of delays in recruiting
staff. The advice we provided acknowledged this. It emphasised
that, although there may be instances where PCTs are unable to
use the slippage for specialist palliative care services in-year
and may, as a result, wish to spend it on other services, PCTs
must ensure that the funding is fully reinstated in the following
year and spent appropriately on specialist palliative care services
as per the agreed cancer network investment plan.
The responsibility for resolving local difficulties
rests with the appropriate Strategic Health Authority. Should
these difficulties persist, the Department of Health's Recovery
and Support Unit (RSU) will then work with the SHA to address
these concerns. In both Greenwich and Swindon, appropriate action
was taken to resolve the concerns raised.
The National Partnership Group is—at the
request of Ministers and as outlined in the Department of Health's
memorandum to the Committee—carefully monitoring the use
of the £50 million central budget to ensure it is appropriately
used for specialist palliative care. Should there be any further
concerns from the voluntary sector we will take similar action
to that taken for Greenwich and Swindon, first through the relevant
SHA and then, if needs be, through the Department's RSU, to ensure
such situations are appropriately addressed.
The concerns in Greenwich and in Swindon were
both, therefore, appropriately addressed and have now been resolved.
In Swindon, the RSU was able to confirm with
the SHA that they would link with Swindon PCT to ensure they understand
the need to spend all of their "earmarked" palliative
care funding as per its designated use within the required timescale.
In Greenwich, the local health economy faced
considerable cost pressures during 2003-04 and it was decided
locally that slippage of £135k from the central budget for
specialist palliative care should be re-profiled through the following
year. The issue was taken up by the RSU and TPCT has explicitly
confirmed that in setting its plans for 2004-05 that it will increase
investment in palliative care services by a minimum value of £135k.
As a result of the difficulties experienced
this year the local Cancer Network has arranged a stakeholders
meeting. These meeting are held throughout the year, however the
PCT and Cancer Network felt that it would be beneficial to all
parties if a specific discussion was held regarding the slippage
money from last year. The meeting has been confirmed for the 14th
June. The Bexley & Greenwich Hospice, Bexley PCT, Greenwich
PCT and the Cancer Network will all be in attendance.
The Department of Health RSU has requested an
update from the SHA following the meeting on 14 June.
21 May 2004
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