Select Committee on Health Written Evidence


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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