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Mr. Meale: I must say that I am a bit confused. My area is being capped. At present Boston has 15 places, and Leicester has 50 or 60. We are talking about an area containing more than 4 million people, and the thousands of children to whom my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) referred. The Bluebell project will provide a couple of score more places, but there is still a gap. I am not criticising the NHS or the Department's work. Because of the work done by the Minister and some of his colleagues, children in my constituency who need care are going to Great Ormond Street hospital, Birmingham children's hospital—the whole works. But fewer than 100 places means that there is a gap—a gap that we must fill.

Dr. Ladyman: That is exactly why we drew up the national service framework, which is mandatory for the NHS. In it we describe what a palliative care service should be like. It is the responsibility of every PCT to implement the national service framework. There are no targets apart from that: it is mandatory. If that gap exists, it is the responsibility of my hon. Friend's PCT to start the process—which I am about to describe—of filling it.

Mr. Meale: I understand the Minister's dilemma, but the figures given by my hon. Friend the Member for Barnsley, East and Mexborough show that we have a problem. Without the Bluebell project, we have 60, 65 or 70 places to serve a region containing millions of people. The services that are being provided are fine, but a particular service is needed. I accept that responsibility lies with the PCTs, but they could be given some encouragement from the centre.

Dr. Ladyman: They are being given such encouragement. They have a responsibility—a duty—to fill that gap. One reason why I do not think it right to impose an arbitrary target on its funding for hospices is that if the gap is serious enough in a particular area, it is
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in the gift of the PCT to fund the hospice in its area 100 per cent., or to work with other PCTs in the area to do so. PCTs are not limited to 43 per cent., 40 per cent., 60 per cent. or 5 per cent. If, to fill the gap in my hon. Friend's constituency, they need to provide all the funds for a hospice, they can do it under our arrangements—and they will have to do it, if that is the only way in which they can fill the gap.

My hon. Friend the Member for Mansfield talked about children being placed in hospital a long way away—such as in Great Ormond Street for example—but he should not confuse the palliative care that a child may have to go into hospital to receive with the palliative care that the child will receive in a hospice.

Mr. Meale: I accept that, but I want to pay tribute to his Department and to the Under-Secretary. The care given to young people by our health service now is far superior to what it was and I am grateful to the NHS, and to my PCT, which, if a child needs to go to Birmingham or Great Ormond Street, puts up the money. It is not all bad news.

Dr. Ladyman: It is not, and the national service framework will take the work even further. It has been identified by experts as the world's leading description of a health service for children, and the health services of the world are now coming to us to learn how we went about writing it. They will use it as a model to try to move their health services forward. My hon. Friends and I can be proud of what the Government have done on children's health services.

Mr. Drew : This week my hon. Friend has been talking about direct payments. In this field, is it possible for the parents of a child with a need for palliative care to draw down those payments, which they may choose to spend on a hospice, to support themselves at home or on some other form of service? Is that what my hon. Friend has in mind?

Dr. Ladyman: That is exactly the situation. Where people are receiving any funding from social services departments, it can be made as a direct payment. Whether that is in respect of the provision for the person being cared for or whether it is in respect of meeting the assessed needs of the carer themselves, there is a duty on the council to make that payment as a direct payment if requested to do so. People can then make their own decisions as to how best they spend that money. It is not legal—at least not at present—for the NHS to make direct payments to people but, in cases where services are being jointly funded by the NHS and social services, people work in partnership and come up with innovative solutions to ensure that those who need them can access direct payments for their care. My hon. Friend is right and people may want to take that into consideration; if they feel they need some respite care by making use of a hospice, they are entitled to do so through a direct payment.

The guidance is there and primary care trusts must use it to identify their needs and the gaps in their service. My hon. Friend the Member for Barnsley, East and Mexborough mentioned a number of PCTs that told a hospice that they would not be providing any funding. The question I would suggest that hospice and my hon.
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Friend need to ask the PCTs is whether they have provision in place to guarantee that no child in their area will need a hospice place. If they have come up with such comprehensive strategies for palliative care for children that they are absolutely confident that they do not need to help fund a hospice, it is perfectly reasonable for them not to offer any funding. But they should not then change their mind at a later date when they discover that they have children who need hospice support, because then they will have to pay for it.

In addition to the guidance, the PCTs will soon be able to use information from the national child health mapping project, which will include palliative care. It will give PCTs valuable information to help with the commissioning of local services and will be available to them next year. Using all these documents and guidance, I would expect PCTs to come up with a strategy for how they will meet the needs of their local populations, providing the full range of palliative care, including care at home or respite care and hospice care. PCTs will then look at where that hospice care might come from, who they will commission it from and how close the local hospices are, bearing in mind that—as my hon. Friends have said—children's hospices cover wide catchment areas.

If needs can be met by using existing resources and existing hospices, then there clearly is no problem. PCTs will commission places for children as and when needed from that provision, and pay a fee that they have negotiated for those services. On the other hand, they might identify a gap in local provision, in which case, they will have to start asking themselves questions such as, "How do we commission that type of care pathway for children who need that sort of care?" They will then ask, "Which partners will join in, how will they fund the development of that service, and whom will they commission it from?" They will look at the voluntary sector and the state sector, and work out a strategy for making sure that all the pieces of the jigsaw are in place.

The hospice will need to ask the PCT what the gaps are in service provision and to consider what it might offer to meet those needs. They could be met not only by providing respite care within a hospice building, as my hon. Friend pointed out; they could also be met by focusing on outreach support services for the child's family in the home, or by sharing the hospice's expertise in palliative care by focusing on training for local NHS staff and local authority staff. In other words, the hospice movement has a lot more to offer than just places in a hospice.

The PCT will then need to plot a way forward. That could involve encouraging the hospice movement to develop a new service, which, in turn, might involve its guaranteeing a certain level of support or investment. On the other hand, that might involve its guaranteeing to take a certain number of days of care, or simply giving the hospice movement sight of its plans, so that the hospice can work out for itself what part of its capacity might be taken up. But in any event, different local areas will need different local decisions and, therefore, different levels of funding for hospice care.

Of course, to meet the demand for palliative care the NHS must be properly resourced, which is one reason why it is currently receiving the largest sustained
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increase in funding in its history. PCTs will be able to use these extra resources to deliver on both national and local priorities, including—as they determine—services for children with life-threatening illnesses. As I said to my hon. Friend, there are no restrictions on possible funding for children's hospices; it is for individual hospices to negotiate funding with the PCTs that they serve. That is why I do not believe that a centrally imposed hospice funding formula or a general uplift in funding for children's hospices is the right action to take. In some areas, PCTs might want to guarantee the lion's share of funding to the local hospice. In others, however, they might not want to make any guarantees, but instead to buy occupancy only as and when needed.

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