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Jeff Ennis: I have been listening closely to the many telling points that the Minister is making about this emotive and complicated issue. Does he agree that this negotiation model—it has arisen from discussions between communities and PCTs, and I fully support it—is more likely to prove successful for adult hospices that have to negotiate with a maximum of three different PCTs, given the defined area that they cover? Children's hospices, however, will have to get involved in mass negotiation with up to 27 different PCTs, as I have pointed out. Surely the Minister can see that the sheer volume of such an exercise will create problems, and that it will be very difficult for children's hospices to find their way through that negotiation maze.

We are talking about a new funding structure for adult and children's hospices that involves PCTs. I understand the Minister's argument about not wanting to provide a certain level of core funding for children's hospices, but can he guarantee to me now that under the new formula and the new negotiation structure, current NHS funding for children's hospices, which stands at less than 5 per cent., will be increased massively, so that they will have not only a short-term but a long-term future?

Madam Deputy Speaker (Sylvia Heal): Order. That was a lengthy intervention.

Dr. Ladyman: I regret that I cannot give my hon. Friend the guarantee that he seeks. I can give him the guarantee—I believe that it is the duty of any Health Minister to give it—that every child who needs palliative care will receive it. We have to make a judgment on the needs of the individual child, irrespective of whether the care is delivered in the hospice movement, in hospital, at home or in any other environment. What primary care trusts must do is ensure that they have a framework in place whereby they can guarantee that every child in the area will receive the individualised palliative care that is necessary. As I said, whether or not that happens through the hospice movement is a matter for the PCT to decide.

I can guarantee for my hon. Friend that we have described what the palliative care should look like, and I shall say a little more about that in a few moments. Once the national service framework is implemented, I guarantee that every child will get palliative care as required. The Government are committed to maintaining that if we continue to be responsible for these matters. We can give this guarantee: every child will get the palliative care, because we will implement
 
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the NSF for children. Whether that translates into a general uplift of funding for the hospice movement, however, is not a guarantee that I can offer. It may well do, but I cannot guarantee it. My guarantee applies to the outcomes and relates to the quality of life and health of our children.

As to the negotiations, I recognise what my hon. Friend said about the problem of engaging with multiple PCTs, but I can suggest two mechanisms to help resolve it. First, in many areas within a strategic health authority, the PCTs—they are used to commissioning specialist services that cross many boundaries—will often appoint one PCT as the lead negotiator.

Secondly, I can suggest a new mechanism. It has not been used in connection with children's palliative care, but there is no reason why it cannot. My hon. Friend will know that the Government introduced the Children Act 2004, under which a director of children's services has a duty to examine services for children across an entire local authority area. One of those duties is to co-operate with PCTs in developing plans for children's services. It applies vice-versa, as PCTs have a duty to co-operate with the director of children's services. If such a director believes that there are gaps in the palliative care provision in the local area, he may instruct PCTs to deal with the gap in their local delivery plans. That could lead to increased support for a local hospice movement and the PCT could even decide that the most practical person to lead the negotiations with the local hospice movement is the new director. The mechanism has not yet been used because the directors are only just being appointed, but there is no reason why it cannot.

For all those reasons, I do not believe that a centrally imposed formula for hospice funding or a general uplift is the right way forward. Nor, in my view, could an uplift in funding be based on some predetermined linkage to adult hospices or a pre-set percentage of hospice running costs, rather than on allowing the level of NHS funding to be determined by the NHS commissioning arrangements.

I share my hon. Friend's desire to see the children's hospice movement succeed, but I cannot agree with centrally designed solutions. Children's palliative care needs to go far beyond centrally imposed solutions. A primary care trust could not be expected to ensure a proper balance of provision or full availability of home care in the area if it were told that, irrespective of what it needs, it must fund an arbitrary proportion of hospice costs even though it had no strategic role in planning those hospices or commissioning their services.

My hon. Friend the Member for Barnsley, East and Mexborough has to remember that the money all comes out of the same pot. If we insist that more money goes into the hospice movement, there will be less left in the pot for other forms of children's palliative care.

Directing PCTs to fund hospices by some given percentage would unbalance the essential mix of care. Favouring hospice care over home care could diminish the latter. We would also be acting as if we were more aware of the changing dynamics of local demand than PCTs, and that is not the case.

That does not mean that the centre is without a role in securing the right level of hospice services. That is why, in September 2004, we launched the national service framework for children, young people and
 
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maternity services. It includes a module focused on support for the disabled child, with a section specifically setting out our vision for palliative care and the support of children with life-threatening illness. It clearly identifies that high-quality palliative care services should be available for all children and young people who need them.

The NSF notes that palliative care services are provided by a network of agencies, including the NHS, children's hospices, the voluntary sector, and the social care and education services. Co-ordination and close liaison between agencies is therefore essential. It also notes the importance that we attach to recognising the changing needs of young people receiving palliative care as they move through and on from children's services.

The NSF makes it clear that local authorities, PCTs and NHS trusts are to ensure that palliative care services provide high-quality, sensitive support that takes account of the physical, emotional and practical needs of children or young people, and their families, including siblings. Services must be sensitive to the cultural and spiritual needs of the child, young person and family. Services must also maximise choice, independence and creativity to promote quality of life, and they must be delivered where the child and family want—in the home, hospital, hospice, or other setting. Services must include the prompt availability of equipment to support care, access to appropriate translation services, and workers skilled in using communication aids.

Palliative and terminal care services must be regularly reviewed with parents or carers, children and young people, and gaps in provision identified and addressed. Short-term breaks, palliative and community health services and social care services for children and young people with life-limiting conditions and/or complex health needs must be planned in partnership with voluntary sector providers and children and young people's hospices, in those localities where they exist.

All these basic standards are set out in the NSF and, as I said earlier, their achievement is mandatory for the NHS by 2014. To help in achieving this standard, I can tell my hon. Friend the Member for Barnsley, East and Mexborough that we will soon be publishing a practical guide to children's palliative care for PCTs, reinforcing the need to commission a range of services to meet the palliative care needs of local children. That is a new announcement, so my hon. Friend has achieved something this evening.

In conclusion, I am mindful of the invaluable contribution that children's hospices make towards the needs of children and young people who have life-threatening illness. However, I firmly believe that they will be served best by a partnership between the NHS and voluntary sector organisations that continues to value the contribution that both sectors can make, and that funding and planning decisions are best made locally by people who know the local area.

I suspect that I have still not convinced my hon. Friend the Member for Barnsley, East and Mexborough, but I have done my best, and that is all that I can do.

Question put and agreed to.




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