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30 Jan 2008 : Column 98WH—continued
David Taylor:
I am grateful for that comment. I declare an interest as a member of the Hospice Hope campaigning organisation in North-West Leicestershire. The hon. Gentleman said that there is no party political edge to this debate, and there really is not, either in this place or in wider Parliament. Does he agree that hospices, particularly children’s hospices, are so embedded in the emotions, culture and lives of their local communities that they get huge and widespread support? The Rainbows children’s hospice in Loughborough, which serves the whole of the east midlands and south Yorkshire, is currently seeking to raise £4 million under its building
for the future appeal. The local radio station, Radio Leicester, which is in its 40th year of operation, set itself a target of raising just £400,000 for that appeal, but it soared past that target and the £500,000 mark and is now almost at £600,000 as the appeal year ends. That is a measure of the support for hospices and children’s hospices, and I am sure that the Government will want to reflect on that. What they did a few years ago in giving a short-term boost was very popular electorally, and could be so again.
Bob Spink: The hon. Gentleman is right to raise the issue of children’s hospices, which are a very special sector of the hospice movement. It is much more difficult for the adult sector to raise funds. Donations and legacies to the adult hospice sector provide only 52 per cent. of adult hospice funding, whereas in the children’s sector they provide 79 per cent. Clearly, there is a difference, which the hospice movement wants to resolve.
In the early 1990s, the children’s hospice movement started to emerge strongly in this country, and the Little Havens hospice was built in my constituency. Children’s hospices are different from adult hospices in many ways. However, both share the ethos of providing care during terminal illness and through bereavement, and of treating the whole person, addressing their unique physical, emotional and spiritual needs, as well as supporting those who love them. In addition to providing palliative care, they dispense cheer, optimism and fun in equal amounts. In the early 1990s, I secured the first debate in the House specifically on children’s hospices, in which I highlighted funding issues. Since then, Little Havens has become an outstanding exemplar of all that is worthy and wonderful about all UK hospices. It serves a wide area and is much loved. It is part of the Havens hospice group, which includes Fair Havens in Westcliffe. Our local hospices are equally cherished, and we must ensure that they are equally well funded.
Annette Brooke (Mid-Dorset and North Poole) (LD): Will the hon. Gentleman give way?
Bob Spink: I shall just finish this point. I very much welcome the Essex Havens hospices initiative, which includes and overarches Fair Havens and Little Havens and brings them together. They are not in competition; they are equally wonderful and worthy.
Annette Brooke: I declare an interest, in that I am a patron of Julia’s House, which is a children’s hospice in my constituency. Its chief executive is concerned about Government funding from March onwards. Does the hon. Gentleman agree, bearing in mind all the wonderful work that hospices do, that such great uncertainty—right up to the wire—makes their work more difficult than it ought to be?
Bob Spink: The hon. Lady is extremely wise. She works in this area, and anticipates a point that I shall come to shortly.
Over the years, I have made many interventions and held debates on hospices. Last year, I took the Association of Children’s Hospices and the indefatigable Andy Smith of Little Havens hospice to
see Tony Blair. The then Prime Minister was magnificent. He tossed aside his bureaucrats’ objections and gave the £27 million that we requested to fill the three-year funding gap that had emerged for children’s hospices. He set up a review of funding not just for children’s hospices but for the whole children’s palliative care sector, which supports some 20,000 life-limited children and their families each year. His courage and decisiveness were remarkable.
Subsequently, during business questions, the Secretary of State for Justice and Lord Chancellor, who was then Leader of the House—a great man, indeed—promised me a debate in Government time on this issue. It will cover the review set up by Tony Blair, the new Government strategy that has since been developed, and the solutions needed to protect the children’s hospice movement’s voluntary ethos while protecting the public purse. It will also cover how we can ensure that statutory sector providers such as the wonderful Diana teams are not driven out of existence for lack of funding. The new strategy must deliver fair play in funding for children’s hospices, and for the children’s palliative care sector as a whole.
I understand that the strategy has been finalised, yet no date has been given for its launch. I urge the Minister to reassure the House today that the strategy will be launched without further delay. Equally, can he state exactly how much money has been made available from the Department of Health to primary care trusts for short breaks for disabled children, which children’s hospices provide, and for children’s palliative care in general? The Department for Children, Schools and Families has stated that it is giving more than £280 million to local authorities for this purpose, and we believe that the Department of Health may have matched that funding, but we do not know. As yet, nothing has been confirmed. May I ask the Minister to tell us today—or, if he cannot, to write to me later—how much PCTs will actually get?
It would be wonderful if, starting today, we could see much-needed major funding increases for adult hospices. Let me give some general background. Hospices and palliative care were started by the superb and innovative British voluntary sector, which characterises Britain and helps make it great. Volunteers contribute massively to the hospice sector, which would not exist as it does without them. The Government now have a commitment to providing palliative care, but hospices have never, under any Government, been fairly funded for the services that they deliver. Hospice funding is locally negotiated on an annual basis with PCTs, so funding varies widely across the country and often changes from year to year. That makes it difficult for individual hospices to plan future services.
The Government have agreed that voluntary organisations that deliver public services should be paid the full cost of providing those services, including a proper overhead element. That goal was to be met by April 2006 but it was not achieved, and it is still not clear how the Government will ensure that PCTs deliver on the promise.
The Parliamentary Secretary to the Cabinet Office, the hon. Member for Corby (Phil Hope), replied to my parliamentary question of 21 January. He stated:
“It is legitimate for third sector organisations to recover the appropriate level of overhead costs associated with the provision of a particular service. Third sector organisations are not expected to deliver a public service contract for which they are not reimbursed on a sustainable basis. We recognise the added contribution that some third sector organisations bring over and above the core requirements of public service contracts, for example, through the use of volunteers.”—[Official Report, 21 January 2008; Vol. 470, c. 1545W.]
That certainly applies to the hospice movement.
Despite Government commitments to a level playing field for organisations that deliver public services, charitable hospices face extra costs that statutory providers do not. There is no mechanism to help hospices meet staffing costs or regulation costs such as Healthcare Commission fees. I ask the Minister to agree today that he will review the practice by which charitable hospices are charged the same amount of regulation fees as NHS or private sector health care providers. I hope that he will challenge the health care commissioner’s decision, which is patently unfair. Hospices cannot recover the cost but other organisations can. Hospices raise cash to care for terminally ill people, and, in so doing, take a massive burden off the state. It is rubbing salt in the wounds for the state then to demand payment from the hospice sector for the privilege of delivering that service and taking that burden off the state. A bit of joined-up government is required, and I am sure that if the Minister can—he may have constraints—he will look at that. The NHS does not pay regulation fees out of its budget, and the private sector can and probably does bill its clients in full for its regulation costs. I hope that the Minister will give an undertaking on that.
From 2008-09, fairer funding for palliative care was to be achieved through payment by results. That system should be based on agreed national costs for specific services. It should be auditable to protect the public purse, and it should ensure that hospices are paid for providing services. However, the timetable for implementing the system is no longer in place. While hospice funding will be considered as part of the Government’s forthcoming end-of-life care strategy, it remains unclear how the Government will meet the cost of care provided by hospices on behalf of the NHS. I respectfully ask the Minister to clarify the policy on that.
I shall try to rush through, Mr. Williams, as many Members wish to speak. The public cherish our hospice movement, as I know you do, sir. An independent survey found 97 per cent. satisfaction among people whose loved ones had received hospice care. Would that the NHS had such satisfaction levels, although I praise and congratulate the hard-working and dedicated doctors and nurses in the NHS.
May I quote The Guardian—I do not often do that—of 9 April 2007? It stated:
“An Ipsos MORI poll commissioned by the charity”—
“found more than three-quarters of respondents said the government should pay at least half the cost of hospice care.”
I accept what the Minister said about arbitrary and unfair funding and not protecting the public purse. We have to find a formula to provide funding on a rational and fair basis. The quote to which I referred continued:
“But adult hospices in England receive on average just a third of their costs from the government, with some receiving much less. Most are suffering a real-terms cut in funding.”
Let me cut to the bottom line. Hospices are not asking the Government to meet all their costs, but just to give fair payment for services that the NHS would otherwise have to provide. As the current Prime Minister promised when he was Chancellor—he made the promise to me personally—
Bob Spink: A great man, yes. I am tempted to bring in other promises that the Prime Minister made. The European Union debate is going outside this place.
The gap between what hospices in England spend on NHS patients and what the NHS contributes is estimated to be £150 million to £200 million a year and it is widening, according to the National Council for Palliative Care’s submission of 1 August 2006 to the end-of-life care strategy. The Government have indicated that they will undertake funding for hospices as part of the end-of-life care strategy announced in July 2006, but we still need to see the colour of the money. We need urgent action to ensure that hospices, which are now sinking faster and deeper into deficit, can at least maintain current levels of service. We do not want to see cuts. We must all accept that the services that hospices provide will probably grow in future, and that is what we want to see.
There can be no doubt that the hospice movement needs Government action now. The Government must provide full, fair and nationally consistent payment for the care that is delivered by charitable hospices on behalf of the NHS. They must ensure that future funding arrangements are flexible enough to enable hospices to provide high-quality sustainable services, whether in a hospice building or in the patient’s home. The Government must continue working with all palliative care providers to determine how they will meet the costs of core hospice services, as part of their commitment to patient choice at the end of life and as part of the anticipated end-of-life care strategy.
We would like to see the Government back their commissioning guidance with stronger enforcement to ensure, for instance, that PCTs always offer hospices funding contracts for at least three years, that funding is agreed before the start of the financial year, and that payments are met on time to enable financial planning and security and to prevent cuts.
Mr. Mark Francois (Rayleigh) (Con): I am grateful to my hon. Friend for giving way. I apologise to him and to you, Mr. Williams—I am involved in the debates in the main Chamber on the energy elements of the Lisbon treaty, so I am just nipping in to make a point and then nipping out. I mean no discourtesy and I hope that other Members in this Chamber will understand what I am trying to do.
I support my hon. Friend, particularly regarding the point that he just made about primary care trusts supporting hospices. I hope that the South East Essex primary care trust will do more to support Fairhaven hospice, which is local to my hon. Friend and to our colleague, my hon. Friend the Member for Southend, West (Mr. Amess). Fairhaven is an important hospice
that does good work. I hope that the PCT will take that into account, even though it is under financial pressures of its own, in helping that hospice to do so much good work for people who so desperately need its help.
Bob Spink: I am grateful to my hon. Friend and parliamentary neighbour for supporting this debate. We had a meeting with our local hospices just a week ago, and we both know about the superb work that they do locally. I will come to that in my concluding remarks.
I hope that the Minister will agree to meet a delegation from the adult hospice movement to discuss these issues and share a cup of tea. I suspect that he will; he is a highly distinguished Minister and a caring man. After I have said that, he can hardly deny me the meeting. We must ensure that solutions continue to be developed to the adult hospice funding problems, just as we are doing for the children’s hospice sector.
I thank Members for their patience in listening to me today and for their support, and I thank all those who work with or raise funds for the Havens hospices in Essex, which my hon. Friend the Member for Rayleigh (Mr. Francois) has just mentioned. He will agree that they are all true stars.
Hywel Williams (in the Chair): Order. I remind Members that we intend to start the wind-ups at 3.30 pm. I therefore appeal for contributions to be brief.
2.53 pm
Ian Stewart (Eccles) (Lab): First, I congratulate the hon. Member for Castle Point (Bob Spink) on securing the debate. He and I do not always agree, but on this issue I fully support him and the comments he made during his contribution. He must be congratulated on his sustained and powerful advocacy on behalf of the hospice movement.
I wish to recognise the wonderful work of the hospice movement in general and specifically the work of the staff both at St. Ann’s adult hospice and at Francis House children’s hospice. I am conscious that time is limited so I will mention only St. Ann’s adult hospice, but my comments apply equally to Francis House children’s hospice.
I welcome the Government’s investment in hospices, including the recent £50 million for refurbishment, and for their end-of-life care strategy. However successful our preventive health strategies may be, there comes a time when we have to deliver for the people both the choice of where, and the way in which, they die. That is vitally important for those of us who have gone through the hospice system with our loved ones who have come to the end of their lives. It is only when we go through that process personally that we fully understand just how wide and deep the provision is in the hospice movement. That applies not only to the patient—the person coming to the end of their life—but to other family members’ experience of a hospice, which is equally important because it sets the attitude of families about the hospice movement and the contribution that it makes to health and end-of-life
care. The hospice movement helps to deliver dignity and respect and a death that is as pain-free as possible. That is a significant challenge for any health care provider.
Although many people express a preference to die at home, we all know the high regard that patients and relatives have for our hospices, which are a source of expertise and solace. They offer outreach work for those who are dying at home and they also offer training, both of which are greatly valued.
I would like to mention the work done by St. Ann’s hospice and I am sure that my neighbour, the hon. Member for Cheadle (Mark Hunter), will also support it. He has actively provided excellent support for the hospice movement, particularly St. Ann’s. I try, in my own way, to help co-ordinate information going to all Greater Manchester MPs from all parties. Although this is a very political issue, it is a non-partisan one.
St. Ann’s hospice, under the excellent stewardship of its chief executive, Terry McDonnell, serves my constituents and all residents of Greater Manchester. St. Ann’s is one of the largest adult hospices in the UK with 60 in-patient beds. Although cancer-related conditions account for about 95 per cent. of all hospice admissions, St. Ann’s services are available to patients with any life-threatening illness. The hospice provides care free of charge to more than 3,000 people each year across three sites. Some 42 per cent. of patients admitted to St. Ann’s Hospice return home after treatment. Patients are involved with their personal plan of care, which is tailored to meet their needs.
St. Ann’s was voted the second-best company to work for in Britain in 2005—not only the second-best hospice—and has been listed by The Guardian as one of Britain’s top employers in 2007. On my regular visits to St. Ann’s I am always struck by the dedication and expertise of the staff and the atmosphere of serenity and, perhaps strangely, conviviality, experienced by my family and others.
The hospice movement leads the way in palliative and end-of-life care. It needs more Government assistance, but it must remain independent to be free to develop innovative practices from which the NHS can learn and benefit. Like other hospices, St. Ann’s needs to raise £16,000 a day, every day, through voluntary contributions to offer its wide range of services. It costs £8.75 million to run the hospice annually and 35 per cent. of that comes from the Government. More than 80 per cent. of every pound of its income is spent on patient care. Good quality care does not come cheap. For example, £97 pays for one out-patient session; £63 will cover the cost of one session with a bereavement counsellor; £265 is the cost of looking after an in-patient for one day; and it costs £500 to run one of the hospital’s ambulances for two months.
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