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30 Jan 2008 : Column 104WH—continued

Briefly, there are still problems. I congratulate the Government, as Opposition Members have done, on the improvements that they have made. However, my constituent, Frances Green, lost her husband Denis recently. She knew that he was dying and had to be taken to St. Ann’s hospice. St. Ann’s tried to get an ambulance to take him from home to the hospice but could not, so the family had to ring the normal ambulance service and explain that the hospice required him to be taken there. For them to be told that there would be no ambulance available from the time
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they phoned, around 1 pm, until 12 midnight is unacceptable. We must look not only at the hospices, but at the surrounding services that families need to call on.

Needless to say, St. Anne’s is as inventive as anyone in raising funds, but it believes that the Government should give more money to hospices, and I support that view. Our hospices offer a wonderful service, but they could do even better if they knew that their funding was secure, and could channel all their energy into delivery of care for patients and their families. The way in which we treat family members of someone who is receiving end-of-life care and palliative care is a measure of our society and decency. I know that the Government, particularly the Minister—we have been together to the Rainbow Trust and other hospice movement events—are sincere. We must turn that sincerity into an identification of how we can improve the situation and the relationship between the hospice movement and families, and the hospice movement and the NHS. I hope that the Minister will listen carefully to the points made by the hon. Member for Castle Point, and I hope that he will address the issues that I have raised. I know that he will try to do so.

3.1 pm

Mr. David Amess (Southend, West) (Con): I congratulate my hon. Friend the Member for Castle Point (Bob Spink) on securing this timely debate, and I agree with everything that he said. I am delighted that my hon. Friend the Member for Rayleigh (Mr. Francois) was able to intervene. My hon. Friend the Member for Rochford and Southend, East (James Duddridge) would have been here, but his wife has just had a baby, so I am sure that hon. Members understand why he is not.

No hon. Member this afternoon will say that hospices are not wonderful, and the Government think that they are wonderful. All that is understood, but I want to ask the Minister for something. There is no point in hon. Members having Adjournment debates if we just read out our speeches and send out press releases, and they are then forgotten about. I like Adjournment debates that achieve something tangible. I achieved something tangible when I raised the subject of St. Luke’s hospice on 24 May 1985. The then Minister who responded, now Lord Patten, listened to me and delivered.

The Minister will gather that there is a particular crisis in funding in Essex, which I raised in a pre-Christmas Adjournment debate. The conscientious deputy Leader of the House referred the matter to the Secretary of State for Health, and a letter arrived from him two days ago, which I am pleased with. However, as the Minister said during his intervention, the answer is: “Yes, the Government support hospices; yes, the Secretary of State is getting more money from the Treasury, but at the end of the day it is down to the primary care trust.”

I am looking the Minister in the eye and saying that that is a cop-out. The Government say that they are giving more money to the primary care trust, which is responsible for deciding how it allocates it, and that is technically correct. I ask the Minister to listen to what
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I and other hon. Members have said, and to give a message, at least to my primary care trust, that it should be supported and receive more share of the cake. I am sure that if he gave that message, my local primary care trust would listen to it.

Dame Cicely Saunders was responsible for developing the hospice movement in the 1960s at St. Christopher’s hospice in south London. That inspirational lady said that

Until I became a Member of Parliament, I had no experience of the hospice movement. I witnessed a miracle in Basildon, because we had a plot of land and we built a hospice with no wealthy benefactors and no largess from this Parliament or the European Parliament. The Duchess of Norfolk opened it—

Mr. Ivan Lewis: Just before you left.

Mr. Amess: —and Princess Diana came to launch a strategy that we enjoyed in the hospice. St. Luke’s hospice in Basildon has become an enormous success.

My next point for the Minister is that the role of hospices has changed enormously. They are no longer add-ons. They provide core services.

David Taylor: The hon. Gentleman is absolutely right. The service has developed to include day care, essential respite care, which is the most crucial of all, and terminal care, for which hospices are well known. Because of the value that hospices provide, we should be close to the last days of their finances depending on weekly raffles, cake stalls, and collecting tins. Important as those are, they should not provide core funding; they should provide add-ons to improve the quality of service, not the fundamental day-to-day, week-to-week funding of £50,000 a week that the Rainbows children’s hospice in Loughborough needs merely to survive. That must not be allowed to continue.

Mr. Amess: The hon. Gentleman, as always, makes an excellent point. Fair Havens hospice in my constituency receives 72 per cent. of its funding from charitable giving, which is huge. The hon. Gentleman also made an excellent point earlier about children in hospices. We found locally that everyone will give to children’s hospices, but it is a great struggle at the moment to raise money for hospices for older people. I represent the area with the most senior citizens in the country, and we have a particular crisis.

To return to the point that I want to make to the Minister, I have spoken about St. Luke’s hospice in Basildon. He could not resist making his little gibe, but I just smiled broadly at his little joke. When I became the Member of Parliament for Southend, West, I was delighted to find that it already had a hospice—Fair Havens—which was founded 25 years ago by Dr. Michael Stuart and Mrs. Daphne Hall, two wonderful people. But 25 years on, it can no longer survive just on charitable giving. We have a real crisis.

The range of services is first class, as was the most recent Healthcare Commission inspection report. Fair Havens provides day care, community Macmillan nursing, home care, spiritual and pastoral support and diversional therapy treatment. When I think of those
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heady days in Basildon, I remember the founder of St. Luke’s hospice. Trudy Cox was a district nurse who, when out nursing once day, went into a lady’s bedroom and found her dead with the children gathered around the body, not even realising that their mother had died. She resolved that she would never, ever allow anyone to die in such circumstances again. That is why she became so involved with the hospice movement, as did Cicely Saunders.

We have a crisis of funding. I have any number of testimonies to Fair Havens hospice’s wonderful work in Southend. It costs £2.6 million a year to run with only £600,000 provided by the Government. During 2007, Fair Havens has experienced progressive difficulties in fundraising. I am not being party political, but the worldwide economy is in difficulty, so we are finding that it is not as easy as it used to be to raise money locally, and that trend will continue.

The hospice receives a sizeable grant from the primary care trust, but it simply is not enough to cover costs. Fair Havens will experience a funding deficit of £250,000 in the period to 31 March 2008 and another £250,000 shortfall soon after, bringing the total deficit to £500,000. Although the funding that it receives from the PCT has increased by 8 per cent. in cash terms over the past four years, that funding has decreased by 6.8 per cent as a proportion of total care costs.

The reasons for that are clear: increased demand, the negotiated contract with doctors, increasing salaries for nurses—a number of things have added to the financial crisis. At a time when Fair Havens has been increasing its services and stepping in to help plug the gaps that have been opening up in the publicly funded sector, it has suffered a real reduction in its funding from the PCT. Staff costs, have risen from £135,000 a year and will reach an anticipated £243,000 this financial year, which is an 80 per cent. increase. Without the staff, one can hardly run a hospice.

If the situation is not addressed, the number of beds at Fair Havens will have to be cut, the at-home service will be halted, the hospice’s Macmillan nurses will find that they cannot be employed and the bereavement and family support services will also have to be cut. The hospice immediately launched a funding campaign and is trying to raise £250,000 by 31 March. The appeal has raised £32,000 and hopes to raise £100,000 by Valentine’s day, and all local Members of Parliament will be supporting it.

To conclude, I repeat that there is no point hon. Members having an Adjournment debate if we simply smile at one another and share platitudes, but nothing happens. I ask the Minister please to send a message to my local PCT asking it to support Fair Havens hospice.

3.12 pm

Mark Williams (Ceredigion) (LD): It is a particular pleasure to serve under your chairmanship, Mr. Williams. I pay tribute to the hon. Member for Castle Point (Bob Spink) for securing this important debate. I know that he feels strongly about the issue and has a fine record of campaigning on it.

When I looked at the World Health Organisation’s definition of palliative care, I was struck by the size of the issue. The definition referred to

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In practice, that involves a huge range of services, including occupational, physical and complementary therapies, as well as core medical services. It is a vast area, but care, by its very nature, must be tailored to the needs of individual patients, their families and carers.

In discussions with the hospice movement, all hon. Members will be clear that there must be a partnership between the national health service and the hospice movement. The movement strongly feels that it is best equipped to deal with the innovative practices that we need to develop, and I shall come later to how that work will be resourced.

Let me start, however, by paying tribute to the hospice movement, which has been at the forefront of developing special services and raising the profile of the care given to the dying. In my constituency, we are privileged to be served by the charity Beacon of Hope, which was set up in 2000 by Mrs. Elizabeth Murphy. The charity provides immediate comfort and ongoing practical support to people in Ceredigion with terminal and life-limiting illnesses. It subscribes to an holistic package of care, which complements nursing care and supports carers, and includes a volunteer service to help with respite, which is crucial, as the hon. Members for Castle Point and for Eccles (Ian Stewart) said. The charity also provides bereavement counselling and runs a limited benevolent fund.

Mrs. Murphy told me that the problem facing Beacon of Hope—the experience of many hospices across the UK—is that a range of possible funders will not fund capital or revenue costs. When asked what they fund, people say “Projects”, but projects must surely involve a capital or revenue-cost dimension. Other funding streams, such as the lottery, are laudable, and I do not denigrate them in any way, but they have often changed their criteria for awarding grants. Some changes have hit hospices hard and caused immense frustration in the sector. Beacon of Hope secured a three-year voluntary community and sector grant of nearly £250,000 from the lottery, but that has now come to an end. The lottery’s criteria have changed, and funding now comes through the people and places programme, which has new criteria, based on revitalised communities, improved community relations and enhanced local environments. That has not helped the charity to secure the kind of funding that it requires.

I was slightly surprised when the hon. Member for Castle Point talked about the proportion of funding that he was looking for, and I understand what the Minister said in his intervention. In the Welsh context, Beacon of Hope wants core funding in the region of 50 per cent. and is confident that it can continue to raise the sums it requires from its local community.

Bob Spink: I was trying to say that there should not just be an arbitrary percentage. The figure might be 40, 50 or even 70 per cent., but the point is that there should be funding from the public purse for the core services that the hospice sector provides and that the NHS would otherwise have to provide.

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Mark Williams: I am pleased that the hon. Gentleman made that point, particularly given that some charities are looking for an upper threshold.

The sad reality for adult hospices in Wales is that only 36 per cent. of funding comes from the Government, and I gather that the figure is little more than a third for hospices in England. Beacon of Hope’s running costs next year could amount to £400,000, not least because there is renewed demand for its work, which it hopes to expand much further.

That is not a criticism of the Government—I applaud what they have done, in so far as they have done something—but Government policy in Wales has been characterised by a series of not insubstantial yet, critically, one-off announcements that have not addressed core funding. Last October, funding of £2 million was announced and £10 million was announced in 2003, but the kitty is very limited and will not address concerns such as those expressed in Essex, which the hon. Member for Southend, West (Mr. Amess) mentioned.

I want to draw a distinction between hospices in urban and rural settings. Alarmingly, a 2005 report dealing with mid-Wales identified no palliative care service that met the definition of specialist levels of service across the whole of Powys and Ceredigion. That shortfall is now being partly met by charities such as Beacon of Hope and by the excellent Ty Geraint facility at Bronglais hospital in Aberystwyth, which was named after one of my predecessors in the House, and provides some palliative services.

I want to focus, however, on the challenge of providing hospice services in a rural area. The hon. Member for Eccles talked about the outreach work of St. Ann’s in his constituency, but outreach work is hospice provision in rural Wales. Mrs. Murphy of Beacon of Hope told me that it is highly unlikely that there would ever be one dedicated building to provide services in a big rural area such as Ceredigion. Schemes such as the charity’s palliative hospice at home service are much more responsive to the needs of community, and it is for such services that the charity needs its core funding. Beacon of Hope has recognised the importance of those services and last year set up a three-month pilot scheme, with two contracted nurses and 10 bank nurses responsible for 350 hours of care in some of the most remote rural communities that one could imagine. That is very important in areas such as mine.

As hon. Members have said, we are talking about lifting the burden from the national health service, which is why core funding is so important. In Wales, as in England, a review is being undertaken. The palliative care planning group set up by the Assembly is looking into the issues.

Hywel Williams (in the Chair): Order. I remind the hon. Gentleman that health is largely devolved, and not a matter for this place.

Mark Williams: Thank you, Mr. Williams. It is particularly appropriate that you should remind me of that. I was complimenting the experience of Wales and its interface with England. The message is the same. From whichever side of Offa’s dyke we function, the issue is much more than the laudable shaking of collection tins on street corners; the need for core funding is
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something that Governments on both sides of the border must address. I wish the reviews the best of luck in both England and Wales.

3.20 pm

Mr. Angus MacNeil (Na h-Eileanan an Iar) (SNP): I congratulate the hon. Member for Castle Point (Bob Spink) on securing the debate, which highlights the real and valuable work that hospices undertake. I am aware that the hon. Member for Cheadle (Mark Hunter) is anxious to contribute to the debate as well, so I will be brief.

I want to highlight some of the difficulties that are faced by people who carry out valuable work, and in some cases good Christian work. The Bethesda care home and hospice in Stornoway on the Isle of Lewis is one such great example. It is a charitable institution that provides excellent and conscientious care. Based in the heart of the community, the hospice raises a lot of money locally for its vital work. I would not be surprised to hear that relatives of the Chancellor of the Exchequer, whose mother lives on Lewis, had benefited from the hospice’s professional compassion. The funding and the services provided by the care home and others like it help the Government. Unfortunately, the help is not always reciprocated, although I am sure that is something the Government will try to rectify in the best way they can. I see that I have the Minister’s attention on that point.

To meet the requirements of new legislation, the already excellent Bethesda care home and hospice has to upgrade its facilities and build an annexe, for which, unfortunately, it has to pay VAT. Although the institution already reduces the burden on the state, it will have to pay an extra £94,000 as the construction takes place. It has to pay VAT because there has been no decision from the relevant VAT office. I have a letter from the Financial Secretary to the Treasury, which starts, “Dear Angus” but then vacillates a little about the decision. In the last paragraph, as far as I and the chief executive of the hospice can make out, the Treasury seems to indicate that zero VAT would be appropriate.

Surely, when tax collectors vacillate, there is no case for raising the tax at all. The current indecision is costing £94,000, which should be used for patients. Worse, it will not be possible to claim or debit the VAT through the contractor, and the hospice will have to go through the long and tortuous process of VAT reclamation, if it is determined that zero VAT is the correct decision.

Should charitable institutions spend money, which has been raised through hard work and community good will, on VAT? I urge the Minister to use his powers and influence to push for the correct decision. We cannot continue with the current limbo that is costing us so much money. It is a scandal that such charitable institutions have to pay VAT. I am not asking for changes in VAT designations, I simply want to ensure that Bethesda is in the correct classification.

We do not want Bethesda to be taxed to a standstill. We want it to continue its good work. The hospice is valued in my constituency of Na h-Eileanan an Iar and provides a tremendous service on the Isle of Lewis. I commend it to all hon. Members as a great example of
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what can be done when the will is right. I hope that the will of the Government—the Minister is nodding—is to achieve a zero rating and to help the hospice continue its good work.

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