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30 Jan 2008 : Column 111WH—continued
3.23 pm
Mark Hunter (Cheadle) (LD): It is pleasure to contribute to this debate under your chairmanship, Mr. Williams. I congratulate the hon. Member for Castle Point (Bob Spink) on securing this important debate on hospice funding. I would also like to thank him for being one of the first MPs to sign my early-day motion, tabled last year, on St. Ann’s hospice in Heald Green, in my constituency. This issue is very close to my heart and I and other Members feel very strongly about it.
I have visited St. Ann’s hospice on many occasions and have seen for myself, in both a public and personal capacity, the truly exceptional work that hospices do and the difference that such provision makes for those in need of palliative care and their families. I continue to be genuinely shocked by the lack of Government support for all the hospices that play such a vital role in the national health service. Despite Government assurances that the voluntary organisations that deliver public services should be paid the full cost of providing such services, hospices still receive, on average, only one third of their total costs.
St. Ann’s is a case in point. As the hon. Member for Eccles (Ian Stewart) pointed out, it receives only £3 million out of the £9 million that it needs each year, so it has to find the other £6 million itself. That equates to a whopping £16,000 a day. Surely the Government want such hospices to spend more of their time providing the excellent care that the NHS needs, rather than having to spend time and energy raising so much money each and every day of the year.
Charitable hospices provide 80 per cent. of adult in-patient palliative care beds, yet their funding has dropped in real terms over the past few years, leaving 28 per cent. of independent hospices in deficit in 2006. Palliative care is a core service for patients—it is not, and never has been, an optional add-on. If independent hospices cease to exist, the NHS will have no option but to pick up the slack. The Government should be acutely aware of that fact and address the funding shortfall while there is still time. We do not want excellent hospices such as St. Ann’s and the others that have been mentioned today to be unable to continue because of short-sighted funding arrangements.
We are all aware that hospices ask only for a level playing field; they want to be treated in the same manner as other NHS service providers. Hospices such as St. Ann’s fulfil a necessary function in a society in which debilitating and life-threatening diseases such as cancer are sadly on the rise, and they do so in a manner that is truly laudable. They provide a unique and personal service that improves the quality of thousands of patients’ lives. They also support patients’ families and carers. When the Minister responds, I hope that he can tell us what action the Government intend to take to put right this desperate situation, and to ensure that hospices get the stable funding regime they so desperately require.
3.58 pm
Greg Mulholland (Leeds, North-West) (LD):
I congratulate the hon. Member for Castle Point (Bob Spink) on securing this debate, and I pay tribute to him
for his consistent commitment to hospices. I also pay tribute to all the other Members who have contributed; they have provided powerful accounts of their experiences of the hospice movement in their constituencies. We are all very aware of the wonderful work that hospices do in dealing with those who have a terminal illness. Hospices provide not just palliative care but a whole range of services—a point that often does not come out—including not only skilled nursing care, pain relief and counselling, but activities such as art, music and physiotherapy. Of course, hospices offer services not only for patients but for their families, as other Members have made clear.
The key issue is, and the purpose of the debate is to discuss, the consistency of funding across the hospice sector. Members on both sides of the House have related some very interesting and concrete examples. Each and every hospice faces a struggle month on month, year on year, to secure the funding that it needs to continue doing its vital work. We have heard from Help the Hospices that, on average, just 34 per cent. of funding comes from Government—a little over one third. I think that we heard a slightly lower figure for Wales from my hon. Friend the Member for Ceredigion (Mark Williams). Of the £1.2 million needed by hospices every day, only £360,000 comes from the Government, so every day hospices have to find an extra £840,000 to carry on their work.
Inequality of funding—I am referring to the proportion of money that hospices receive—has been touched on. For some, it is potentially as high as 62 per cent.; for others it is considerably lower. My hon. Friend the Member for Cheadle (Mark Hunter) made the point, which was clearly not acknowledged by the Minister, that funding for hospices has dropped in real terms in recent years. That is putting considerable extra pressure on the hospice movement.
In speaking on behalf of my party from the Front Bench, I point out that I am proud to have a hospice in my constituency—Wheatfields hospice, in Headingley. Like the other examples that we have heard about, it does wonderful work in dealing with patients and their families in the tragic situation of the end of life. Wheatfields needs about £2.25 million every year to keep going, and the Wheatfields fundraising team has to raise approximately £1 million a year for it to continue its work. I have visited Wheatfields and seen the amazing fundraising operation—the remarkable and professional sales that it organises all week, and the twice-weekly public sales. It runs a joint lottery with the equally excellent St. Gemma’s hospice, in the constituency of my neighbour, the hon. Member for Leeds, North-East (Mr. Hamilton). Together, they run a lottery and do so much for that area of Leeds.
The key point that has been brought out, particularly by the hon. Member for Castle Point but also by my hon. Friend the Member for Cheadle and others, is that we do not have equity with other areas. My hon. Friend said that there is not a level playing field, and the hon. Member for Castle Point referred to unfair treatment. The message is clear: there simply must be equity for hospices and other partially funded sectors of the health service. The reality is that we are talking about mainstream NHS palliative care. Unfortunately, the hon. Member for North-West Leicestershire (David Taylor) has left his place, but he
put it very clearly when he said that fundraising should provide add-ons to core services, not the core funding itself. Many people in this Chamber will feel that that was an astute analysis.
Sue Ryder Care has estimated that the state receives about £200 million-worth of palliative care from the hospice sector at no cost to itself. That is the level of contribution that the sector makes. Sue Ryder, which runs the Wheatfields hospice, estimates that it subsidises primary care trusts and social services up and down the country to the tune of £7 million, and that is one organisation. Clearly, this is a real concern for the hospice movement, which I am sure the Minister will acknowledge. I am conscious that the Government are considering the issue, which is why this debate is particularly timely. I hope that the Minister will accept that there are real concerns, and that several questions are being asked in the hospice movement about funding, equity and the differing proportions of funding for some hospices.
Liberal Democrat Members welcome the grant that was announced to refurbish hospices, but as I am sure the Minister will acknowledge, that is not a long-term answer to the questions being posed. In the new strategy, will he commit to an increase in hospice funding not only overall, but proportionately? Will the Government seriously consider that? Will he address the issue of equality of funding across the hospice sector? Will he comment on the idea of a tariff-based system for hospice care, which has been mentioned by Sue Ryder? Given the Government’s commitment to full cost recovery and closer partnership with the voluntary sector, the simple question is: why does that still not apply to hospice care, and when will it?
I again pay tribute to all Members who have taken part in this most important debate; I look forward to the Minister’s contribution. One thing that Members on both sides of the House are absolutely committed to and 100 per cent. behind is the view that we must do whatever we can to support the wonderful work done by hospices.
3.35 pm
Mr. Stephen O’Brien (Eddisbury) (Con): I, too, congratulate my hon. Friend the Member for Castle Point (Bob Spink) on securing this very important debate. He is a tireless campaigner on behalf of hospices both in this place and outside it, in his constituency and beyond it. I applaud his priority in campaigning and seeking to hold the Government’s feet to the fire on this issue. His speech and, indeed, securing the debate itself is a touching and fitting tribute to his sister, to whom he paid a tribute in which we all join. I dare say that as a district nurse, she was as inspired as my wife—who is a district nurse by training—by the example of Dame Cicely Saunders and the work that she did in Sydenham. I am sure that that has been an inspiration to all those who have given their lives and careers to nursing and caring for others.
All the speeches today have shown the deep care and genuine compassion that we have as elected representatives on behalf of all our constituents, particularly those who dedicate themselves to the excellent work of hospices.
Notwithstanding the fact that health is a matter for the devolved Administrations, we heard speeches from the hon. Member for Ceredigion (Mark Williams) about Wales, and from the hon. Member for Na h-Eileanan an Iar (Mr. MacNeil), whose constituency I regard as the highlands and islands when I enjoy my holidays there.
I pay tribute to the hospice in my constituency. St. Luke’s hospice—another St. Luke’s hospice—in Winsford is absolutely wonderful and it is close to my heart. I spend a lot of time at and have a great deal of concern for that hospice, particularly because my wife has been nursing there as a volunteer over the past eight years.
I echo the concerns expressed by my hon. Friend the Member for Castle Point about the financial stability of hospices throughout the country. He noted that on average every UK hospice has to raise £4,500 a day through fundraising just to continue providing care, and a further £500 a day to fund building expenditure. Of course, those figures can vary from hospice to hospice. He also noted that the number of hospices in deficit rose from 43 in 2005 to 52 in 2006. Against those background facts, a National Council for Palliative Care survey last year found that about 60 per cent. of hospices were experiencing a decrease in the value of the funding contribution from the NHS, in part because of the constraints on NHS cash that applied.
I hope that the Minister will shed some light on why the number of hospices in deficit appears to be rising as we speak. Many people—mainly those who are thinking about continuing to contribute to hospices—are saying to me that they do not understand whether that has to do with financial mismanagement or inefficiency at hospice level, in which case they would lose confidence in that being the right place to send their money, or the Government failing centrally. It would be helpful to have the Minister’s view, to ensure that we send what messages we can from this place and give reassurances.
The remarks of my hon. Friend the Member for Castle Point, who was characteristically gentle with the Minister, were slightly short on emphasising where things have got to. I hope that my attitude will be seen as unaggressive and all-party, but it is fitting that we should be debating hospices in this Chamber when in the main Chamber, a debate is taking place on the Lisbon treaty. There is a great problem in respect of that treaty because one has a real sense—if one is not a Government Member—that one is dealing with a broken promise. We all expected, as a result of the Labour party manifesto, that there would be a referendum.
In contrast to that, here in Westminster Hall the Minister has an opportunity to take the opposite approach, and I am confident that he will take it, given that some 40,000 people per annum receive palliative care in hospices and 120,000 receive some sort of palliative care, and considering the 300,000 people—around two thirds of whom will die each year—who would benefit from some sort of palliative care in the last year of their lives, according to Professor Irene Higginson, head of palliative care policy at King’s college, London.
The Government have promised to double funding for palliative care and to introduce payment by results.
We need to examine those commitments. The 2005 Labour party manifesto said:
“In order to increase choices for patients with cancer we will double the investment going into palliative care services, giving more people the choice to be treated at home.”
That promise to double investment—we take that to mean spending, from the way the Government use the word—was repeated in the 2006 White Paper, “Our health, our care, our say”. However, there is a problem with that: to double anything, one needs to know the number that one is starting with.
Mr. Ivan Lewis: Unless you are a Liberal Democrat.
Mr. O'Brien: I was being non-aggressive.
The Government have said that they do not know how much is currently spent on palliative care. The former Health Minister, now a Transport Minister, the right hon. Member for Doncaster, Central (Ms Winterton) admitted that the
“Department does not routinely collect data on palliative care”.—[Official Report, 14 July 2006; Vol. 448, c. 2170W.]
Will the Minister explain the basis for the Government’s claim that they will double investment? Is that still their position? When can we expect to see the figures?
The Government’s 2005 response to the Health Committee report on palliative care said:
“We remain on course to implement Payment by Results (the national tariff) with respect to palliative care in both the NHS and the voluntary sector by 2008/9”,
which is almost upon us. It went on to say:
“In palliative care the national tariff will, in effect, provide the full cost recovery recommended by HM Treasury’s Cross Cutting Review on Voluntary and Community Sector in Public Service Delivery.”
However, in a letter to me, the former Health Minister, who is now the Secretary of State for Culture, Media and Sport, admitted the following:
“Since this statement was made”—
the statement to the Health Committee—
“our priorities have changed”.
He also said that the Government intended to publish
“proposals for a consultation”
on the future of payment by results, and said:
“This will include discussion of whether and how we can expand the current range of services and providers covered by PbR”.
The use of the conditional “whether” is obviously very significant.
The Minister is here, live, as it were, and we will welcome his answers to those points in couple of minutes. Let us not, on this vital matter, have the normal knockabout by saying “Labour and Health Ministers have broken their promises”, as my hon. Friend the Member for Southend, West (Mr. Amess) so invigoratingly suggested. However, let us examine the context in which the Minister will, hopefully, stand up to give us some welcome news.
The Government response to the Health Committee was issued when the current Prime Minister was Chancellor of the Exchequer. As I said, it stated:
“In palliative care the national tariff will, in effect, provide the full cost recovery recommended by HM Treasury”.
The Treasury gave a commitment in “The Role Of The Voluntary And Community Sector In Service Delivery:
A Cross Cutting Review”, which arose out of the 2002 spending review, that by April 2006, full cost recovery funding should be in place. It stated:
“Funders should recognise that it is legitimate for providers to include the relevant element of overheads in their cost estimates for providing a given service under service agreement or contract...All departments will incorporate the review’s funding recommendations fully into their procurement policies by ensuring that the price for contracts reflects the full cost of the service, including the legitimate portion of overhead costs”—
Those principles were reflected in the compact with the voluntary sector, so I am sure that the Minister will not be content to allow the voluntary hospice sector to continue to subsidise the NHS, two years after such arrangements were supposed to come to an end. The official Opposition promise to implement the national tariff with respect to palliative care. In effect, that will mean offering full cost recovery to voluntary sector providers. I hope that the Minister will join us by doing likewise.
Will the Minister also explain the second delay in the publication of the end-of-life care strategy, which was originally due to be published in the autumn of last year? In response to a parliamentary question on the issue, the Minister told me that publication had been deferred until after the publication of Lord Darzi’s next stage review, but in the noble surgeon’s interim report, no mention was made of end-of-life care, other than to flag up a talking shop on the issue. Will the Darzi review bring forward concrete proposals that will deliver on the Government’s previous promises?
The Government will require the Healthcare Commission and all other regulators in England to recover the full costs of regulation from fees by the 2008-09 financial year, which is almost upon us. In the past, fees for hospices have been at discount rates. The commission works from the principle that the fees should reflect the actual costs of regulation, not what establishments can afford to pay. The commission said:
“We believe that if a special case were to be made for voluntary organisations’ fees, it would be for democratic Government—not the regulator—to decide that public funds or other establishments’ fees should be used to subsidise them...We do however acknowledge that voluntary organisations and small business feel the impact of a fixed overhead such as regulatory fees more acutely than large businesses. Our fees scheme takes this into account”.
The commission has proposed charging increases for 2007-08 of £2,376, which is a frozen fee, for hospices with four or more beds. A hospice with, for example, three in-patient beds, would see the burden of costs rise from £907—that includes a registration fee plus a flat rate for inspection costs—to £2,213, which encompasses the doubling of the registration fee for small hospices, plus the new, increased flat-rate inspection fee, plus the removal of the exemption from the per bed charge for hospices with fewer than four beds. The impact on smaller hospices will be disproportionate, but it also seems to run counter to the commission’s stated goal of
“finding a balance between full cost recovery and affordability for voluntary organisations”.
I hope that the Minister will take a serious look at that.
The Royal College of Physicians has reported that terminally ill patient’s access
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