Hospices: Funding

Baroness Finlay of Llandaff Excerpts

Thursday 24th October 2024 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the noble Lord, Lord Farmer, and I declare all my interests in relation to hospices and palliative care, especially in Wales.

In 2008, the Welsh Government Health Minister Edwina Hart commissioned a strategy for palliative care. That report recommended that there must be fair access to specialist palliative care as a core service, available at all times, wherever the patient is, with patient information. I had the privilege of being asked to lead this work, and I had a budget of just over £2 per head of population. Together with my colleague, Dr Andy Fowell—who, tragically, died recently in a cycling accident—we created a funding formula to plug gaps and move specialist medical staff on to NHS contracts to ensure that they could integrate with oncology, surgery, anaesthesia, emergency departments, and so on. We stipulated a minimum number of actual or virtual beds for a population, and minimum staffing levels of specialist care in the community and in-hospital support teams. We set quality standards for rapid response to referrals, stimulated research and ensured education and training. I pay tribute to my colleague Dr Robert Twycross, who died just a few days ago. He was at Oxford and he was one of the great pioneers in research and education. The strategy has driven patient-centred care that meets the needs of every person and their family, especially when children are facing bereavement.

With encouragement, my wonderful colleagues moved on to seven-day pooled rotas to cover nights, weekends and bank holidays. As a colleague said, “We got rid of frantic Fridays and mad Mondays”. Our specialist nurses realised how many crises at nights and weekends could be intercepted when working a weekend or a bank holiday. Work with pharmacists and paramedics is improving access to just-in-case medication and care. For many years, through the Marie Curie Hospice, we have run a 24-hour all-Wales helpline for any health or care professional to get advice on a difficult situation.

In Wales, we created a floor—a minimum—but, of course, it is not enough and we still have workforce gaps, although Welsh Ministers have been unfailingly supportive of hospices and palliative care teams in Wales, despite competing demands, financing that becomes difficult and provision that is especially hard in remote and rural areas.

Research has repeatedly shown that good care costs less than bad care. No one should be told that there is nothing more that can be done. Seeking help and advice from colleagues, and being humble enough to questioningly review a situation, can find solutions to make each day better, accepting the inevitability of death for us all. Will the Government look at the Welsh data to comprehensively review the whole model of such services in England, to ensure that people’s needs are better met and hospices can once again flourish?