Hospice Funding and the NHS Pay Award

Desmond Swayne Excerpts

Wednesday 31st October 2018 Westminster Hall

[Liz McInnes]

My hon. Friend makes an important point: hospices seem to be facing a choice of asking the community to give them extra money, or reducing the service they provide.

[Sir Desmond Swayne (New Forest West) (Con)]

Am I incorrect in my understanding that hospices adopting the full Agenda for Change will receive Government assistance? Perhaps the Minister will clarify that. The difficulty for hospices in adopting it is that they lose control of their salary budget. The difficulty is in getting that balance right, and I hope that the Government will be able to help.

[Liz McInnes]

The right hon. Gentleman is absolutely right. I will explore the Agenda for Change later, because adopting it presents huge difficulties for non-NHS organisations.

The three points from the chief executive of Springhill Hospice were tabled as parliamentary questions. Sadly they received identical answers that included:

“We are considering carefully the impact of any agreement on non-NHS organisations such as hospices that may be affected by the proposed pay deal; however no decisions have been made. Staff in hospices do a fantastic job in delivering world-class care and the Department remains fully committed to improving palliative and end of life care.”

In July, I wrote to the Secretary of State for Health and Social Care, asking for an update on the issue. The response stated that he “understood concerns” that

“hospices may find recruitment and retention challenging if some of their staff choose to leave in favour of organisations that employ staff on the Agenda for Change contract”.

In summary, the Government will finance the pay award for non-statutory, non-NHS organisations only for organisations employing staff on the Agenda for Change contract, which is the nationally agreed set of terms and conditions for most NHS staff. The rationale for that was that:

“Additional funding relies on organisations employing staff on the Agenda for Change contract, because it is the Agenda for Change pay and non-pay reforms that together will help deliver the productivity improvements the Chancellor asked for in return for additional pay investment”.

What are the reforms that can only be made under Agenda for Change? On examination, it seems to be an emphasis on training and apprenticeships and a programme of appraisal and personal development. There is also a slightly vague statement on the improvement of the health and wellbeing of NHS staff, to improve levels of attendance, with a reference to

“positive management of sickness absence”,

whatever that may mean.

The response from Springhill Hospice was grim. The chief executive wrote to me:

“Very few charitable hospices employ their staff on Agenda for Change contracts, and as a result, Springhill Hospice, along with many other hospices, will miss out on the funding being set aside by the Government. This will place us at a considerable disadvantage in recruiting and retaining essential staff to deliver the services that we offer to people with life-limiting illness in this community, and will leave us with a significant additional cost.

Recruiting and retaining skilled staff is a critical challenge for us, and in order to remain competitive, we will have little choice but to increase pay for clinical staff. Over the course of the three-year NHS pay deal, we estimate that this will bring an additional cost to the hospice of in excess of £250,000. Without support from the Government, this extra cost can only be met by asking our communities to give more, or by reducing the services that we provide.

We are already asking our community for in excess of £2 million contribution each and every year, and in an area of high deprivation, I can only envisage that any additional ‘ask’ will not be able to be met by our community, so sadly we may have to look at service reduction, which in turn will place additional burden on an already stretched NHS.

NHS staff will start to see the pay increase reflected in their pay packets from this month onwards. Without government support, Springhill Hospice will see a significant additional cost fall to the charity as a consequence.”

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[Liz McInnes]

I thank my hon. Friend: that is exactly the point that I wanted to make. A deal has been done in Plymouth for a social enterprise provider that is not a hospice but a provider of mental health services. Obviously, smaller deals are being done. My hon. Friend the Member for Plymouth, Sutton and Devonport is not able to be with us today, but I was very interested in the evidence that he sent me. The Department of Health and Social Care needs to look at the smaller deals that have been done and ask itself what on earth is going on.

To return to the issue of physiotherapists, they are clinical staff whose role in hospice care is sometimes forgotten. The CSP told me that its members overwhelmingly backed the pay changes when consulted earlier this year. It pointed out to me the importance of the physiotherapist’s role in enabling people with a terminal illness to stay active as long as possible—a really important role—and went on to say that with the current shortage of physiotherapists, it is relatively easy for staff to change roles if they wish to do so, and that employers who cannot broadly match NHS pay rates will find it increasingly difficult to recruit staff.

There is clearly real concern that the NHS pay award will have an unforeseen but damaging impact on charitable hospices and other organisations that are already at a significant disadvantage compared with other non-NHS providers in not receiving reimbursement for the costs of the care that they provide to NHS patients. A sustainable hospice movement is an essential component of delivering the improvements in end of life care that the Government have rightly sought. The Government must look again at the conditions imposed on non-NHS providers and consider how funding may be made available to prevent a diminution of the end of life care service.

[Sir Desmond Swayne]

May I therefore, through the offices of the hon. Lady, put in my bid to the Minister for just such a local agreement for Naomi House and the Oakhaven Hospice in Hampshire?

[Liz McInnes]

I thank the right hon. Gentleman for that intervention, but we want a national agreement rather than a piecemeal set of local agreements. I hope that that will be addressed today.

I shall conclude by quoting NHS Employers:

“Patients are at the heart of everything the NHS does.”

How does that square with the Department of Health and Social Care’s refusal to finance the pay award for hospices, and how is that refusal putting terminally ill patients, at the time when they are most in need of care, at the heart of our NHS?

--- Later in debate ---

[The Minister for Care (Caroline Dinenage)]

As ever, it is a great pleasure to serve under your chairmanship, Mr Davies. I add my voice to those congratulating the hon. Member for Heywood and Middleton (Liz McInnes) on securing a debate on this important matter, and congratulate every Member who has been involved, either through a speech or an intervention. As MPs, we are all aware of the crucial role that hospices play in supporting and caring for our communities at a time of great need. I understand the concerns that have been raised, and have listened carefully to the strong arguments that have been made.

Hospices across England are delivering excellent end of life care and contributing to their local communities, as they have for many years. The Care Quality Commission’s “State of Care” report, published on 10 October, is testament to that. That report showed that hospices have continued to provide high-quality care at the end of people’s lives, even improving on their performance last year, which saw them rated as the highest performing secondary care servicer, with 27% of hospices—more than a quarter—rated as outstanding. I know that Springhill Hospice in the constituency of the hon. Member for Heywood and Middleton was rated as good overall in the CQC’s most recent assessment, but was rated as outstanding in the delivery of care and effective services, and people spoke highly of the kindness and caring attitude of staff. That is why the hon. Lady is right to raise this debate. I add my thanks to all those working and volunteering in the hon. Lady’s hospice, and in hospices up and down the country, for the quality of care that they offer.

We all know that palliative care can take many forms, whether at home, in a hospice, or in a hospital. There is never a more important time to make sure people get the right level of care. My hon. Friend the Member for St Ives (Derek Thomas) spoke about the immeasurable support that was given to his mum by his local hospice, and he rightly mentioned the crucial role of local commissioners in ensuring that hospices can do their amazing work, which I will speak more about in a moment. My mum was responsible for fundraising to build the Naomi House children’s hospice that my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) mentioned earlier.

[Sir Desmond Swayne]

Will the Minister address the question that was raised about local deals, and will she acknowledge the bid that I made?

[Caroline Dinenage]

Sadly, I cannot comment on individual cases. I am not aware of any individual deals being done with the Government, but of course, this could be a local arrangement. For 2019-20 and the remaining two years of the deal, funding will follow the usual route. It goes through CCGs, so I imagine that the instance that the hon. Lady mentioned is due to that, but I am keen to hear more.

--- Later in debate ---

[Caroline Dinenage]

That is a very good point. NHS England will bring forward its report on hospice care very shortly, in November.

I want to talk about staff funding. In common with much of the sector, I know hospices have faced financial challenges. I recognise the concerns of hospices that the recently announced NHS pay rise is putting them under pressure to match the uplift awarded to staff employed on the Agenda for Change contract not only to retain the incredible staff they already have, but to attract the staff they need. We have agreed that for 2018-19, non-NHS organisations that employ existing and new staff on the Agenda for Change contract will be eligible to receive additional funding. Most hospices do not employ their staff on the Agenda for Change contract because of the cost that would entail and so are ineligible.

[Sir Desmond Swayne]

Is it possible for a hospice to employ some staff on those contracts and then achieve the benefit of doing so without handing over its entire employment budget and losing control over it?

[Caroline Dinenage]

That is a very good question, which I will drop my right hon. Friend a note to answer, if he does not mind, as we need to make a few more inquiries about that.

It is important to stress that the Agenda for Change pay deal does not seek to make any distinction between the value we place on staff working in NHS and non-NHS organisations. Staff work incredibly hard to provide services, always putting patients and service users first. Funding is linked to the direct costs of implementing the Agenda for Change pay deal, which includes both pay and non-pay reforms. As the hon. Member for Heywood and Middleton mentioned, it is not just about headline pay. It is right that those organisations that employ existing and new staff on the Agenda for Change contract and must implement the entire pay deal should receive additional funding for 2018-19.

The hon. Lady is right to raise the matter, and I thank her again for doing so. I have listened carefully to the issues that have been raised, and we will look again at all of them and what we can do to better support our hospices to continue doing their vital work.