End of Life Care

Kirsty Blackman Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Kirsty Blackman (Aberdeen North) (SNP)]

Thank you, Madam Deputy Speaker, for allowing me the opportunity to speak in this debate, during the second day of our consideration of the 2015-16 estimates. This is the fourth of our estimates debates and it is on end-of -life care. Supporting an individual at the end of their life is a difficult experience for all involved, be they family members, friends or healthcare workers. Health and social care services play a vital role in making palliative care as dignified as possible, and in ensuring that the patient’s wishes and needs are taken into account. The Liaison Committee has recommended that this important subject be debated today as part of the estimates process.

The Scottish Parliament is partly funded by a block grant. The change in this block grant is determined every year by the Barnett formula. In simple terms, the Barnett formula looks at the change in each Department’s funding in England for that year, and applies either an increase or a decrease in the level of funding that Scotland receives. The calculation takes into account the level of devolution of each Department, and allocates Scotland a population share on that basis.

The Department of Health, as it relates to end-of-life care, has a 100% comparability percentage when it comes to the calculation of Barnett consequentials, which means that any change in the departmental expenditure limit will have a full population share effect on the block grant for this area. Naturally, I was looking forward—indeed, I was on the edge of my seat—to scrutinising the changes that the Government were making to the budgets for end-of-life care. I picked up HC 747, “Central Government Supply Estimates 2015-16”, and flicked speedily to the Department of Health section on pages 97 to 112. Members can imagine my shock and disappointment when I found that the words “end-of -life care” were not mentioned anywhere in the booklet. It is a bit surprising considering that it is 736 pages long—one would have thought that end-of-life care would have appeared somewhere.

Then the Order Paper came out. Hurrah, thought I, this is my opportunity, because it mentioned a number of documents associated with end-of-life care. I thought that I could look at the budget in relation to end-of-life care and see what the knock-on effect would be for Scotland. I picked up all the various documents, but found that none of them lays out the budgetary spend, or the saving, associated with the changes. The documents do tackle major issues of great importance in relation to end-of-life care in NHS England. They highlight both the strengths and the weaknesses in current end-of-life care provision and lay out the UK Government’s plans to make changes, but they do not lay out the budgetary spend or saving associated with any of those changes.

End-of-life care is important to those many families and individuals who are struggling to come to terms with bad news, navigate the health and social care systems, ensure appropriate support is in place for themselves and their loved ones, and make plans and take decisions that they never dreamed they would have to make. It is important that Parliament ensures that end-of-life care is funded appropriately. I know that many Members want to talk about the issues that have to be faced and the ways to solve them—or at least how to alleviate the suffering a little for these families and individuals—but it is nigh on impossible for Parliament to provide appropriate scrutiny of the funding when we are not provided with the budgetary costs associated with the plans.

I want an increased spend in the Department of Health budget as it relates to end of life care, but I am struggling with these documents, as I cannot discover how much is currently being spent on it. Also, I am not allowed to table an amendment that proposes to increase Government spend in this area. If I desired to amend the total net budget of the Department of Health, which is £25,869,317,000, my only option would be to amend the budget downwards by £1,000. There are no other amendments that I can table in relation to this, so I cannot, during the estimates process, move an amendment to increase the Department of Health budget in relation to end-of-life care or to anything else and, consequentially, the Scottish block grant.

I am very pleased that we are discussing this vital and difficult issue, but I am distressed that we are not able to discuss in any detail the funding of this area, which is becoming increasingly important as our population ages.