Hospice Care

Steve Brine Excerpts

Wednesday 2nd February 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) on securing this debate and on laying out the issues so clearly. We must draw attention regularly and repeatedly to the contribution that hospices make to our society. As he rightly said, they are in the vanguard of the big society. He was right to paint the picture of the factors that drive us to focus on the role of hospices, such as the demographic pressures that he described.

My hon. Friend talked with eloquence about the difference that St Elizabeth hospice makes to his constituency and his constituents. I join him in paying a warm tribute to that hospice and to the others that have been mentioned. Recently, I have had the privilege of visiting my local hospice, St Raphael’s, and St Ann’s hospice in Cheadle Hulme. I share his and other hon. Members’ admiration for the tremendous care and compassion that is provided by staff in those places.

We want to ensure that these institutions grow and flourish as part of a more personalised approach to end-of-life care. How can we do that? First, we need to get the funding right to ensure that hospices can plan for the future with confidence. Secondly, we need to be much clearer about the role that hospices can potentially play in end-of-life care, and have that role recognised in the commissioning and shaping of local services. Thirdly, we need to establish end-of-life care as a clear priority for improvement across the NHS, using levers such as the outcomes framework, the operating framework and the forthcoming quality standard.

I know that my hon. Friend the Member for Central Suffolk and North Ipswich and others have concerns about funding. He will know from his recent visit that St Elizabeth hospice has recently undertaken a refurbishment programme. It had to raise a lot of money to pay for that work, but I am pleased to be able to say that part of the cost was funded from a £40 million capital grant scheme that we are making available this financial year. One of the coalition Government’s first actions was to confirm that funding, as an early indication of our commitment to hospice care. Well over a hundred hospices, such as St Elizabeth, are receiving funding from that grant to help them improve their facilities.

My hon. Friend will know that that is part of a much larger sum that we have made available to support the end-of-life care strategy for adults. In the current financial year, £198 million was made available to help improve the quality and range of services for people in the final stages of life. That was an indicative amount set by the previous Government, and there have been doubts, expressed not least by the Public Accounts Committee, about whether the new money for the implementation of the strategy was being used for its intended purpose. The big question is how to ensure that the funding gets through.

Some argue, although the argument has not been advanced tonight, that ring-fencing is the answer. I actually believe that it would be likely to be a retrograde step. It would give the NHS less flexibility, less discretion and less scope to meet local people’s needs at precisely the time when we need the NHS to have a more personalised approach. Ring-fencing can act as a cap rather than a guarantee, putting an artificial ceiling on the amount that an area can spend on end-of-life care rather than encouraging that amount to be commensurate with need.

Ongoing and increasing funding for end-of-life care will be part of the baseline for primary care trusts, and for the GP consortia that replace them. However, the local NHS will get freedom and responsibility in choosing how it spends the taxpayers’ resources committed to health care. That is the key refreshing change that the Government’s reforms will bring about. In return, we expect much greater transparency and accountability for the decisions that are made.

By monitoring how the new end-of-life care funding has been spent, we are doing what we can to shed light on PCTs’ decisions and on the variations in spending that occur. Last year, for instance, just 20% of the money going to PCTs was allocated to hospices. We are repeating the monitoring process for this year and conducting a survey of total PCT expenditure on specialist palliative care, including that provided by hospices. Together, that will give a clearer picture than ever of how different parts of the NHS make use of local hospices in delivering care. That is an essential component of the picture that we need to build to ensure that good commissioning takes place.

End-of-life care will also be given greater visibility in performance structures in the NHS. We have already published the NHS operating framework for the coming year, 2011-12, which emphasises the need for greater choice in end-of-life care. That care also figures prominently in the outcomes framework for the NHS, which will ensure that commissioners and providers give the matter priority. In fact, last month we published a set of performance indicators to work alongside the outcomes framework. For end-of-life care, PCTs are currently planning against the indicator measuring the percentage of deaths that take place in someone’s usual place of residence—their own home or their care home. That will provide a real incentive, real traction and a real opportunity for hospices and other providers to work with commissioners to improve outcomes.

Finally, as I have mentioned, the quality standard that the National Institute for Health and Clinical Excellence is working on will give clinicians, hospices and health managers a clear and shared idea of what best practice looks like. NICE tells me that it expects the standard to be published by November this year.

[Mr Steve Brine (Winchester) (Con)]

Naomi House children’s hospice in my constituency is a fantastically run hospice that raises an enormous amount of money to continue its hospice-at-home service, which recently restarted. It receives about 12% of its direct care costs from the Department of Health, but was told a couple of years ago that that would come to an end this year, and it is not having much luck in securing ongoing funding from the primary care trust, NHS Hampshire. What advice would the Minister give to that hospice for the interim period before GP consortia in west Hampshire are up and running?

[Paul Burstow]

Hospices need to continue to work to demonstrate the huge benefits of their provision to commissioners. If the hon. Gentleman writes to me, I will pay close attention to what is happening in that regard.

My hon. Friend the Member for Central Suffolk and North Ipswich rightly mentioned the difference that GP consortia will make. GPs are the best people to bring together the provision that I have talked about, along with the new local health and wellbeing boards. The advent of GP consortia will change the relationship—quite fundamentally, and in the right way—between hospices and GPs. It will make it natural for doctors to talk to each other and solve problems together, and to draw on different sources of support to help patients get what they need. It is encouraging to note that three of the GP pathfinders—Westminster, Bristol and Somerset—are specifically looking at how they can improve end-of-life care under the new arrangements. That is a sign of GPs’ interest in such care, and the potential for GP-led commissioning to bring about change and to address that challenge.

There is a new opportunity for collaboration and innovation, but hospices must not sit back—they must actively engage. We need them to be proactive in understanding and engaging with the new systems and structures as they settle into place over the next two years. They need to be proactive in talking with their local GPs and building up the relationships and mutual connections that will be essential to how the system works, and proactive in working with local authorities, which will play an increasingly important role in shaping and integrating care through the health and wellbeing boards. Ensuring that health and social care are commissioned and planned together is critical in the delivery of good end-of-life care.

Hospices also need to be proactive in broadening their horizons and innovating to support a wider range of people. As my hon. Friend rightly said, hospices are not just about cancer. We want people to be able to die in their own homes, where they would choose to be, and we need a more flexible and dynamic approach from both the NHS and hospices in that regard.

As my hon. Friend rightly pointed out—this is a key point—contrary to popular perception, only a small number of people actually die in a hospice. A great many more people benefit from their work in other ways. People could, for instance, receive day therapy in a hospice, or, as is the case with the local hospice in my constituency, they can get help from hospice staff working in the community, which was referred to by a number of hon. Members. Children’s hospices, meanwhile, could get more involved in the long-term treatment of children rather than just end-of-life care.

We need to innovate in those partnerships. We need commissioners to make imaginative use of hospices as part of their end-of-life, palliative care plans. Hospices must also have the ambition to explore new ways of offering their skills and services to NHS commissioners. My hon. Friend is right that we need to reach out beyond cancer services—it is essential that services diversify. St Christopher’s in London, which he mentioned, is doing excellent work with people with dementia who need end-of-life care. We need to focus much more on that to deliver the national dementia strategy.

I want more hospices to play a role in supporting people with other degenerative conditions—not just dementia, but conditions of the sort my hon. Friend rightly highlighted. We make that point explicitly in the national dementia strategy, as I said, and we want to reinforce it through the end-of-life care strategy.

The levers and the incentives are in place to enable hospices to secure NHS funding in the years ahead. But in the longer term we know that a new funding model is needed. We made it clear in the coalition agreement that we want to introduce a per-patient funding system that is built around a much clearer understanding of what level of care should be available through the NHS and that is fairer and more sustainable for all providers, including hospices, because it moves us away from the vagaries of grants—we have just heard about the problems those cause to the children’s hospice in the constituency of my hon. Friend the Member for Winchester (Mr Brine)—and gives them certainty of a set level of funding per person.

The debate about this subject has been going on for some time and is well developed. I encourage hon. Members who have spoken to contribute to that work. In July, the Secretary of State for Health appointed Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care, to chair an independent review covering both adult and children’s services. That review will look at the issues raised in this debate to ensure that we have services that reach out beyond the confines of the hospice and address the wider cost issues in rural communities. An interim report was published at the end of last year, which sets out a definition of dedicated palliative care and provides initial thoughts on how a new national funding system could be built.