Children’s Palliative Care

Debate between Steve McCabe and Robin Walker

Tuesday 3rd March 2015 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I am grateful to have secured this debate and glad to have the opportunity to serve under your chairmanship, Mrs Main. I first became interested in this area through the work of Acorns children’s hospice in my constituency, which provides a valuable service to children and families from all over Birmingham. I cannot praise its work too highly.

I begin by acknowledging that I believe the Government are genuine in trying to establish a clear funding path for children’s palliative care and hospice services. I understand that the major change envisaged by the Government is the new per-patient funding system. It would be helpful if the Minister said more about how it will work and how he plans to ensure that it is properly monitored and reviewed. I also want to raise the issue of short breaks and bereavement care, as these elements are not included in the per-patient funding strategy.

The children’s hospice movement supports the principle of per-patient funding for children’s palliative care as a means of providing more sustainable, transparent funding through an NHS currency, commissioned by clinical commissioning groups and designed to complement NHS England’s commissioning of specialised children’s palliative care services.

I understand that the third strand of Government thinking is that local authorities should continue to be responsible for commissioning necessary elements of social care and that together this should create an overarching system where all elements of the care—clinical and non-clinical aspects, short breaks and bereavement support—are all provided for.

My purpose in seeking this debate is to address a genuine fear that the impending general election and uncertainty over the new system could lead to a funding hiatus that could have a damaging effect on the children’s hospice movement. If I have understood it correctly, the per-patient system is designed to reimburse providers according to the activity they undertake, and to incentivise both commissioners and providers to deliver palliative care in a child’s home, community or hospice setting, if that is consistent with the wishes of the child and the family, and clinically appropriate.

The idea of the currency is set out in NHS England’s 2014 document, “Developing a new approach to palliative care funding: A revised draft for discussion”, in which it is argued that the currency should make it easy for clinical commissioning groups to understand the specific needs of children with life-limiting conditions. It should also be possible for clinical commissioning groups to have a better understanding of what constitutes palliative care and of the potential cost drivers for commissioning.

What steps have the Government planned to ensure that those elements of palliative care not covered by the new per-patient funding system will be properly funded by local authorities and clinical commissioning groups? This new system is the product of hard work and, as I have indicated, the sector is generally favourable towards it, but it is worried about a number of aspects. For example, how will the costs incurred by providers during the transition be met, including costs of setting up new systems to record activity and of ongoing data collection demands?

The Government-commissioned palliative care funding review by Hughes-Hallett, Craft and Davies in 2011, was clear that introducing and implementing the new system should be cost-neutral to the sector. What support does the Minister envisage for the voluntary sector providers to enable them to implement this new approach?

It would be useful if the Minister outlined any plans to provide models of practice that show how the currency will work, especially in situations for children and young people subject to continuing care packages and personal budgets, as introduced by the Children and Families Act 2014. It would also be useful to understand how the data quality will be monitored and how comparisons of models of care and outcomes will be assessed.

It is not clear to me how the new system will deal with the issue of transition from child to teenager to young adult.

[Mr Robin Walker (Worcester) (Con)]

I congratulate the hon. Gentleman on securing this important debate. Acorns children’s hospice serves my constituency as it serves his. It has a fantastic hospice in Worcester. It has done some important work on transition space and supporting the many people who, because of advances in medicine, are living longer. Does he agree that it is vital that the Government engage with it on this work, to make sure that transition is properly supported by the future funding system?

[Steve McCabe]

Yes, I agree. That is exactly the point. It is fantastic that so many children now survive for so much longer. That creates new demands and service needs that have to be considered. I should be grateful if the Minister said what work is being undertaken, both within Government and the NHS, to ensure that these transition issues are being considered in any new funding plans. I concur with the hon. Gentleman on that. The Care Quality Commission report, “From the pond into the sea: children’s transition to adult health services”—that is its title, I kid you not—also indicated that this focus is important.

We are moving towards the election, so it would help if the Minister clarified where we are with all these plans. As I have said, I acknowledge that the intention is to create a fair and sustainable framework, but we are now in March—the projected launch date for the introduction of the new non-mandatory currency is March—and as yet, unless I have missed something, we do not know the Government’s intention. What I would really like to know, and what I think the hospices would like to know, is what is going to happen with the hospice grant? Is the intention that it should continue during 2015-16 and beyond? I am sure that the Minister appreciates that not knowing is a real source of anxiety and a blow to any attempts at long-term planning.

Almost 96% of children’s hospice organisations are worried, according to the Together for Short Lives survey, that CCG funding will be less than their existing grant and harder to access. That grant covered about 13% of the care costs incurred by children’s hospices and existing clinical commissioning group funding represents about another 12%. Uncertainty over almost 25% of previously guaranteed funding is a difficult basis from which to operate.

I am sure the Minister knows that these bodies rely massively on public generosity and fund-raising efforts, but they also need some core guaranteed funding. If the grant ceases and is not matched by equal funding elsewhere, 89% of children’s hospice organisations could be forced to reduce their services. Areas at risk include short-break services for 60% of users.

Fuel Poverty and Energy Efficiency

Debate between Steve McCabe and Robin Walker

Wednesday 16th January 2013 Commons Chamber

[Steve McCabe]

I did indeed hear the Secretary of State’s words. What I understood quite clearly from them was that he is filching money from the Warm Front scheme to pay for a scheme that he announced some time ago, and that he did not tell us at the time that he was robbing Warm Front. It is what, in the trade, is normally called sleight of hand.

Ongoing concern about green deal finance means that it is unlikely to get going until around autumn this year, if ever. The Government’s own impact assessment shows that their plans will cause the loft and cavity wall insulation industry to fall off a cliff. Why does the Minister not act now? He does not have to say that it was the idea of my right hon. Friend the Member for Don Valley (Caroline Flint); he could announce an interim plan in a couple of weeks, and take all the credit himself. That would be OK: we would not tell anyone.

I want to be fair to the Government, so I will assume that they did not set out to rob people as they are doing through so many of their other policies. I think that on this occasion their problem is that they simply do not know what they are doing. As a flagship policy, the green deal is costly and complex. The scandal of punitive up-front assessment fees needs to be tackled as a matter of urgency before the whole idea falls into disrepute, and the Government need to look again at the interest rates associated with the project. At 7.5%, it will be far cheaper for those who have the cash to pay up front for improvements than to use the green deal, and, of course, those who cannot raise the cash will simply shiver or find themselves exploited by a Government scheme that is beginning to look like it was modelled on payday loans. Then there is the helpful penalty charge if people want to pay it off early, which means they will be rinsed for another few thousand pounds. I am afraid that any objective analysis of this programme suggests it will fail, and the Minister really ought to act now before it is too late.

There is speculation about the abolition of Ofgem. What I and my constituents want is a regulator with some teeth and some backbone who will stand up for their rights, who will not be conned over wholesale price rises and who will force energy suppliers to pass on price cuts when wholesale energy costs fall.

[Mr Robin Walker (Worcester) (Con)]

Given what the hon. Gentleman is saying about the regulator, does he regret the fact that when the Leader of the Opposition was Energy Secretary he left a situation in which fines levied by Ofgem on the industry were given back to the industry, so this coalition Government are having to change the law to make sure fines levied by Ofgem will be given back to consumers?

[Steve McCabe]

I do not think there is any problem with the regulator redistributing that money if it is to the benefit of people. I would be a bit wary of talking about fining people, however. I also remember that this Government’s first direct hit on energy consumers was the VAT rise they imposed not long after coming to power.

We need a tougher regulator because at present the energy companies are running rings around Ofgem. An Institute for Public Policy Research study found that as many as 5 million homes are being overcharged by their supplier, and some households are paying almost £300 per year more than they need to pay. It also states that if the market was a truly competitive market, that could knock £70 off the average household bill at a stroke.

It is not too late for the Minister to take corrective action on Warm Front and the green deal and to help thousands of families and elderly people, as well as protecting jobs. If he does not take some corrective action in respect of the regulator, we will be mortgaging our homes to pay our fuel bills before this Government leave office.