St. Christopher"s Hospice, Sydenham (Hansard, 23 June 1988)

§ Sir Philip Goodhart (Beckenham)
In about six weeks, Her Majesty the Queen will visit St. Christopher"s hospice in my constituency, which is celebrating its 21st birthday. Many people who have visited the hospice, which primarily looks after people who are terminally ill with cancer, have testified to the remarkable spirit—one might almost say the remarkable soul—of the hospice. It would not be an exaggeration to say that in the past 21 years St. Christopher"s has become an inspiration and an example to the rapidly growing hospice movement both in this country and overseas.
The driving force behind St. Christopher"s has been Dame Cicely Saunders, who celebrated her 70th birthday yesterday. I have described her in the past as a jolly saint. It is her humour, energy and faith which have inspired the place. However, it is not, of course, a one-woman show. At the moment St. Christopher"s has a staff of 114 nurses who take care of the 62 beds, do the home support work and carry out much of the teaching. St. Christopher"s is a teaching centre. That is why we are having this Adjournment debate.
A few weeks ago my right hon. Friend the Secretary of State for Social Services announced a substantial pay award for nurses, which would cost the National Health Service £800 million in a full year. It was to be fully funded by the Exchequer. There was much rejoicing and a considerable amount of heat went out of the controversy about the National Health Service, at least temporarily. Shortly after the announcement was made I rushed round to see the Secretary of State and the Minister for Health and said, "Please do not forget the impact that the pay award will have on voluntary hospices." I am afraid, however, that the hospice movement was not included in the category that can expect full extra funding to meet the cost of the nurses" pay review.
Let us put the matter into perspective. There are 124 hospices with 2,000 beds and there are many more home care teams. National Health Service support for those 124 hospices varies from zero to 100 per cent. The pay review will cost those hospices an extra £6 million a year. The NHS provides, on average, 27 per cent. of the funds of each hospice, and St. Christopher"s hospice comes pretty close to the national average. Last year St. Christopher"s spent £3.33 million and received £1,052,000 from the NHS through the south-east Thames region. St. Christopher"s reckons that the cost of the pay award will be £408,000, or exactly four tenths of its existing support from public funds. It is not surprising that that figure should be so high. The three most common groups of nurses employed at St. Christopher"s are ward sisters, staff nurses and nursing auxiliaries. The average pay of a ward sister at St. Christopher"s, with London weighting, is increasing by no less than £3,007 from £11,430 to £14,437.A staff nurse"s salary will go up by £2,277 a year and a nursing auxiliary"s pay will go up by £1,862 to a fraction under £8,000 a year.
What is the likely impact of that substantial increase in expenditure? St. Christopher"s wisely budgeted for the increase in nurses" salaries, but obviously it could not foresee the extent of the increase that was to come. It had set aside £160,000 for extra pay, which would have been 1361 gathered in by further energetic fund-raising efforts. A long-awaited day centre will have to be postponed because the work would cost an extra £150,000.Perhaps the south-east region could be prevailed upon to increase its slice of support, which now stands at almost exactly £1 million, by perhaps £100,000 or so. If that does not happen, we are faced with the ugly prospect that, within a few weeks of the Queen visiting St. Christopher"s, some beds may have to close.
What should happen? Naturally I believe that the Government should meet in full the nurses" pay award for voluntary hospices. I know that my right hon. Friend has great personal enthusiasm and sympathy for the hospice movement and I salute him for that. I am sure that he would like to be helpful. However, I expect that he will tell me that there is no extra money.
I must raise a sceptical eyebrow. The regrading process has not yet been completed and. until that happens, health authorities cannot tell with precision how much they may need or will receive. Within the global £800 million NHS settlement, I believe that there is an extra £6 million sloshing around somewhere. I note also that during recent months the DHSS has found £6 million or more for an AIDS publicity campaign which, in my opinion, is badly targeted and a faintly offensive waste of public money.
During recent weeks, to our dismay, the European Court has thrust National Health Service money into the Treasury by requiring it to extend VAT to certain areas, especially the optical sector.
I reiterate my hope that the level of financing of voluntary hospices will be considered within the NHS review. In the early days of its noble career, St. Christopher"s received rather more than 50 per cent. of its income from the NHS; now it receives less than one third. I believe that 50 per cent. support is at the right level for an establishment that gives so much help to the NHS and to the people of this country.

§ The Minister for Health (Mr. Tony Newton)
I thank my hon. Friend the Member for Beckenham (Sir P. Goodhart) for his kind words about me, and I reciprocate, with considerable fervour, by paying tribute to the assiduous way in which, over the years, he has supported the hospice movement in general and, not least, St. Christopher"s in particular. It is barely 15 or 16 months since my hon. Friend last initiated an Adjournment debate about St. Christopher"s, to which my hon. Friend the Member for Derbyshire, South (Mrs. Currie) replied.
As my hon. Friend said, I have a strong interest in these matters and, indeed, have some connection with hospices in and around my area—especially the St. Helena hospice in Colchester, which I visited recently, and the prospective hospice in Chelmsford that is nearing completion. I wish all those concerned with the hospice very well indeed.
It is also pleasing to join my hon. Friend in paying tribute to Dame Cicely Saunders. I had not registered the fact that it was her 70th birthday yesterday, but now that I have that additional piece of intelligence, I hope that my hon. Friend will take my belated congratulations and good wishes to her. As my hon. Friend knows, she studied at St. Joseph"s hospice in Hackney, where she developed drug regimes for pain and symptom control before she went on to found St. Christopher"s hospice in Sydenham in 1967.It is fair to say that she is considerd by many people, and, in 1362 my view, rightly so, as the founder of the modern hospice movement. Not only has her work been copied around the world, but it has, literally, changed the face of death for large numbers of people.
St. Christopher"s is by no means the only charitable organisation providing care for cancer patients. There are many other voluntary hospices; my hon. Friend has given the numbers around the country, and I have referred to one existing and one prospective hospice in my constituency.

§ Mr. Newton
For a moment I thought that I had gone out of order, Madam Deputy Speaker. I thought that if what I have said was out of order, the rest of my speech is sunk completely. I am glad to know that it was simply the usual procedures of the House producing that otherwise extraordinary interruption.
I should refer also to Marie Curie Cancer Care which runs II homes in the United. Kingdom and provides day and night nursing for cancer patients in their own homes. The Cancer Relief Macmillan Fund is becoming increasingly well known. It works very closely with the NHS and has provided the capital costs of a number of hospice projects which it has then handed over to the NHS to run. That organisation also helps the NHS with the cost of Macmillan nurses, and plays a major and important role in developing education for doctors and nurses in care of the dying.
It would be fair to say, not least as a further tribute to the work of Dame Cicely Saunders, that the combined total of the effort by the voluntary charitable sector and the NHS probably makes this country the world leader in providing much-needed care for a very important group of patients.
I wish to make one or two general observations before coming to the more specific points raised by my hon. Friend. I want to emphasise that terminal care in Britain is no longer provided exclusively by the voluntary sector, as it was for a time. The Government are firmly committed to providing a full range of good care services for people who are dying from any illness. Our initiative started in 1980, when we set up a working group of the standing sub-committee on cancer to consider the organisation of terminal care services for cancer. That working group was chaired by Professor Eric Wilkes, another widely known and respected personality in the hospice movement, who has done so much to develop it.
The working group"s report stated: Terminal care is not a matter of new buildings or expensive equipment. It depends primarily on enlightened professional attitudes. Our objective now should be to ensure that every dying patient has access to professional staff who can provide the appropriate care. The group"s recommendation was: The way forward is to encourage the dissemination of the principles of terminal care throughout the health service and to develop an integrated system of care with emphasis on co-ordination between the primary care sector, the hospital sector and the hospice movement. That report was circulated throughout the Health Service.
The Government then decided that it would be useful to bring together people from the NHS and voluntary groups to discuss how each can maximise its contribution to terminal care.
1363 With that in mind, we organised with the National Association of Health Authorities a major conference in December 1985, which was opened by His Royal Highness the Prince of Wales. My predecessor but one, my right hon. and learned Friend the Chancellor of the Duchy of Lancaster, opened the conference by saying: I would like to see every health authority drawing up comprehensive plans for providing services for those facing death. This means looking carefully at the range and type of specialist care which is needed in their district and, where possible, working with local and national voluntary groups to provide the necessary services. By the time the conference took place, my predecessor, my right hon. Friend the Member for Brentford and Isleworth (Sir B. Hayhoe), was the Minister responsible. In his address to the conference he said that the Health Service should make a most careful assessment of the services the voluntary sector is providing and can provide in the future, and that where the voluntary sector was fulfilling part of the need health authorities should make an adequate contribution to the costs involved.
Another speaker at the conference, one of our regional general managers, outlined practical ways in which regional and district health authorities could help the hospice movement. One suggestion was the provision of a more secure financial foundation.
As my hon. Friend the Member for Beckenham will be aware, that was followed by collaboration between the Department and the National Association of Health Authorities on a guide for health authorities on good practice in care of the dying. That was issued to health authorities in January 1987.By that time, I had become Minister for Health and it was my privilege to launch that publication, in which there is a chapter of guidance for health authorities on funding terminal care services.
We sought to buttress and support that in February 1987, with a Department of Health and Social Security circular on terminal care—HC(87)4—which asked health authorities to examine their current plans for terminally ill patients and to plan to fill any gaps, where possible in conjunction with the voluntary sector. We have asked health authorities to describe their plans for terminal care in their planning statements, which we expect to receive next month. I assure my hon. Friend that we shall be examining those with care to see whether further action will be necessary.
I have emphasised that because it sets the scene and I hope that it illustrates the effort we have already put in and the commitment that we can claim to have shown to provision for terminal care, based on greater collaboration between the NHS and the voluntary sector. I am glad to say that many health authorities are providing terminal care services of their own and are working well with the voluntary sector.
My hon. Friend is entitled to say, in a rather old-fashioned phrase, which he did not use, that fine words butter no parsnips. Good relations are important but, faced with increasing revenue costs and the problem of competing with many other worthy charities to raise money from the general public, the security of some guaranteed statutory funding for hospices would be welcome.
Hospices are essentially providing a local service, and it is right for the health authority concerned, or a number of 1364 health authorities where that is appropriate, to decide the correct level of funding for a hospice or any other voluntary services in support of local health services, according to their judgment as to the right pattern in that locality. It would not be right for us to attempt to second-guess that judgment from the centre. If we did, we would face considerable difficulties.
My next point picks up something said by my hon. Friend the Member for Beckenham and echoes something that I have said in the House in recent weeks. It seems clear that if the Government were to fund hospices in the same way as they fund health authorities—there was an element of that in what my hon. Friend was suggesting about the way in which the consequences of the recent pay award should be funded—the risk, at the very least, is that the voluntary hospice movement would lose that special voluntary factor which makes it so special and which has been such an important part of its contribution.
Having said that, I acknowledge that, although many health authorities already help hospices financially in one way or another, there are many in the hospice movement who believe that some health authorities do not give them enough. I repeat: we have told health authorities that they should be providing the full range of terminal care services, in-patient beds and home care and day care services, and that where a voluntary group such as a hospice is already providing some of those services locally the health authority should agree with it a contribution to its cost. We have asked health authorities to provide us with information about those arrangements in the planning statements that we expect next month.
It is difficult for me to go further than to repeat that statement of Government policy in my speech tonight. However, I promise my hon. Friend that we shall carefully consider the information we receive from health authorities and will assess the need for any further steps we might appropriately take in the light of the provision which health authorities tell us they are making in terms of hospice support.
I acknowledge the point made by my hon. Friend, that the nurses" pay award could affect many homes run by charities, concerned not only with terminal care but with a whole range of problems, disabilities and medical conditions, where nursing staff need to be employed. I hope that health authorities will be particularly conscious of the impact of nurses" pay on hospices" revenue costs, where there tend to be higher than usual nurse-patient ratios. I trust that health authorities will bear that point in mind when considering the provision they make from the money available to them for 1988–89 as a whole, including —as was emphasised by my hon. Friend—the very large additional sums which have been made available to health authorities for the nurses" pay award.
My hon. Friend said that, last year, St. Christopher"s received a little over £1 million from the National Health Service and that of that the South East Thames regional health authority donated more than £900,000 towards the hospice"s running costs. I am not sure that my hon. Friend acknowledges that in the present financial year, 1988–89, the region has already increased its allocation by 4.5 per cent. to take account of inflation, which is the same as the inflation element in the region"s extra allocation from central Government. That is in itself a significant contribution to the costs of the pay award, in the same way as the 4.5 per cent. inflation element has been treated as a significant contribution to the costs of the nurses" pay 1365 award to the National Health Service as a whole. The Government have made money available to meet that part of the bill that is above that percentage.
I am glad to tell my hon. Friend, who expressed some hopes about this, that my clear understanding is that, over and above the extra 4.5 per cent. that the South East Thames regional health authority has already agreed to provide, it plans to make available this year extra money to help cover the cost of the nurses" pay award. I am not in a position tonight to put any figure on that because that must be for the regional health authority to decide. However, I have its authority to say that it plans to make an additional allocation. I hope that that encourages my hon. Friend in his efforts on behalf of the hospice.
Apart from the substantial help that St. Christopher"s receives from the South East Thames regional health authority, it receives assistance from a number of health districts in the South West Thames region, most of which try to relate their funding of the hospice to the costs it incurs in treating patients referred to it by that health authority. I frankly acknowledge that, having looked at the figures, I can see some scope for—how shall I put it? —further discussion between the hospice and some of those health districts about whether their contributions adequately reflect the costs incurred. It would be unwise of me to go beyond that from the Dispatch Box tonight, but I will say that I believe that the South-East Thames region has set a good example, which I hope will be followed by other health authorities concerned with the hospice. I also hope that they will consider the matter carefully in the light of what my hon. Friend has said.
There are a number of other points that I could touch on, and a number of other difficulties that hospices have experienced in some of their financial affairs—in relation, 1366 for example, to the cost of drugs, and their dealings with the income support part of the social security system. I hope that some of the work that we are doing will enable us in due course to take steps that will be of additional help to hospices. There is, however, nothing that I can announce tonight. I think that those concerned with the hospice movement know that these are difficult and complex matters, which take time to consider and which need to be considered in a wider context—for example, that of the Griffiths review of community care and its application to income support.
I shall not speculate on any of that tonight; I shall conclude my speech by returning to the central theme which my hon. Friend has raised, and to which I have sought to respond as helpfully as I can. It is our firm policy that health authorities should take full account of the contribution made by hospices to the important aspect of providing our people with health care. While we do not feel it right to go down some of the paths that my hon. Friend has invited me to tread tonight, we strongly wish to urge on health authorities the need to take account of all the factors affecting hospices in considering the amount of financial help that they give. Not least, we urge them to take account of the sort of problems to which my hon. Friend has referred—together with the additional money that the Government have made available for the nurses" pay award this year—in considering how they should respond to those needs, not only in my hon. Friend"s constituency but in all the other locations where hospices flourish up and down the country, when considering the pattern of their policy for the remainder of the year.