St. Christopher's Hospice, Sydenham (Hansard, 9 November 1990)

§ Sir Philip Goodhart (Beckenham)

At the beginning of each parliamentary Session, it is customary for the two hon. Members who have been chosen to open the debate on the Address to describe their constituencies in some detail. In a similar position, I should have referred to the benefits that have flowed to the sick from two establishments in my constituency—the Wellcome research laboratory and St. Christopher's hospice. The research workers at the Wellcome laboratory have a remarkable record for producing drugs that combat disease and suffering, while St. Christopher's hospice has become an inspiration and an example to the rapidly growing hospice movement, both in this country and overseas.

I am especially grateful that, so early in the Session, I have been given the opportunity to discuss once again the financial problems facing St. Christopher's, a hospice in which I know that you, Mr. Speaker, take a great interest. For the first 23 years of its life, the driving force behind St. Christopher's has been Dame Cecily Saunders, the only saint I know who was educated at Roedean. For those 23 years, it has been her energy, humour and faith that has inspired St. Christopher's. Like Florence Nightingale, she holds the Order of Merit; and like Florence Nightingale, I expect that her reputation will survive for generations.

When I first raised the subject of St. Christopher's in June 1988, the hospice faced a financial crisis following the last major increase in nurses' pay. Those problems have not gone away; in fact, they have grown. However, I am happy to say that the hospice movement as a whole has grown.

I shall put the matter in perspective. In June 1988, there were 124 hospices in the United Kingdom, with 2,000 beds; by June 1990, there were 145 hospices, with 2,600 beds. They are supported by 277 home care teams and 115 day care units. More than 30 further projects are planned. The National Health Service provides, on average, rather more than one third of the funding. Of course, the demand for hospice care for terminally ill patients is growing rapidly. In St. Christopher's, the work load has grown by 10 per cent. during the past year.

Even greater than the growth of in-patient care has been the demand for home care. In 1986, St. Christopher's looked after 50 patients in their own homes at any one time. In October 1990, the number receiving home care exceeded 100 for the first time, and in January 1991, the hospice will expand its work in south Croydon, bringing a further increase of 25 per cent. in home care work.

The hospice also hopes to open a new day centre by Christmas, which will look after between 15 and 20 patients each day, not only providing essential therapy but giving families at home a much-needed break and an opportunity to recharge their batteries.

Ten years ago, in 1980, St. Christopher's received 50 per cent. support from the National Health Service and needed to raise £250,000 in donations to break even. In 1990, even after the hospice received its share of the extra £8 million for hospices announced by my hon. Friend the Minister for Health on 15 December 1989, National Health Service support will meet only 38 per cent. of St. 305 Christopher's expenditure, and donations of £2.5 million are needed. St. Christopher's is by far our largest local charity—virtually every club, pub and organisation in the community raises funds for it—but the cost of the services provided by St. Christopher's next year will push expenditure close to £5 million.

Looking at hospices other than St. Christopher's, I note that, even with the extra £8 million announced by my hon. Friend the Minister, it seems inevitable that there will be some bed closures and cut in services unless the Government provide further funding. St. Oswald's in Newcastle, St. Michael's in Hastings, and Butterwick hospice in Cleveland face particular problems, while Michael Sobell house in Oxford, in which I also have a personal interest, has closed four beds, with further cuts threatened.

With the introduction of health service reforms, hospices will be required to negotiate contracts with individual authorities. St. Christopher's is notably well administered, but that new arrangement is bound to increase its administrative problems, as it will have to agree contracts with no fewer than 10 separate district health authorities.

In the debate on 23 June 1988, I called for 50 per cent. support from the National Health Service for St. Christopher's and all hospices. I was delighted when, on 7 October 1989, my hon. Friend the Minister with responsibility for health matters in Scotland announced that that would happen in Scotland, and that the Government would match pound for pound public support for Scotland's 13 hospices. He said: Hospices are a splendid example of partnership in health care. The movement is well-established and has been recognised for many years as providing an integral part of the care for cancer patients. I cannot stress strongly enough the importance I attach to supporting hospices and ensuring that they are equipped to face the challenges of the future, confident in the belief that they will be able to maintain and further improve upon the already high standards of patient care that they offer. We must acknowledge the expertise that hospices have in the care of the terminally ill and assist the hospice movement to improve and develop its services and encourage the growth of locally based services. Therefore, I intend making funding available to match, pound for pound the support given by the public. This will result in a substantial increase in the amount of public funding provided to hospices. Working for patients is the watchword. The terminally ill and their families deserve as much care and support as we can possibly give them. The hospice movement has proved its worth, and in this very worthy area of service, and I am very pleased to be able to share in carrying their burden. That was a splendid announcement. In implementing this 50:50 funding scheme, there have been some problems, as one would expect, but in the seven months that the scheme has been in operation, I note that individual donations have increased. As one might expect, the reality of the Government doubling gifts has encouraged benefactors. I was also encouraged by the Minister of Health's statement on 15 December last year, when she said: The Government's objective is to work towards a position in which the contribution from public funds available to voluntary hospices and similar organisations matches that of voluntary giving. This will provide a clear basis on which to plan ahead."—[Official Report, 15 December 1989; Vol. 163, c. 847.] 306 Yesterday, the Chancellor of the Exchequer was able to announce another massive increase in funding for the national health service. As the Secretary of State for Health said yesterday: Next year the NHS in the United Kingdom will get the biggest ever year on year increase in resources. The service will have £3.2 billion more to spend than this year. This is an increase of 11.6 per cent. or 5.3 per cent. after allowing for inflation. Fifty:fifty funding for hospices in the United Kingdom will cost approximately £15 million. Yesterday afternoon we were talking of sums in excess of £3 billion. I hope that today, or in the near future, the Minister will be able to come to the Dispatch Box and say that he can take extra steps towards 50:50 funding, which we are all agreed is a sensible objective.

§ The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

I congratulate my hon. Friend the Member for Beckenham (Sir P. Goodhart) on the fact that, for the third time in four years, he has drawn the attention of the House to the history of St. Christopher's hospice in his constituency and to the fact that it is a shining example that not only should be, but has been, followed on many occasions and by many people who are interested in the subject in different parts of the country and of the world.

My hon. Friend may remember that on both previous occasions he had the good fortune to start his debate before the time for the introduction of such business and therefore got more than his half hour. On this occasion he was limited to 15 minutes, but used his share of time with the grace and skill of an accomplished and experienced parliamentarian.

In his introductory remarks my hon. Friend drew attention to your own interest in this subject, Mr. Speaker. It was also drawn to my attention by my Department, and if my hon. Friend had looked behind him, he could have drawn attention to the interest of my hon. Friend the Member for Chislehurst (Mr. Sims); he and I were able to discuss the matter briefly before the debate.

I echo the tributes paid—not only by my hon. Friend the Member for Beckenham, but by my two predecessors who answered the two earlier debates—to St. Christopher's and all that has been done there since its establishment. As my hon. Friend said, the enormous progress that has been made in the development of palliative care is, in a very real sense, attributable to the example of St. Christopher's, and especially to the guiding light of that institution, Dame Cicely Saunders. Her work there, and the institution that she established, have come to represent an international beacon of excellence in palliative care. The lessons learnt there have been widely applied, both in the voluntary hospice movement and in wider thinking about palliative terminal care in our own health service and in other health care systems around the world.

Dame Cicely's efforts, and those of the dedicated staff who have worked at St. Christopher's since its establishment, have brought a sense of peace and well-being to thousands of dying people, and—perhaps equaly important—to their relatives and friends. They have established new standards of excellence in palliative care. Her work has been founded on the principle that, although a doctor may tell a patient, with rational and 307 clinical detachment, "I am sorry, there is no more that I can do for you", that should not be the end of health care and the caring professions. People who are concerned for the well-being of patients and their families want to ensure that dying people—and their relatives and friends—have the best possible support and quality of life.

One of the major benefits of this concept has been a much greater openness in the discussion of death, and of the conditions and support that can be provided to people as they approach it. The support that we give can reduce the natural dread of dying that we all feel, and encourage us to think less about dying from cancer and more about finding a way of living with it in the days that are left to US.

Since the launch of St. Christopher's in 1967, the hospice movement has mushroomed nationally and internationally. The lessons not merely learnt but demonstrated at St. Christopher's have been applied in similar institutions elsewhere in the world. It is an enormous tribute to those who have been involved in that endeavour from the beginning that their ideas are now so widely applied—and, indeed, regarded as the norm in the care of terminally ill patients.

Having demonstrated the Government's recognition of the importance of the work done at St. Christopher's, I should like to trace the history of the Government's thinking about the development of terminal care. Since 1980, as we can show, official thinking has developed—perhaps not as fast as Dame Cicely Saunders's might have, but we have progressed in our own pedestrian and official way.

In 1980, one of my predecessors set up a working group under Professor Eric Wilkes to examine this subject and to report on the development of care of the terminally ill.

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 working group's recommendation was this: 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 was the basis on which we began to develop our official thinking.

As a consequence of the report, the Department convened a conference in December 1985 which was opened by His Royal Highness the Prince of Wales. My right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), who until a week ago was my boss in the Department of Health, delivered a speech in which he said: 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. It was the first time that a Minister made explicit the Government's wish that the NHS should work with the voluntary sector and apply the lessons learnt by the hospice movement.

Thinking has moved on further since then. In January 1987, the National Association of Health Authorities in England and Wales published a guide that it distributed to its members on the practice of care for the dying. In 308 February 1987, the Department of Health issued a circular that set out the Department's official thinking on terminal care. It contained the important statement, for the first time, that where a voluntary group provides a service that represents an essential element in a health authority's overall plans for terminal care, the health authority should agree with them a contribution to the costs of that service. By 1987, therefore, official thinking had moved to the point where it wanted to apply the lessons learnt from the hospice movement. Moreover, the Department's official policy, set out in that circular to health authorities, was that where NHS patients ended their days in a hospice the NHS should make a contribution towards the cost of hospice care. That was a clear policy statement by the Department.

Our thinking has developed even further. In December 1989, my hon. Friend the Minister for Health announced for the first time a special grant of NHS funds to health authorities specifically to support care in hospices. My hon. Friend the Member for Beckenham referred to the £8 million grant that was announced on that occasion. It represented the first explicit direction of central Government funds to hospice care and reflected the Government's view that it was important to make further progress towards reaching the objective that has been set out in the press release that was quoted by my hon. Friend the Member for Beckenham: to ensure that official funds matched the funds flowing into the hospice movement from the voluntary sector. The sum of £8 million was made available because we recognised that we must make progress towards achieving that objective. It represented significant progress towards ensuring that official funds matched those raised by the voluntary sector from non-public resources.

Progress has been made in the development of official thinking, from regarding the hospice movement as an inspired voluntary movement somewhat separate from the health service to it being an important part of the health care package on which the health service has come to rely and which therefore, quite properly, expects a contribution from the health service.

My hon. Friend the Member for Beckenham recognised that and quoted extensively from the utterances of my hon. Friend the Minister of State, Scottish Office, who has blazed a trail towards achieving the objective of official funds matching those raised by the private sector. I hope that my hon. Friend will not misunderstand me when I say that it is an attractive characteristic of the Scots that they regularly pioneer new ideas and approaches. My hon. Friend the Member for Stirling (Mr. Forsyth) will particularly appreciate it when I say that the Scots, from Adam Smith onwards, have had a particularly pioneering approach to the development of new ideas.

We share the Scottish Office's commitment to matching the funds raised from the voluntary sector, but we must recognise that in the competition for resources within the health service in England, the pace that we have been able to set in achieving the objective has been somewhat less ambitious than the pace that the Scots have been able to achieve.

I congratulate my hon. Friend the Member for Beckenham on his impeccable sense of timing. This is only the second Adjournment debate since my right hon. Friend the Chancellor announced the increases in public expenditure for the financial year 1991–92. I congratulate 309 my hon. Friend on making the first bid for the hospice movement in the internal redistribution process within the health service. We shall consider seriously what he has said and shall consider ways, if not in 1991–92, in future years, of delivering for the hospice movement the objective of ensuring sufficient official funds to match the funds raised by the voluntary sector.

310 I cannot give a commitment that we shall achieve that in 1991–92, but I assure my hon. Friend that his bid is the first in the hat and that it will be seriously considered. If we do not achieve it in the financial year 1991–92, the commitment still stands and we shall continue to seek ways of achieving the objective that we share with him.