§ Mr. Tim Rathbone (Lewes)I welcome the opportunity to raise this issue in the debate, which comes, by good chance, this morning. First, I will remind the House about some characteristics of the hospice movement, although I doubt whether any Members are unaware of them.
Through its in-patient facilities, the hospice movement provides specialist care for people in advanced stages of serious illness. Through day care, it provides opportunities for expert help with symptom control, for counselling and for other therapies, as well as mental and physical refreshment for patients living at home and for their carers. Home care is provided by qualified hospice staff to support community nursing services, to assist patients and carers in daily nursing routines and regular assessment, and to maintain an open door to in-patient respite care.
I mention all those services because they are less well known than the major and best known hospice service, which is in the treatment and care of people whose condition cannot be cured, particularly to reduce, if not eliminate, patient discomfort and to improve patients' quality of life. Specialists are there to allay fear, to prescribe possible treatment and to provide holistic support to improve the quality of life.
Time never stands still and the needs of people suffering terminal illness will always become greater and require increasing support. That is the function of marvellous hospices such as St. Peter and St. James's home and hospice at Wivelsfield Green in my constituency. The Minister's colleague, Baroness Cumberlege, who visited the hospice recently, can vouch for the impressive quality of its work. I must say immediately, however, that the benefit from the hospice's care and service covers adjacent constituencies as well as my own and is almost equally provided to patients from East Sussex and West Sussex, which causes part of the funding problem.
Hospice funding does not depend entirely on health authorities. Like other hospices, St. Peter and St. James's depends to a large extent on charitable donations. It is only through such generous public support that: the hospice survives and can continue to give vital assistance so marvellously. It devotes much energy and innovation to fund-raising activities and local people are continually wonderfully generous, but health authorities also must contribute from the funds provided to them by Government to do so.
The Minister will know—indeed, his colleague has told me—that until last year Government funding was specific and had risen from £8 million in 1991 to £48 million in 1994–95, which is to be welcomed. Since then, funding has been built into health authorities' general allocations, with an aim to meet hospice needs on a 50:50 basis. The Department of Health guidance states specifically that removal of separate identification from funding for specialist palliative care—for hospices—should not be viewed in any way as representing a reduction in priority for that sector. That was confirmed by my hon. Friend the Minister for Health in his letter to me on 14 August.
The East Sussex, Brighton and Hove health authority's contract with St. Peter and St. James's is for three years—its last year is next year—at £50,942 per year. I am told 314 that that equals only about one third of the cost of in-patient services alone. No extra funding is provided for day care or for home care services, either from the authority or from local social services. It appears that no more funds are available for this wonderful hospice while a new hospice is being developed in Brighton and Hove. It is invidious to choose between the two. Both need better support.
The picture is even bleaker with regard to funding from West Sussex. Patients from West Sussex, just across the nearby county border, represent approximately 50 per cent. of the hospice's work, but the authority provides only £10,550 per annum—an invidiously small remuneration for the wonderful services provided to many people for whom it is responsible. It is not prepared to pay for any day care services, thus forcing patients requiring those services from St. Peter and St. James's to pay for them themselves.
The net income from both East Sussex and West Sussex health authorities of just about £60,000 leaves St. Peter and St. James's with the need to raise between £400,000 and £500,000 each year. That is far removed from the 50:50 funding guideline goal and shows a dramatic reduction in priority for palliative care funding, contrary to the Government's guidelines.
I will give one dramatic illustration. Recently, an East Sussex AIDS patient in a West Sussex hospital was moved to St. Peter and St. James's with the promise of necessary funding to come with him. The money never appeared. The hospice became the pig in the middle between health authorities and social services. Eventually, money was agreed only under threat of having to move the patient elsewhere and receiving negative publicity for that action. Sadly, the money was paid only after the patient had died.
That was a human tragedy. The hospice charges for that AIDS patient are approximately one third of the cost elsewhere and the hospice's services for such a patient are infinitely better—indeed, unmatched. Professional and dedicated people are trying to do their best for a desperately ill and dying patient and for many others like him, but they are not being provided with the basic funds to do so. That is one illustration of an omnipresent problem which has threatened St. Peter and St. James's literally with closure, so desperate is its financial position. But for one generous and substantial donation out of the blue last week, the hospice would probably have been closing as we pursue the debate.
What do I ask my good and honourable friend the Minister to do? First, I ask him to issue new hospice funding guidelines to health authorities to ensure that proper funding is provided in at least the same proportions as previously provided under the specific ring-fenced money provisions of yesteryear. Secondly, he must ensure that health authorities move speedily—I stress speedily—to a 50:50 funding proportion, to establish a deadline for them to do so and to fund them accordingly. Thirdly, he should make certain that health authorities provide fair funding to cover the needs of patients from their region and do not hide behind contracts that have been overtaken by increasing needs, nor rely on the good will of people dedicated to provide those services while denying them the funds to do so, as the West Sussex health authority is doing. Fourthly, some better mechanism must be established for decision-making on funding matters between health authorities and social services to avoid 315 in-fighting such as that recently faced by the St. Peter and St. James's AIDS patient. Fifthly, the Minister should make sure that the principles of the patients charter apply, so that patients go where they can get the services that they need and the funds go with them. Sixthly, and finally, my hon. Friend should see what can be done to provide assistance to hospices to help them to deal with health authorities and social services on a more equal basis in their contractual and financial dealings.
The House will realise that people in the advanced stages of illness, and often apparently approaching death, need special help. Hospices such as St. Peter and St. James's uniquely provide with care and dedication the specialist services required. They continue to deserve public support, and I am sure that they will continue to get it. But they also deserve better support from Government-funded bodies such as health authorities and social services departments. I call upon my friend the Minister to give that help.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Horam)I am pleased to have the opportunity to respond to my hon. Friend the Member for Lewes (Mr. Rathbone), and I congratulate him on securing time for a debate on the funding of St. Peter and St. James's hospice. I have no doubt that it is an extremely important issue.
I have listened carefully to my hon. Friend. He feels that the hospice provides a valued service for the people of Lewes and Haywards Heath in East Sussex, and I understand any concern that he has for its future.
Before I respond to my hon. Friend's concerns about funding, I should like to express sadness at the untimely although not entirely unexpected death of Julian Wellesley, chairman of the East Sussex, Brighton and Hove health authority. He was a well respected man, with a successful career in finance and commerce. He devoted considerable time and energy to the health service, and was appointed to the position of health authority chairman in 1990. He proved to be an outstanding chairman, leading his authority with great style and skill, and his name will live on in the many improvements to local health services that he pushed through.
§ Mr. RathboneI should like to add my support for my hon. Friend's words. I knew Julian Wellesley for many years before I came to the House. He started his work in the health service on the board of Eastbourne general hospital. He was then appointed chairman of Eastbourne health authority and most recently he was a marvellous chairman of East Sussex, Brighton and Hove health authority. He engineered the bringing together of the local health authorities and community care providers under one wing. I believe that my hon. Friend's words are justified.
§ Mr. HoramI am grateful to my hon. Friend.
I know something about St. Peter and St. James's home and hospice from my colleague, Lady Cumberlege, who visited the premises on 20 August, as my hon. Friend said. She was very impressed by what she saw. The charity's efforts are obviously much appreciated by patients and the local community.
316 St. Peter and St. James's home was built 20 years ago to provide residential care for severely disabled people and elderly people. It branched into hospice care in the early 1990s. The hospice comprises six in-patient beds and a new day centre. It also provides home support services for patients in the community.
St. Peter and St. James's is one of a number of hospices in Sussex. Like other voluntary hospices, it is funded from charitable sources, and also by the health authorities. I will have more to say about health authority funding of hospices, which ultimately comes from the taxpayer, of course, but first I should like to pay tribute to the excellent work done by charities up and down the country in raising many millions of pounds every year for hospice care. None of us is under any illusion about how difficult it can be to raise the sums required, and we are extremely grateful for the considerable unpaid time and effort so generously given by so many people.
I should make it absolutely clear that our commitment to palliative care is undiminished. I also remind the House that the United Kingdom is a recognised world leader in the care of the terminally ill. Significant advances have been made in pain and symptom control and in improving the overall quality of life for patients with cancer and other life-threatening illnesses. The aim of our policies is to ensure that the benefits of those improvements in treatment and care are available to all patients, wherever they may live.
The spectrum of palliative care provision and support required to meet patients' and carers' needs continues throughout the patient's illness and into the carer's bereavement. It ranges from the promotion of physical and social well-being to highly specialist palliative care involving physical, psychological, social and spiritual support. It is provided in both community and in-patient settings. It will vary according to the stage of illness, and may be required from the time of diagnosis.
To provide such services, the Government's support for hospice and specialist palliative care services has, as my hon. Friend acknowledged, increased sixfold between 1990 and 1994. In 1994, that funding reached nearly £48 million. As of January this year, there were 171 hospices operating in England, with a total of 2,599 beds, 308 home care teams, 89 hospital support teams and 191 day hospices. Some of those are part of larger national voluntary bodies, but most are locally based individual charities such as the St. Peter and St. James's hospice. As the House will appreciate, the care of the terminally ill nationally is a large undertaking, which has grown enormously in the past 10 years.
As my hon. Friend said, since 1994, funding for specialist palliative care has been built into health authorities' allocations and has not been ring-fenced as it originally was. My hon. Friend is concerned that that practice has diminished support. I can tell him that my Department has a good working relationship with the National Council for Hospice and Specialist Palliative Care Services. We rely on that organisation to identify local problems. The council is co-ordinating a survey of all health authorities and is interviewing those responsible for palliative care. The picture is incomplete because the survey is expected to be published early next year, but the evidence so far is that health authorities are at least maintaining—I emphasise that word—their palliative care funding levels. 317 The change in the funding approach was designed to ensure that health authorities planned for palliative care in the same way as they planned for other health services. Health authorities are free to negotiate with individual providers the level and form of support required to meet the palliative care needs of their population. That flexibility in the use of funding has enabled the palliative approach to become more widely adopted in all settings, including hospices, hospitals, nursing homes and the patient's own home.
It is, of course, essential that hospices and health authorities work in partnership when drawing up and developing local strategies for palliative care. Agreement between them must be based on the assessed health needs of the resident population and should take into account local priorities, available resources and existing patterns of services. That should allow resources to be used effectively and avoid undue duplication.
It is also important for health authorities to ensure that new developments do not divert resources from established palliative care units if they are delivering high quality care. That fact needs to be emphasised in the context of today's debate as I know that St. Peter and St. James's is a valued as well as an established palliative care unit. I am sure that that point will not be lost on the health authorities. Indeed, if there was any danger of that, we re-emphasised that point as recently as 15 October 1995 in guidance to all health authorities.
East Sussex, Brighton and Hove health authority and West Sussex health authority are responsible for contracting for palliative care services in Sussex and the area served by the St. Peter and St. James's hospice. While I understand the wish of that hospice and those connected with it to secure as much funding as possible from their health authorities, it is for the two Sussex health authorities, as purchasers of health care for their residents, to determine what level of resources to devote to palliative care, and which particular providers to use.
My hon. Friend the Member for Lewes referred to the level of support being provided and mentioned a total contribution of approximately £60,000 from the two health authorities to the more than £400,000 required to maintain the hospice. Those are large sums of money for the authorities, but I readily agree that they are small in relation to the total sum required. My hon. Friend was correct to say that approximately 30 per cent. of the costs of patients from East Sussex are being matched by funds from their health authority, and that the percentage provided by the West Sussex authority to maintain patients from its area is even smaller—perhaps as low as 10 per cent.
§ Mr. RathboneI remind the Minister that those figures apply only to funding for in-patient services and not for other services.
§ Mr. HoramI accept that, but those are the amounts being provided by the two health authorities.
The matter of what resources are available to the health authorities is a separate issue. As a Member of Parliament representing a Sussex constituency, my hon. Friend the Member for Lewes will be aware of the difficulties faced by the West Sussex and the East Sussex, Brighton and Hove health authorities. This year, the disparity between the target and actual amounts that the East Sussex health 318 authority should receive is more than £18 million, while for West Sussex the amount is more than £15 million. Those disparities are among the worst in the country. My hon. Friend will be aware that the authorities are some distance from the target amount of funding that they should receive.
My hon. Friend will also be aware that we are endeavouring to diminish the disparity between the ideal and actual amounts over time. Therefore, this year the two authorities received increases that were very much higher than inflation. They can also expect increases very much above inflation in future years. I am sure that my hon. Friend will be aware of the commitment made by my right hon. Friend the Prime Minister at the Conservative party conference to real-term increases in the health budget, which will be reflected in the amount of money going to health authorities.
At this time of year, health authorities do not know how much money they will receive next year, but they will know fairly soon. I hope that the authorities will appreciate the point made by my hon. Friend the Member for Lewes in this debate and bear in mind the situation facing St. Peter and St. James's hospice when they consider the disposition of their resources, which have been increased in real terms. I hope that they will consider the situation very carefully when they know where they stand.
My hon. Friend the Member for Lewes made an important point about the need for co-operation between the two health authorities. It is important that the problem does not slip between the fingers of both authorities as they are both taking their own point of view and not co-operating with one another. I am glad to be able to tell my hon. Friend that there is correspondence between the two authorities on the matter. As he knows, there is also correspondence outstanding between the hospice and the West Sussex health authority. So the problem is being dealt with. My hon. Friend also raised the important issue of ascertaining the exact financial position. I agree that that must happen soon, and I hope that the two authorities will talk with the hospice to deal with the problem.
I hope that my reply has reassured my hon. Friend that I should like the problems to be dealt with urgently by the health authorities, after they are made aware of the resources that will be available to them in the next financial year.
§ Mr. RathboneA couple of questions arise from the Minister's reply—which I much appreciated. He has certainly reassured me about what he would like to see happen, but it does not reassure me about the behaviour of the authorities. There have been long-drawn-out conversations between the East Sussex, Brighton and Hove authority and the West Sussex authority, which have reached a complete impasse. Based on my correspondence with the authorities, they have shown no sign in the past year of overcoming that impasse. Any additional guidelines that the Minister can provide would help. Any assistance that he can give to hospices, so that they can be on a more equal footing in their contractual arrangements, would also be appreciated.
The Minister mentioned the need to close the funding gap for the two authorities to bring them up to the national norm. Therefore—I did not anticipate that the debate 319 would reach this conclusion—the problems of the St. Peter and St. James's hospice rest on the shoulders of the Minister.
§ Mr. Deputy Speaker (Mr. Michael Morris)Order. The hon. Gentleman knows that interventions should be used to intervene in the debate and not to make a second speech.
§ Mr. RathboneI agree absolutely, Mr. Deputy Speaker, and I stand admonished by your ruling. I was seeking clarification from the Minister on two extremely important points. I hope that he has taken them on board. He still has a moment in which to apply his mind to them.
§ Mr. HoramFirst, I realise that the problem has been a matter of debate between the two authorities. As a result of the points made by my hon. Friend in this debate, and particularly because of the immediacy of the financial problems faced by the hospice, I shall ask the authorities to re-examine the matter, in conjunction with the hospice, to discover the exact financial problems.
Secondly, I can reassure my hon. Friend that we realise the funding problems faced by the authorities. We hope that there will be further progress in narrowing the gap between the authorities' current position and the norm in the announcement about health authority funding for the next financial year. That will mean increased real resources for the two health authorities to tackle the problem and will allow them to give the problem the priority that they would wish to accord it.
§ Mr. Deputy SpeakerOrder. As the hon. Member for Islington, North (Mr. Corbyn) and the Minister are in the Chamber, we can begin the next debate early.