Marie Curie Cancer Care (Hansard, 13 May 2002)

§ Lady Hermon (North Down)

First, I should like to thank you most sincerely for giving me an opportunity through an Adjournment debate to raise the serious funding concerns of Marie Curie Cancer Care and other voluntary hospices. I declare an interest because even after my election to the House last June, I could not bear to break my links with Marie Curie Cancer Care in Northern Ireland and chose, therefore, to remain as the unpaid chairman of its North Down support group.

In my absence, I have a committee of ever cheerful volunteers who continue to work enthusiastically as fundraisers for Marie Curie Cancer Care, and I am proud of the people of North Down, who continue to give generous support to their fundraising efforts.

I am extremely pleased to see you in the Chair, Mr. Speaker, because I know that you have always taken a keen personal interest in the great good work of Marie Curie Cancer Care, especially in Hunter's Hill, which is in your constituency and one of only two Marie Curie centres in Scotland—the other is in Edinburgh.

You are, Mr. Speaker, widely recognised as a loyal and active supporter of the hospice in your constituency, and in its silver anniversary year, your generosity in offering to host a reception in Speaker's House is greatly appreciated by Marie Curie. Hunter's Hill is regarded as a centre of excellence in specialist palliative care, but most regrettably, financial constraints mean that its full complement of 41 beds cannot be used.

Beyond Scotland, there are eight other Marie Curie centres throughout the rest of the United Kingdom—one in Wales at Penarth, six located around England at Newcastle, Liverpool, Bradford, Solihull, north London and Caterham in Surrey. Last, but certainly not least, there is one centre in Northern Ireland. The Marie Curie centre in Belfast was formerly known as Beaconfield. Again, it regrettably now functions with only 19 beds providing specialist palliative care.

We need to raise approximately £3 million for capital investment in an extension and we would obviously welcome Government support for that. In addition to the 19 beds in the Belfast centre, approximately 700 patients are cared for each year in their own homes by Marie Curie nurses across Northern Ireland. All staff make a wonderful commitment.

I want to pay warm tribute to the staff in the 10 centres as well as those Marie Curie nurses who cared for some 17,000 cancer sufferers at home in 2000–01. Their selfless dedication and compassion give tremendous comfort and support to those with cancer and their families. In that context, I should like to quote briefly from a letter that I received from a constituent, Mrs. Yvonne Mortlock, who described the last days of her father's life in the Marie Curie centre at Caterham. She wrote: The building was a haven of peace, kindness, love and compassion, which wrapped itself around one when entering the building. It was all so tranquil. The nursing care was superb, so professionally administered it looked easy. But what was also so admirable were the love and care shown to the close relatives of the patient. 618 Mrs. Mortlock concluded: I commend this Government to pledge itself to support in whatever way is possible the tremendous work the Marie Curie charity has done, is doing and hopefully will be able to continue to do in the future. Without question it is a deserving organisation. Mrs. Mortlock's plea is echoed by many Members of the House, and I am sure that the Minister will be well aware of early-day motion 1081, entitled "Hospice Funding", which has already been signed by 133 Members.

I should like the Minister to address two key questions tonight. First, are the Government supporting, in whatever way possible, the tremendous work of Marie Curie Cancer Care, as my constituent has requested? Secondly, are the Government supporting other voluntary hospices around the country? Sadly, the figures suggest that the answer to both those questions is no. Despite the fact that voluntary hospices provide three quarters of palliative care, the NHS contribution to voluntary hospices has dropped from 35 to 28 per cent. of annual running costs. This 7 per cent. drop has occurred since the Labour Government came to power in 1997.

The main reason for the fall has been that inflation uplifts to the voluntary sector have not kept pace with the voluntary hospices' increasing costs. For example, the Government have—quite rightly, I must say—made significant improvements to the salaries of NHS doctors, nurses and other staff. That, of course, means that voluntary hospices have no choice but to match the increases for their staff, without whom they could not function.

Moreover, the increase in employers' national insurance contributions announced in the recent Budget will mean that Marie Curie Cancer Care will need to find considerable funds to keep its 10 hospices running and to pay for its nursing service. I look forward to what I hope will be a guarantee from the Minister that the additional funding raised by the Budget for substantial investment in the NHS will also be extended to increase public funding to Marie Curie and other voluntary hospices that will have to bear the additional burden of increased national insurance contributions.

Another way in which hospices such as Hunter's Hill are severely penalised is through VAT. In the last financial year alone, Marie Curie paid £1.4 million in irrecoverable VAT. That is a huge amount of money. The amount of VAT that is being paid by hospices generally is not widely recognised. Surely it is time, therefore, that the Government gave active consideration to making voluntary hospices exempt from VAT.

In fairness to the Minister, however, I must say how delighted I was—I mean that truly—that, last Friday, 10 May, the Government announced that they were taking action to tackle the inconsistencies in the current system, in which some NHS trusts charge hospices for providing support services, such as NHS ambulances, pathology, imaging and pharmacy services, while others provide them free.

In their NHS cancer plan, issued as long ago as September 2000, the Government made a commitment that by 2004 an additional £50 million would be made available to the NHS for investment in hospices and specialist palliative care. I would welcome clarification from the Minister as to exactly how and where that £50 million will be spent. Does she agree that, in light of the 7 per cent. drop in NHS contributions to hospices 619 since 1997, £50 million may not now be sufficient? We all know that cancer has no respect for class, sex, colour, creed or any other status. Instead, it is a frightening fact that one in three people will get this awful disease, and that one in four will die from it. Looking around the Chamber and quickly totting up how many Members are here, that is a frightening statistic.

Hospices that care for terminally ill cancer patients have widespread public support from many, many thousands of volunteers who not only raise funds, but give of their time voluntarily in the hospices. I suggest that the Government must not risk losing the confidence of the general public or of those volunteers. Instead, they must give a firm commitment to developing a proper funding relationship with voluntary hospices as part of the forthcoming spending review. Like my constituent, Mrs. Mortlock, I commend the Government to pledge themselves to support, in whatever way possible, the tremendous work of Marie Curie.

§ The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I am happy to congratulate the hon. Member for North Down (Lady Hermon) on securing this important debate on hospices, specialist palliative care and, in particular, the excellent work of Marie Curie Cancer Care, which she highlighted. Policy responsibility for cancer services in Northern Ireland rests with the Assembly, so I am able to speak on those issues only as they affect England. However, I trust that what I have to say will interest Members, whichever part of the United Kingdom they represent.

The hon. Lady set out the success of the hospice movement clearly, passionately and in human terms. I hope that she accepts that this country is at the forefront internationally of standards in palliative care. I am the first to recognise that the hospice movement first showed that such care is possible and that patients, families and carers can be supported through illness and death, as well as during bereavement through counselling.

It surprised me to learn just how recent are the developments in palliative care. Only in the 1960s through dogged persistence, careful research, tireless fundraising and skilful lobbying did the hospice movement help others to see that such care was not only possible, but at the heart of excellent practice. Therefore, those health care developments are relatively recent.

The hon. Lady eloquently set out the important and valuable work that Marie Curie Cancer Care does to provide comprehensive care to people with cancer and their families throughout the UK. I am pleased to have the opportunity to acknowledge its work and to thank it for the way in which, over the years, it has worked constructively in partnership with the Department of Health. This certainly is not an example of the voluntary sector going along one track and the Department taking another. We constantly learn from each other in developing services for people in the community.

On the development of specialist palliative care, the hon. Lady asks how we shall help hospices throughout the country to provide a good standard of service. She will recognise that problems are associated not just with the diversity of palliative care, but with the massive regional inequalities in access to such care.

620 A survey conducted in 2000 by the National Council for Hospice and Specialist Palliative Care Services on behalf of the Department showed dramatic variations between regions: only 38 per cent. of health authorities in London had full palliative care strategies, whereas 92 per cent. in the west midlands were already well on the way to developing far-reaching palliative care strategies. In-patient provision varied across regions and there were similar variations in day care, home care and hospital support services. That is not good enough, and we are committed to trying to tackle those inequalities so that people throughout the country, wherever they live, can rely on good-quality palliative care services.

Inevitably, services that have developed from the voluntary sector depend to some extent on the ability, charisma and passion of individuals to take forward their fundraising programmes. That results in patchy service across the country. That is why the NHS cancer plan, which we published in September 2000, set out our intention to invest an additional £50 million in specialist palliative care by 2004. For the first time, NHS investment in this area nationally will match that of the voluntary sector, so there will be parity of funding.

It is true that merely increasing investment will not necessarily address the inequality of provision. That is why we have put in place other measures to try to tackle these issues. We have commissioned the National Institute for Clinical Excellence to undertake an evidence-based review of palliative care services as part of the supportive and palliative care service guidance. Initial findings are likely to be available later in the summer, and they will contribute to the strategy that we are developing as part of the overarching cancer plan. That will enable us, for the first time, to develop standards, so that people will know exactly what service is on offer and whether there is consistency and parity across services.

We have instituted a series of cancer networks, each of which has a palliative care strategy. Part of that strategy is to consider current population, the needs of a local area and how to build a service for cancer patients at community level involving primary care, secondary care, tertiary care and palliative care. We now have comprehensive data on the map of palliative care provision across England. That will enable more realistic support for voluntary hospices, and will help hospices to plan their own care, so that they can fit in with the network and collaborate with a whole range of professionals—clinicians, nurses and community support workers.

We recognise the importance of ensuring that the needs of voluntary sector providers are fully reflected in the investment plans that are developed, so as to ensure that we get maximum value from the extra £50 million. We have made central funding available to the national council to support people working in the voluntary sector and enable them to have a real input into the development of local plans. We do not want the plans to be a top-down mechanism. They should be based on the experience of local communities, and should build on the work, knowledge and expertise that voluntary sector providers have acquired over the many years they have been involved in this area.

We also want voluntary sector providers to have a role in helping to shape the standards that will be developed through the work of NICE, because learning from their 621 experience will be key to ensuring that standards are relevant to the needs of the people who will access the services.

The role of primary care trusts will be significant for palliative care, because they will spend 75 per cent. of the NHS budget by 2004. We have issued national guidance on the new arrangements for primary care trusts for this year's planning process, including the specific role of cancer networks. We have said that all primary care trusts should use the networks' service delivery plans to commission cancer services for their localities. That should ensure that there is proper planning, so that services do not spring up as a result of local initiatives that are unable to provide an equitable service for people across the community. Proper resources together with proper, detailed planning based on local people's experience should give us a much more coherent provision of cancer services and palliative care services than we have had in the past.

The hon. Lady raised some specific issues about hospice funding. I understand her concern that the sector should be adequately funded. Estimates by the national council show that total expenditure on adult palliative care services is about £300 million, of which about £170 million is provided by the voluntary sector and £130 million by the NHS. When the £50 million extra investment for the NHS comes through in 2004, funding from the voluntary sector and the NHS should be broadly equal. At a local level, that investment must be based on the agreed plans for palliative care provision within each of the cancer networks' plans.

According to the figures that the hon. Lady produced, it appears that NHS funding for the hospice movement—the proportionate funding, not the absolute funding—has fallen in recent times. The voluntary sector has been able to increase its fundraising by about 22 per cent. and NHS funding has gone up by about 14 per cent. Clearly, it is not matching the 22 per cent. increase by the voluntary sector. Therefore, proportionately, the figure will go down, but the absolute increase in cash terms has been about 14 per cent. over the past two years. Therefore, real funding for the sector is going up.

I congratulate the voluntary sector on being able to raise funds at a faster rate than the NHS. That does not mean that NHS funding is going down, but clearly the proportion will be less than the proportion of voluntary sector funding, which is increasing at quite a dramatic rate. I am delighted that local communities and individuals want to contribute voluntarily to the excellent fundraising of Marie Curie and a range of different cancer charities. As I said, this does not mean that the NHS contribution is falling, but it is not rising as fast as the voluntary sector contribution.

I say that not to blind anyone with figures and statistics, but to show that the Government are just as committed to putting money into the sector. However, we have not been able to do so as fast as the voluntary sector. That does not mean that the hon. Lady and her colleagues should not continue to press Government on the issue because it is obviously an important area for investment.

The hon. Lady has raised a couple of issues about VAT, about which officials at the Department of Health are in close contact with Customs and Excise. I understand that they will shortly be making a report to the Under- 622 Secretary, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), to see whether any relief can be provided in relation to VAT.

We would expect the NHS to take the recently announced increases in employers' national insurance contributions into account when deciding the level of funding for hospices. Clearly, they are a key part of the calculation. Hospices have wage bills to pay, and we would expect those bills to be part of the calculation when primary care trusts decide the level of funding.

The hon. Lady generously drew attention to last week's announcement about several issues that were anomalous in the sector, including funding for training posts in hospices, the cost of drugs, pathology and ambulance transport. I am delighted to confirm that from 1 April this year funding for the full basic salary costs of specialist registrars in palliative care training in voluntary hospices will be met centrally through the medical and dental education levy. Therefore, they will be on exactly the same terms as they are in any other sector. The hospice movement will not have to find those extra costs.

We will be communicating with chief executives of trusts to ensure that their policy on pharmacy, pathology, imaging and ambulance services is consistent across the country, because there are variations at the moment. In some places, there are extra costs; in some places, there are not. NHS patients in hospices should get the free pathology and imaging tests and services that NHS patients in any other settings get, and patients should not be charged for transport by ambulance between hospice, hospital and home. We will be reminding chief executives that fully agreed pharmacy costs for hospices should be met by the NHS. I am pleased to say that we agree that NHS patients should have access to those services and that hospices should not have to bear those extra costs.

The close partnership to which I referred between the NHS and the voluntary sector enables us to provide some of the best palliative care services in the world. I recognise that people want us to do even more and to ensure that people across the country are able to get access to care not just in hospices but, importantly, at home, which is a rapidly developing sector. That is why in the NHS cancer plan we said that we would make an extra £50 million available. It is also why we take cancer itself so seriously. A massive amount of new investment is going into not just treating cancer, but cancer research, which is an important area.

Government investment in cancer research in the past year has been estimated at £190 million. Charities themselves found £180 million in the same year. Those are quite significant and substantial sums, and they are a recognition of the tragic cost to families, individuals and their carers caused by cancer in our community. The stark figures provided by the hon. Lady at the end of her speech brought that home to us.

As well as the extra investment, there is a massive programme of updating equipment. We are putting in more MRI scanners and linear accelerators. We are trying to bring our equipment up to the best standards that would be expected in any other country.

I am delighted to say that more than 95 per cent. of patients referred urgently with suspected cancer were seen within two weeks during October to December 2001, the last period for which we have figures. We are beginning to get on top of this matter, although we can do much more to make sure that we catch the disease as early as possible. 623 An extra 85,000 women have been screened this year in the first phase of the extension of the NHS breast screening programme to women aged 65 to 70. Much more screening, detection and early diagnosis are taking place, and there is much more work on research and, crucially, prevention. One of our top targets was to try to get more people to give up smoking as a contribution to reducing cancer. Over the last 18 months, more than 118,000 people have reported that they have successfully given up smoking using the Government's world-class services to help people to quit.

We have a good programme right across the field in tackling cancer. The hon. Lady is right to raise the important issue of specialist palliative care, which is a relatively new field of health care that has been developed over the last 30 to 40 years. The people involved are some of the most impressive nurses, clinicians and community support workers whom I have ever met. I have visited hospices, and the words of the hon. Lady's constituent—that these places are a "haven of peace" that wrap themselves around people at a difficult time in their lives, and when they are at their most vulnerable—were appropriate. The services that I have seen are absolutely first rate and first class.

624 The task for the Government and the community is to make sure that these services are not simply available where there have been enthusiastic volunteers and that, as a national health service, we have a responsibility to people right across the community to make sure that they can have access to care at home or in a hospice, as well as support for their families and carers. The service must be designed around the needs of the patients who use it.

That is why I genuinely feel that the cancer networks and the collaboratives—local people working together with patients, talking about their needs and the services they would like to see—should be driving not just cancer services, but the whole of our national health service. Patients and the public fund our services, through fundraising or taxes, and our responsibility is to make sure that those services are the very best that we can possibly provide.

I am delighted that the hon. Lady has had the opportunity to raise the subject today. I reassure her that the Government certainly value these services and that we will do our very best to make sure that the new investment gets to them and makes a difference on the ground.