Hospices: Nurses Pay Award (Hansard, 15 June 1988)

§ The Earl of Arran
My Lords, hospices are providing a local service and it is for health authorities to decide the appropriate level of funding to give to any voluntary body which provides services in support of local health services. We expect health authorities to take account of the nurses' pay award when they consider the level of financial support to give to hospices.

§ Baroness Cox
My Lords, I thank my noble friend for that partially encouraging reply. Is my noble friend aware that, while the hospices warmly welcome the pay award granted to nurses, the increase in funding for the average size hospice for the care of the dying would mean an extra £100,000 a year and that unless they receive some help such hospices will have to cut back on the number of beds and the care they provide for terminally ill people?

§ The Earl of Arran
My Lords, if the Government funded hospices as they fund health authorities, hospices would cease to be voluntary and lose that which makes them so special. The responsibility for funding assistance for hospices belongs with health authorities.

§ Lord Molloy
My Lords, is the Minister aware that, overwhelmingly, hospices care for terminally ill people, who will die there? Is he further aware that the relatives of such people receive remarkable advice, help and guidance from the hospices, of which there are about 100 in England? The district health authorities say that they cannot help them because they have already made up their budgets, so the hospices will just have to suffer and the relatives of those who are dying in them will have to put up with it. If they have to close, the cost to the National Health Service will be infinitely higher than if the Government take courage in their hands and pay for the pay increases for those nurses who serve in these Valuable and humane hospices.

§ The Earl of Arran
My Lords, as the noble Lord, Lord Molloy, pointed out, there are already 23 NHS hospices and more than 170 NHS home care teams. We have told health authorities to provide the full range of terminal care services—that is, in-patient home and day care facilities—in collaboration with voluntary bodies. We should like to pay tribute to the many charities working in this field, in particular, for the example they have shown in making death a more dignified part of life.

§ Lord Kilmarnock
My Lords, are we not in a difficulty? Whether a service is provided by the NHS or by a voluntary body is a technicality. Surely what we do not want is a diminution in the number of beds. Might one way ahead be to increase the current limits paid for people on income support in hostels and hospices for the terminally ill, which at present run between £135 and £230 a week and which I believe have not been increased since 1985? Would that not be a way ahead?

§ The Earl of Arran
My Lords, the Government are aware of the problems being faced by hospice patients in claiming social security benefits. Officials in the department are well aware of this problem and are urgently seeking a solution to it.

§ Lord Ennals
My Lords, is the Minister aware that though the voluntary hospices—and there are more than 100 of them—will greatly appreciate his tribute, that will not ease the fact that their budget is now being increased by 12 per cent to pay the nurses' award? Does he not realise that if beds are lost or whole hospices are closed it will be serious for the patients concerned? Will he ask his right honourable friend to consider whether as an interim measure, in view of the fact that the health authorities have already planned their budgets for this year, he can find some resources to help out this extremely valuable service?

§ The Earl of Arran
My Lords, it may be of interest if I mention that independent hospices, of which 266 there are about 80 in the United Kingdom, are registered as private nursing homes. Most are also registered charities and depend upon voluntary donations from patients and the public and on legacies for their main source of income. In addition, as I have already stated, there are 23 NHS hospices. There is at least one private fee-paying hospice which admits only patients who are able to pay for their care. Some of the independent hospices receive some financial support from health authorities, the amount of which varies from nil to 80 per cent., with the average around 38 per cent.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that all people working within the National Health Service know the very many demands on that service? What progress has been made on the lottery? With more people now dying from AIDS, is not the problem regarding hospices becoming very serious indeed?

§ The Earl of Arran
My Lords, hospices are providing a local service and health authorities have the power to assist them financially. They are in the best position to judge the appropriate level of support. AIDS hospices are, however, innovative projects, and the two London-based units will be providing a national service. For those reasons central funding was appropriate. We have given £400.000 to the Mildmay Mission's AIDS ward and £1 35 million to the London Lighthouse for its AIDS centre, which includes an in-patient unit.

§ Lord Stoddart of Swindon
My Lords, is the Minister aware that massive work has been done by ordinary folk and voluntary organisations to fund the hospices which have budgeted on certain criteria? Now, because of the large and justified increase in nurses pay, they find that their budgets are knocked for six. That is the worry. Is it not possible for the noble Earl and the department to make, as my noble friend suggested, a special payment this year at least to tide them over what will be an extremely difficult time? These are voluntary organisations and their work has been immense. I know that because I was chairman of the Prospect Foundation Hospital in Swindon and I so admired the work of these people. I should hate to think that they will now be let down by the department.

§ The Earl of Arran
My Lords, the Government, and every Member of your Lordships' House, are extremely appreciative of the very high standard of continuing care developed and provided by the independent hospice movement and of its increasingly strong partnership with the NHS in caring for people who are terminally ill.

Lord Richardson
My Lords, is the noble Earl aware of a specific example that illustrates a point made in the last but one question and which concerns the North Devon Hospice Trust, of which I have the honour to be president? It is a newly-formed trust in an area which is not especially wealthy. It has budgeted for its out-patient functions, which are its sole functions—it has no beds of its own—and to extend its day-care services, which are enormously 267 appreciated by the dying. Is he further aware that its increased financial commitments will mean that the relatively small sum that it has managed to collect in order to expand the day facilities, which are urgently needed, will not be available for that purpose?

§ The Earl of Arran
My Lords, I am not aware of the example mentioned by the noble Lord. However, in those circumstances it is up to the regional health authority to provide such money for the hospice as it thinks appropriate. I should also like to say that we have informed health authorities in a circular that where a hospice provides a service which forms part of the health authority's overall strategy for terminal care, that health authority should agree with the hospice an appropriate contribution towards its running costs. The circular also requested health authorities to provide information on their arrangements for financial support of hospices in their integrated planning statements which are due this summer. We shall of course be critically examining the information that they provide.

§ The Duke of Norfolk
My Lords, is my noble friend aware that a critical situation has now developed because of the nurses' pay award? The award is a most admirable one and in no way am I suggesting that it is too much. However, it is being suggested that the Minister might look further into the matter. Some hospices are most labour-intensive and in some cases 70 per cent. of their costs are for nurses, or doctors, who also carry out their duties voluntarily.
There is a great need for the DHSS to give some direction to the area health authorities, and perhaps provide some special money.

§ The Earl of Arran
My Lords, I have listened carefully to the point made by my noble friend. However, I can only repeat that if the Government funded hospices, as they fund local authorities, they would cease to be voluntary organisations and would lose the appeal which makes them so special. I say again, the responsibility for funding hospices belongs to the health authorities.

§ Lord Ennals
My Lords, I should like to repeat the question that I put to the noble Earl. I asked him if in the light of what has been said—indeed, more has been said since I put the question—he would discuss with his right honourable friend the Secretary of State whether some funds could be found to enable health authorities, which have already allocated their funds, to make a special grant just for this year to assist voluntary hospices?

§ The Earl of Arran
My Lords, in view of the question posed by the noble Lord, and of the feelings of the House, I shall certainly pass on the comments and concerns about the hospice movement to my right honourable friend.

§ Lord Hailsham of Saint Marylebone
My Lords, is not the noble Earl aware that such institutions really should demand higher donations from the charitably-minded public; and that those who already give money ought to squeeze themselves still further and give a little more?

§ The Earl of Arran
My Lords, I can only say to my noble and learned friend that that point of view is certainly appropriate.

§ Lord Molloy
My Lords, is the noble Earl aware that his earlier reply will be most welcomed not only by all Members of this House, but also by all the people who are working in the hospices? Is he further aware that the hospices which receive an allowance and help at present can only obtain such assistance if they charge the patients? We are concerned with the hospices which do this work voluntarily but which are nonetheless pleased that the nurses have received the pay award. Therefore, when he said that he will look thoroughly into the matter it was indeed a most welcome reply.