Hospices: Funding (Hansard, 15 June 2000)

§ Baroness Lockwood
asked Her Majesty's Government:
What is their policy for funding hospices.

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, the funding of hospices is a matter for local decision. Successive guidance has made clear to the NHS its responsibilities for commissioning palliative care services to meet the assessed health needs of their local communities.

§ Baroness Lockwood
My Lords, I thank my noble friend for that Answer. Is he aware that, for example, in 1999–2000 in the Yorkshire group of the voluntary hospice movement there was a fall in NHS funding of hospices which varied between 1 and 5 per cent, depending on the particular health authority concerned? Is my noble friend also aware of growing concern in the hospice movement that there may be even greater variation once the responsibility for funding is transferred to primary care groups and trusts? Is it possible to have an earmarked percentage funding of all hospices across the board?

§ Lord Hunt of Kings Heath
My Lords, I am sure that all noble Lords accept that the work of hospices is invaluable to the country. At the moment the NHS provides about 31 per cent of the revenue funding of hospices. I accept that there is a variation in the funding of individual hospices which very much reflects both local circumstances and the individual funding positions of those hospices. I believe that the best way round such problems is for every health authority to develop a palliative care strategy which enables these kinds of debates to take place at local level. I am sure that as a result of those debates satisfactory conclusions can be reached between individual hospices, health authorities and primary care groups.

§ Lord Clement-Jones
My Lords, the noble Lord is well aware of the concern of Members of this House about the funding of hospices, particularly since the end of ring-fenced funding six years ago. He is also aware that many noble Lords do not believe that the health improvement programme will necessarily lead to the level of hospice funding that is required. In the debate on this subject on 1st March the Minister promised that the decision-making process of health authorities would be reviewed. Can the noble Lord tell the House what progress he is making in that respect?

§ Lord Hunt of Kings Heath
My Lords, we believe that the development by every health authority of a palliative care strategy, aligned with a health improvement programme, is the way to ensure an agreed programme of support at local level, where the particular needs of hospices can be discussed alongside the development of palliative care services within the NHS. Since that debate I understand that one-third of health authorities have not yet developed those strategies. We shall make absolutely clear to health authorities that we expect those strategies to be developed as soon as possible.

§ The Duke of Norfolk
My Lords, before I ask my question, I should mention that my wife founded a charity called Help the Hospices which provides a meeting place for hospices in London near King's Cross. It was opened by Her Majesty the Queen the other day. It also holds conferences and trains people in the hospice movement. My question relates to funding. In the voluntary sector only 30 per cent of the expenses are covered by the state. Does the Minister agree that it should be 40 or 50 per cent? As has been said, for children's hospices the figure is only 5 per cent. Again, that should be 40 or 50 per cent. The Government simply must contribute a greater sum to the hospice movement than they do now.

§ Lord Hunt of Kings Heath
My Lords, certainly I pay tribute to Help the Hospices because over the years it has done an invaluable job of work. I believe that it is difficult to say what the exact level of NHS support for hospices should be. As the noble Duke says, the current figure is 31 per cent. It is a matter on which decisions must be made locally. The situation at each hospice is different and is best discussed at local level between the health service and the hospice. The development of a palliative care strategy and agreement on a health improvement programme within each health authority area provide the best way forward in dealing with those issues.

§ Baroness Pitkeathley
My Lords, does my noble friend agree that, invaluable though the work of the hospice movement is, many people who are dying and the people who look after them would prefer that to take place in their own homes? Therefore, does he agree that we must consider also the support given in providing palliative care in a domiciliary setting?

§ Lord Hunt of Kings Heath
Yes, my Lords. I believe that that is absolutely right. There is no doubt that in 1758 recent years we have seen the development of many more community services, often based in existing hospices. Those of us who have met the hospice movement recently know that many hospices are keen to develop services in the community. I am sure that that is the way in which those services will develop in the future.

§ Baroness Masham of Ilton
My Lords, does the Minister agree that there are very few hospices for children? Because of that, parents, often with other children, must travel long distances. Can he help with the funding of the travelling expenses of those parents and perhaps encourage more hospices to be established locally?

§ Lord Hunt of Kings Heath
My Lords, I believe that a number of points arise here. With regard to the number of children's hospices, my view is that, as my noble friend Lady Pitkeathley suggested, we need to encourage the development of many more community-based services in order to avoid, if at all possible, the need to travel long distances. Because hospices are in the independent sector, decisions with regard to support for travel costs must rest with the arrangements of the individual organisations.

§ The Lord Bishop of Birmingham
My Lords, does the Minister agree that if there is insufficient support from public funds for hospices, which do an absolutely marvellous job, pressure is likely to fall back on the general wards of ordinary hospitals where people are, in point of experience, likely to die with less dignity and less support than in hospices?

§ Lord Hunt of Kings Heath
My Lords, I believe that the whole development of palliative care services needs to be seen as a partnership between the National Health Service and the independent sector. There is no doubt that the NHS has learned much from the independent sector about palliative care services and, of course, has developed many services within its own NHS hospitals. I should not want to underestimate the high quality work that is being done there. However, I certainly accept the substantive point that the NHS needs to provide support to the hospice movement. I believe that 31 per cent of revenue costs is a reasonable base line. However, at the end of the day those matters must be decided locally on the basis of an agreed palliative care strategy.