Palliative Care Bill [HL]

My Lords, I join other noble Lords in congratulating the noble Baroness, Lady Finlay, on introducing the Bill, which has met with such a warm welcome right across the palliative care profession, and which has been so eloquently praised by many of your Lordships today. We are also grateful to my noble friend Lady Gardner of Parkes and the noble Baroness, Lady Masham of Ilton, for their courage and, indeed, for the service that they have done this House by sharing with us their experiences of the last days of their husbands. I return to the matter of funding, about which I spoke briefly in the debate introduced by the noble Baroness, Lady Jay, on 31 January. I declare an interest as chairman of St John’s Hospice in St John’s Wood in London. That hospice is in the voluntary sector. It is likely that the voluntary sector will be increasingly relied on by the National Health Service, at the very least to maintain its existing place in the palliative care movement; indeed, as pressures on funding from the Department of Health rise, the voluntary sector will probably play an increasing role in it. My case rests on the eloquent explanation of the role of the voluntary sector by the noble Baroness, Lady Finlay. As your Lordships will be well aware, the voluntary hospices recover a maximum of 50 per cent of their costs from the Department of Health. In many cases, the recovery is considerably below that figure. Bear in mind that the majority of voluntary hospices do not enjoy the support of parent charities, as we are fortunate to do—in our case, the Hospital of St John and St Elizabeth. For those charities, it is a real and increasing struggle. The only way to make good the shortfall is by fundraising, and it is becoming an increasingly tough business. An interesting published statistic that I discovered only recently is that, overall in the country, a general practice has only eight patients per annum who need palliative care. All of us involved in the industry know how the relatives of a palliative care patient get tied in emotionally to the hospice, and we are so grateful for the volunteers, particularly in day centres and so on, who give their services so freely. But a remarkably small proportion of the population has the need for palliative care and the facilities that we are talking about, unlike the situation with some of the major charities dealing with complaints such as cancer; for those charities, the appeal is much wider. In its bulletin The Funding Reality for 2006/07, published in November, the National Council for Palliative Care sent out a questionnaire to its voluntary sector members on the state of their funding negotiations with the National Health Service. Twenty per cent had not been able to reach final agreement on the National Health Service contribution for 2006-07, principally because of planned reorganisation of primary care trusts. Twenty per cent had received an uplift of at least 3 per cent, including their allocation from the £50 million pot. However, 50 per cent had received an inflation uplift of less than 3 per cent, and in half of those cases the increase was less than 2 per cent. Across the board, 16 per cent of respondents reported difficulties in maintaining their allocation from the £50 million pot, either in whole or in part. It had been completely removed, cut back, held back or there was simply no uplift. The overall differential between the funding of the voluntary sector and National Health Service units was 1 per cent last year. This year, it is likely to be in the region of 0.5 per cent. These figures may not sound much, but in the realities of the costs in the hospice movement, they are significant. Why should there be any differential at all? In referring to the voluntary sector, the NCPC bulletin stated that very few service cuts were identified. In other words, the voluntary sector hospices are, I surmise, simply getting down to it and getting on with their dedicated mission. Before this debate, I promised the Minister that I would not repeat my accusation of cynicism on the part of the Government. But is it possible that they are taking advantage of this commitment to maintain services in the face of significant funding difficulties? Those of us associated with the voluntary hospice movement have every sympathy with the financial problems faced by hospice units within the National Health Service—indeed, we work very closely with them. My noble friend Lord Patten may be interested to know that I spoke to our hospice director this morning and in her office was seated the director of the Pembridge clinic. That shows the degree of co-operation between hospices in localities. I feel strongly that, with the huge dependence on the voluntary sector for palliative care, which, as I said, I predict will increase rather than decrease, the uplift contribution should be the same for both sectors. I hope that the Minister will be able to give some reassurance on this subject, which I hope to pursue in Committee.