---

Palliative Care

My Lords, we are indeed indebted to the noble Baroness, Lady Finlay, for securing this debate and for introducing it so very ably. In taking part I declare this interest: in the late 1980s I was responsible for much of the research and planning that led to the establishment of St Mary’s Hospice, Ulverston in south Cumbria. I have had continuous involvement with it ever since and I am its current chairman. Nothing I have ever done has made more demands on my time and energy; at intervals nothing has given me greater anxiety and precisely nothing has given me such a sense of fulfilment. I believe that the development of the independent hospice movement in Britain represents perhaps the greatest change for social good which has occurred in my lifetime. I base this rather extravagant sounding claim not entirely on what hospices have achieved but on what they might yet achieve if they are allowed the necessary freedom and space in which to develop. Central to what I have to say this afternoon—it is a slightly different emphasis from other speakers—is that if we lose our independence, then to all intents and purposes the hospice movement that people have come to know and value will be destroyed. I know with what intensity it is valued by people, as I have seen at first hand the lengths people go to both in financial and voluntary terms to support their local hospice. I am not alone in noticing that attractive, popular and successful activity in the independent voluntary sector can give rise to public sector resentment. This resentment is especially evident if money is perceived to be flowing to areas which it does not control. At its Worst, frustrated public bodies use or misuse their considerable power to hinder and obstruct. Our hospice of St Mary’s serves a population of 120,000 people. At today’s prices the operation costs—not the fundraising costs—£1.7 million a year, which equates to £14 for every man, woman and child in the catchment area. That we have raised such sums is a huge tribute to our appeals team. In one of Britain’s less rich areas it represents a generosity of spirit that compares extremely well with any other part of the United Kingdom. However, I am not confident that that is sustainable. We are felt by some to be asking too much and impacting too heavily on the work of other important local charities. Against a government target of 50 per cent grant aid, and figures I have heard of 30 per cent, we get 10   per cent grant aid. Historically that has been all we have ever had. I do not know of any other hospice that gets less. I think it was nearly four years ago that the famous £50 million hospice package was first announced on the steps of our very own hospice, St   Mary’s, by Mr John Hutton MP with much press fanfare. Out of that extremely useful pot we have so far received not a single penny for core funding. Our local primary care trust has turned down all requests for support from that source and is only now offering modest financial packages for non-core services that we neither need nor want, and then with a raft of strings attached. The Minister will say, with some reason, that funding is a matter between the PCT and ourselves. I merely say that I hope it is a matter of concern to him that a policy so publicly announced by his department should have so signally failed in terms of outcome. The truth is, of course, that the local PCT is broke and is also determined to control us by any means open to it. The financial plight of primary care trusts certainly does not prevent them servicing a huge plethora of committees and working groups. We have to attend in person not one or five or 10 but 12 such committees and groups to retrieve the miserable 10 per cent funding to which I referred. In regulatory terms the Healthcare Commission is hugely intrusive. The inspecting team spends two days in our filing cabinets and only 20 minutes on the ward and in day care. Our staff simply cannot understand what the purpose of such inspections is. We measure PCT forms to be filled in by weight; one of the latest of those forms had us defending our performance in the last quarter on why we had not cured any of our patients. We estimate the staff costs of processing the paperwork alone generated by the PCT amounts to £18,000 a year. This absurd second-guessing does not happen with other hospices that I know of. I understand that the Government’s admirable Compact Plus scheme, requiring public sector bodies to be more accommodating to the independent sector, has been adopted in other areas ahead of the official starting date. Perhaps the Minister will have something reassuring to say in that respect. The universal and holistic way in which we in the independent sector understand and practise palliative care is something the NHS cannot hope to match, either in quality or in terms of cost. It is not designed to do so. We have such qualities in our hospice movement, as the noble Lord, Lord MacKenzie, said. He spoke of the importance for patients of the feeling of safety. The other day I was talking to the young and talented chef at our hospice, and she was saying very movingly what a challenge it was, when any patient came in, to find out in the last days of their life, not only what they could eat, but to help them try and get some pleasure from eating it. Little details like that make such a difference. I come now to a suggested way forward for funding. Since virtually all our patients are referred to us by the NHS, and since we care for them without charge, is there not a simple and fair formula for getting public sector finance into our hospices? Reflecting on various options that have been talked about lately, either we could be paid a sum for each patient that is referred to us—and remember how much money we are saving the taxpayer—or the public sector referrer might choose to buy a proportion of our beds and services annually. A healthy and constructive partnership would result from such a course, and it would lead to a much lighter touch in terms of regulation. After all, the referrers will always have the choice of using or not using our services. The other judges and arbiters of our standards of care are the public. I see nothing wrong with that; indeed, I would see only good coming of their being rather more carefully listened to. Finally, it seems likely that cancer will have ceased in 10 years’ time to be the major life-threatening disease it is today. In our catchment area, because of the asbestos-related cancers from the former shipbuilding industry, we will sadly have those patients for rather longer. As has been said so eloquently and so importantly in this debate, there are other cruel diseases and tragic human conditions where our model of care will be ideally suited to people’s needs. We would like to reposition ourselves over the next few years to meet such a challenge. It is a model that works and, beyond all doubt, that people want. When the Minister comes to reply, I would welcome his reaction to my suggested funding methodology. In the important area of our longer-term development, perhaps he will be kind enough to reflect on what I have said, and write to me in due course. As I have illustrated, we have had rather a poor deal at the hands of his department. Rather than dwell on that, however, I would like to see a future partnership that respects our independence in the cause of maintaining and developing excellence in palliative care. At the moment a threat hangs over the hospice movement, and I should like to see it removed.