– in Westminster Hall at 12:00 am on 6 February 2001.

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Motion made, and Question proposed, That the sitting be now adjourned.--[Mr. Jamieson.]

Photo of David Drew David Drew Labour/Co-operative, Stroud 9:30, 6 February 2001

I am delighted to be able to introduce this debate on the future of hospices. I do not intend to take more than my fair share of the time. It is good to see other hon. Members here and I am sure that the Minister will want the maximum time to respond to some of my questions. This is an important issue, which was covered, quite by chance, a couple of weeks ago on BBC television news. The way we treat very sick people is an important part of our health provision, our social care and our general humanity.

I should like to thank Jean-Luc Priez, the chief executive of my local hospice, Cotswold Care in Minchinhampton, and David Praill, the chief executive of Help the Hospices, for their help in preparing this speech. I do not want to spend long looking at the history of hospices, but it is important to put them into context. They have achieved greater prominence recently, but they have been with us for some considerable time. We can look back to the initiatives of the Duchess of Norfolk and the work of the different bodies that represent hospices, such as the National Council for Hospice and Specialist Palliative Care Services and the Independent Hospice Representative Committee, both of which are well known to the Minister.

I should like to make four key points. I shall consider the current position of the hospice movement and the problems that it faces, and perhaps come up with some solutions. I shall consider first the background to the hospice movement; secondly, Cotswold Care in my constituency, which is an exemplar of the best that the hospice movement can provide; thirdly, what the hospice movement has to offer more generally, and, finally, the problems that the hospice movement faces.

There are three types of hospice. There are the NHS hospices, of which Britain has about 20, and those organised and run by large national charities, such as Marie Curie Cancer Care and the Sue Ryder Care, both of which draw down a lot of money from the NHS. I wish to consider the third type of hospice, which is the voluntary or independent hospice. There are 200 such hospices in the country, 180 of which are independent charities in their own right. They receive much less largesse from the NHS and that is the root of their problems.

Independent hospices are essentially local, meeting local needs. They offer impressive care to their immediate community. For example, they provide 70 per cent. of all in-patient care, 87 per cent. of all day care and 44 per cent. of all home care. They are not some marginal group. In many respects they form the core of the hospice movement. The problem is that they tend to receive sporadic funding from the NHS. I am never sure whether it was a tablet-of-stone arrangement or one of those informal agreements, but the previous Government ended the 50:50 funding relationship between what the state tended to provide and voluntary or charitable donations back in October 1996. If my local hospice is anything to go by, there have been significant problems ever since.

The average funding from the NHS is about 30 per cent., but many hospices receive much less than that. That level of funding tends to be capped and has been declining over time. There is much evidence of differential funding from health authorities. The primary care trusts seem to be somewhat unclear on the position of hospices and certainly on how to fund them, if we are moving in that direction. I will deal with that later.

My local hospice, Cotswold Care, is amazingly successful and highly thought of in the community, with a high recognition factor. It opened about 12 years ago and is based on a good and well-organised site just outside Minchinhampton in my constituency. The workers, under Jean-Luc Priez, whether paid or voluntary, are very highly thought of in the community. They cope with about 15 patients a day on four days a week, providing them with all manner of support, such as counselling, therapy and so on. On the fifth day, there is specialist provision for people who suffer from particular diseases, such as multiple sclerosis. The hospice also has an out service to cater for patients who live in the community and the recently bereaved. The main social worker has a case load of about 60 patients.

As I said, the recognition factor is high. I have been involved in correspondence on the issue and was pleased to receive a reply from the Under-Secretary of State for Health, Yvette Cooper, in which she says that she

"greatly appreciates the valuable work undertaken by all hospices like Cotswold Care." That is why I am using it as an exemplar of the very best in hospice care.

The health service increasingly uses hospices, whether it be the health authority or the primary health care teams that pay the money into them, and there are different referrals to those bodies. However, unless my local hospice is different from others, which I do not believe, the difficulty is that hospices are almost certainly working on an annual deficit. Cotswold Care has an annual budget of about £500,000 and runs, year on year, a deficit of about £60,000. The only way in which the hospice can do that is by drawing down its reserves, which have been good and of an order that has allowed it to maintain its service. However, those reserves will not exist for ever. The hospice is in the third year of an operational deficit and now has to consider whether to make cuts in its services. Given that 62 per cent. of its expenditure goes on direct patient care and that it must raise about £450,000 every year, it is obvious where cuts would have to be made, which everyone in the area would find reprehensible.

Last year, Cotswold Care received £48,000 from the NHS, which in effect represented no real increase in funding. It has been trying to obtain a service level agreement, but without success. It is reaching the stage at which it must think seriously about what it can afford and which part of the service it may have to withdraw.

The staff consists of about 80 people, 22 of whom are formal members of staff while the rest are volunteers, which shows the high level of volunteering in the sector. People give hours of their time willingly and in different ways. They do not just drive people around, but contribute pretty high-level skills, such as counselling, to ensure that people receive the support service that they need.

Photo of Mr Peter Pike Mr Peter Pike Labour, Burnley

Is it not also important to remember the work done by volunteers in their continuous fund raising? My hon. Friend has referred to the deficits and difficulties that hospices face. The Pendleside hospice for Burnley and Pendle could not survive but for the dedicated day-by-day work done by volunteers in raising funds every year.

Photo of David Drew David Drew Labour/Co-operative, Stroud

I totally agree. The point is that hospices would inevitably close without voluntary fund raising, so we should in no way underestimate its importance. One problem in fund raising, which my hon. Friend has helpfully mentioned, is the competition with various other fund raising activities, whether in the charitable sector or in the NHS. I have corresponded with Ministers on behalf of Cotswold Care hospice, which feels done down. The NHS is trying to raise money in different ways--for example for cobalt units and chest campaigns--and that money must come from sources that the hospice would also seek to tap.

Legacies are another problem. They are not necessarily in decline, but are ferociously fought over, and cannot by themselves provide an answer. St. Peters in Bristol has done wonderful work in that area, but legacies are not necessarily the answer.

I invite the Minister to come to see the excellent work done by the Cotswold Care hospice, particularly some of its new work. It has recently taken on hospices at home, a genuine partnership with the NHS that, although better funded, is not fully funded, which brings out my underlying point about what we need to do.

Independent hospices have five key advantages: first, they save the NHS money, and we should not pretend otherwise. Without them, their work would almost certainly have to be picked up by the NHS or by some inferior service. Secondly, hospices are the epitome of care and caring. Thirdly, they provide ultimate professionalism, but they also use volunteers to bolster that professionalism. That is the best use of the voluntary sector, which is of interest to many of my hon. Friends.

Fourthly, hospices deal with a Cinderella area that has traditionally been, if not ignored, certainly underfunded and isolated. It would be tragic if we lost some hospices because of funding difficulties. Fifthly, and never to be underestimated, they support individual carers and families who have suffered bereavements. We need to build on their work, rather than see that area decline.

What problems face hospices? I will ask my hon. Friend some questions on that as I finish my speech. Clearly, we recognise and welcome the uplift in cancer and palliative service funding. However, hospices do not seem to fit easily into the system. Discussions have been held between the hospice movement and the Department of Health on the cancer strategy, but there has been no concordat. The Government have come to an understanding with the private sector, but not with hospices. By 2004, the NHS will have invested an extra £50 million in palliative care. It would be good to see how that will be spread among hospices. We accept that it is difficult to give each hospice the same relative funding, but we need some yardstick so that we can know how funding will be invested, and who will receive it.

Hospices face the same cost pressures as every other part of the health service, and increased pressures are arising, principally from wage costs. In addition, if we need to bring people back to the NHS, they can come from a limited number of sources, and one of those sources would be hospices. We still have an on-going battle with some general practitioners. Thankfully, we have turned the corner in my area, but some GPs need to be persuaded that hospices have a valuable part to play and that they should commission care accordingly. I would welcome any comments from my hon. Friend on whether that is one of the ways in which we can provide resources.

We must, at all costs, prevent downsizing, which, as I have said, would take resources directly from patient care. We need to understand where hospices will stand in relation to primary care trusts, not just as regards mainstream hospice provision, but concerning minority groups, whether ethnic or socially disadvantaged, who must always have access to a range of services. It would be tragic if we were hamstrung by the problems that I have mentioned.

I do not expect the Minister to answer my questions in detail, but hope that she will consider them. First, will she voice the Government's support for the hospice movement, whether through the cancer strategy, palliative care or any other initiative, and will she say how valuable the Government consider hospices to be? In particular, how will the cancer strategy be funded in order to support the hospice movement and give it its fair share? Is it possible to see a model of what local health authorities would be expected to provide and what would be a minimum level of the extra funding?

Will my hon. Friend consider other means by which funding could be provided, including, principally, the new opportunities fund of the lottery, which I must say, is both an opportunity and an uncertainty. Some money has been set aside, and it has been suggested that £23.5 million will come from the opportunities fund initiative, but independent hospices will not necessarily receive that money. It would good to know what can be done to engineer some more funds from that source.

If there is an additional funding requirement, how can we build on the services that hospices already operate? I have mentioned the new development of hospices at home, and it would be good to see whether counselling and bereavement services, which have a locus in the health service, could be run more in tandem with the hospice movement. What form of concordat can delivered that would be similar to that for private health, about which I have talked already?

Given the current funding problems, how will hospices be able to struggle on, and is there a short-term solution to those problems, in addition to whatever may be developed in the medium to long term? Finally, will my hon. Friend spell out the role of hospices in the cancer strategy?

I have made a case for additional funding, and I make no apology for that. The debate is timely because of the problems that hospices will face in coming months as they make decisions on their budgets. I leave the Chamber with one thought: an adage always applied to hospices is that we should help them to help us, and it would be wonderful if that could provide the principle under which the Government applied funding to the movement.

Photo of David Ruffley David Ruffley Conservative, Bury St Edmunds 9:46, 6 February 2001

I congratulate Mr. Drew on securing a truly important debate. I first discovered the importance of the hospice movement when I became a Member of Parliament in 1997; I had no previous experience of it. I have benefited from advice and many meetings with members of the St. Nicholas' hospice in the centre of Bury St. Edmunds, particularly Mr. Bob Jones, the chief executive, and Mr. Roger Curtis, the fund raising director. I am here to speak today, not just because of their prompting and helpful advice, but because of the people of Bury St. Edmunds, who are responsible for an absolutely colossal achievement in terms of the amount of voluntary effort and financial support that they put in to running St. Nicholas'. I will later give some indication of the magnitude of that achievement.

The hospice movement is important to my constituency because of the palliative care that it delivers. The importance of that specialist care has undoubtedly increased over the past 10 years. Ten or 15 years ago, people who would have died quick deaths after diagnosis--typically, though not exclusively, of cancer--now live longer because of improved treatments and medication. But that involves a compromise. Living longer, perhaps in difficult circumstances, requires greater support in a range of areas, socially, psychologically and medically. Sometimes, it requires support in an in-patient setting at St. Nicolas' hospice, and at other times it means support in a day setting at home. What is clear is that demand for those services is rising, if not exponentially then certainly massively. Successive Governments have acknowledged that, and the cancer plan unveiled last year by the current Government goes a long way to acknowledging the experience that I have had in my constituency.

The cancer plan acknowledges that our hospices are among the best in the world. It goes on to acknowledge that not enough is being done to meet unmet demand by stating that:

"The care of all dying patients must improve to the level of the best." It is perfectly clear from what the Government have said that there is unmet demand. The cancer plan goes on to say:

"For too long, the NHS has regarded special palliative care as an optional extra. The NHS has relied upon the good will and funding of charities". In paragraph 7.24 it continues:

"Hospices have rightly argued that the NHS should invest more in palliative care services." I acknowledge the Government's important statement in that part of the cancer plan.

Bob Jones, chief executive of the St. Nicholas' hospice in Bury St. Edmunds, wrote to me recently, saying:

"The contribution of hospices is now fully recognised, and clearly the Government wishes to involve them, the voluntary hospices, centrally in the development of cancer services and we applaud that. However, this must be on the basis of secure funding for the future. There cannot be reliance on ever increasing fundraising to meet the gap." There is simply a limit to the amount of voluntary fund raising that can deliver sufficient funds to keep voluntary hospices such as St. Nicholas' going and doing the job that they want to do.

The importance of St. Nicholas' hospice is emphasised by some interesting statistics. The hospice runs five charity shops, which raise a net profit of £120,000 a year. The hospice's own lottery raises £120,000 a year, net profit. In addition, it holds many fund raising events and these, together with legacies, have brought in £500,000 a year. Those are colossal sums of money. Many local people have had members of their family or friends of friends receive care, assistance and--I do not think the word too strong--love at St. Nicholas' hospice.

Gifts also come, large and small. Of the 3,000 gifts received last year, including legacies and financial donations, 2,400 were of less than £100 and 600 were of more than £100. Some were significant bequests. St. Nicholas' hospice raises huge amounts of money. It receives 40 per cent. of what it needs from NHS grants, but it does magnificent work of its own. It serves a catchment area in south Norfolk and west Suffolk with 250,000 people. It has 160 volunteers, and I would endorse the comments of the hon. Member for Stroud. His experience is clearly the same as mine: there is a great deal of local support of a non-financial kind from volunteers. At St. Nicholas' hospice, we have a 10-bed in-patient unit, a 15-patient day hospice, a bereavement counselling service, and the Nicky's Way initiative, which is a separate bereavement counselling service for young children. The latter is an important innovation, and one of the first of its kind in the country. We have a team of six Macmillan nurses who undertake fine and dedicated work among local GPs and with terminal patients in their homes.

There is a great deal of ambition at the St. Nicholas' hospice. It moved into its current premises in 1993, but has wanted to grow. It had a new building project with a capital value of £920,000--it does not let the grass grow under its feet. The management and governing body are innovative, and received £350,000 from the National Lottery Charities Board. They are working hard to raise additional money above the hospice's annual running costs to extend the in-patient and day centre areas, and to construct a new building called the Ark, which will house new counselling and bereavement services that are innovative not just in East Anglia, but throughout the country.

A huge amount of money is required to satisfy the ambitions of a hospice that wants to grow, not stand still, and I shall outline some of the pressures faced by the hospice this year. There is expenditure of £92,000, due mainly to medical price inflation, but also to an increased pay award for nurses, the new deal for junior doctors and pension contribution increases, amounting to an increase of at least £50,000.

This financial year the hospice received a grant from the Suffolk health authority of £642,000--a 4 per cent. increase. That grant is welcome, but the hospice lacks a clear statement of the future path of grant via the NHS in the county. It is difficult to plan for years, rather than for one year, ahead. That problem becomes especially acute when a hospice is as ambitious as the one in Bury St. Edmunds. As a result of cumulative pressures, the hospice is running a deficit for the first time in several years. The trainee GP post runs out within a year and it seems unlikely that it will continue. The Macmillan community specialist nursing team is the only one in the eastern region not to be 100 per cent. NHS funded. We want future resourcing to secure the full complement of the excellent Macmillan nurses at St. Nicholas' hospice.

In a spirit of co-operation, I want to ask the Minister some questions. I believe that the present Government, in common with the previous Government, are listening to the hospice movement and recognise its huge importance. I endorse the powerful and detailed points made by the hon. Member for Stroud. The NHS benefits from the voluntary activity of hospices in Bury St. Edmunds. The NHS is incomparably better off for the hospices, which deliver palliative care that mainstream hospitals are insufficiently specialist to deliver, so to what extent will the £50 million extra announced under the cancer plan be targeted to purely NHS hospices? Will there be favouritism? Will the two NHS hospices in East Anglia get the lion's share of the £50 million allocated to the area? I hope not.

Is it intended that the £50 million should plug the gap where provision for palliative care is almost non-existent? Only one third of health authorities have developed palliative care strategies, which is a surprisingly low figure. In my part of Suffolk, we benefit from good strategy, which includes good, co-operative relationships. Will success stories, such as St. Nicholas' hospice, be a victim of their own success because the areas without such good provision will get most of the new money? There is a new philosophy afoot in Whitehall and the Treasury in the public service agreements and the comprehensive spending review that suggests that the successful providers of public services might reap the reward of increased funding. It is hugely important that good performers such as St. Nicholas' hospice in Bury St. Edmunds should be encouraged by receiving increased funding; but under the Government's public spending regime, more money goes to plug the gaps in inadequate public service provision.

Areas such as Suffolk cannot draw down money from the new opportunities fund because, understandably and fairly, it is targeted at socially disadvantaged groups, especially those areas with large ethnic minorities where there is no tradition of palliative care. As west Suffolk has a very small ethnic minority population, it is unlikely that it will receive money from the new opportunities fund. Admirable though it is, the announcement about that fund will not help my constituency.

Does the Minister think that there should be a national funding agreement to take account of voluntary hospices' provision? Is she considering a concordat with the hospices, signed by the Government, similar to the agreement with the private sector for non-palliative services announced last year by the Secretary of State for Health? Does she think that the present regime, which leaves matters to local negotiation, is working satisfactorily? Does she believe that agreed service levels have been properly set and that there is adequate monitoring of service levels, taking into account the allocation of resources? Have she and her Dept measured the shortage of provision and compared it with funding shortages, and, if so, when will that work be published?

Finally, can the Minister give us some comfort about the allocation of the £50 million of national cancer plan money? This is a plea for the rural areas, which may not be economically disadvantaged or have a high concentration of ethnic minorities, but which nevertheless have great needs that are not being met. There is no reason why the demand for palliative care services should be overlooked merely because the area is rural.

I thank the Minister for taking copious notes on my speech, and I look forward to her response.

Photo of Mr Keith Darvill Mr Keith Darvill Labour, Upminster 10:04, 6 February 2001

I congratulate Mr. Drew on securing this important debate. I shall be brief, and shall echo the comments made by Mr. Ruffley.

I want to place on the record my admiration for all who work in the hospice movement. Like other hon. Members, my experience comes from my connections with my local hospice since the 1997 general election. St. Francis hospice, on the border of my constituency and that of Mrs. Gordon, is held in the highest esteem by the community, and covers the Barking and Havering health authority area.

I want to concentrate on funding issues, which lie at the heart of this morning's debate. I visited the hospice recently to discuss funding, and wish to bring a few points to the Minister's attention. St. Francis hospice, with an annual budget of £3 million, is large in comparison with others. Out of that budget of £3 million, 38 per cent. of last year's income came from legacies, 6 per cent. from "in memory" donations, 10 per cent. from non-trading income from shops--there are 12 local St. Francis shops--18 per cent. from the local health authority, 3 per cent. from interest on other income, 8 per cent. from the Friends of St. Francis hospice, 14 per cent. from the development trust, and 3 per cent. from general donations. That highlights the uncertainty of that funding, which makes planning difficult.

Last year, the trust did well--in a manner of speaking--from legacies, one of which brought in more than £400,000, which was a tremendous boost to that year's funds. The budgets of previous years were exceeded, and there was even a spending deficit at a time when the hospice wants to develop services to meet the needs of the community, particularly in the innovative hospices at home sector, which has been supported by the community. The scheme not only provides important palliative care to the community, but does so where most people would like that care--at home. The service meets a popular demand, and we want to increase it, but to do so will require certainty of funding.

In addition to the uncertainty to which I have referred, there is uncertainty in other areas, such as charitable donations. The hospice is in competition with other charities in the area. For example, several children's hospices in our area rightly earn support, but at times when public support goes to the children's hospices, support for the adult hospice may decline.

In addition, with the introduction of the national lottery, when more giving went to lottery funds--rightly, given the good causes that the lottery supports--there was a dip in charitable donations. Charities throughout Britain have had to cope with that, and it has led to uncertainty. The hospice movement, which combines public and voluntary service, needs certainty.

I echo what hon. Members have already said in that regard. The NHS cancer plan, which most Members welcome, will provide an additional £50 million for the service up to 2004, but how much of that allocation will go to the voluntary sector? The independent movement throughout the country awaits an answer to that question. There is also the question of whether we want a more national framework in this area, and I am sure that that point will be discussed, which will help to clear up some of the uncertainty.

Will my hon. Friend comment on funding through the new opportunities fund? Clearly the concept of additionality runs through lottery funding. The question arises of how the voluntary sector fits into that concept and whether hospices need to take that into account. Guidelines would be helpful.

I conclude by congratulating all volunteers in the hospice movement, particularly those at St. Francis in my constituency, on their sterling work. The care that they give their fellow citizens is much appreciated and we could not deliver the level of service without them. I am sure that all those hundreds of thousands of volunteers throughout the country would welcome a positive move from the Government that encourages them to give more commitment to a worthwhile concept.

Photo of Jacqui Lait Jacqui Lait Conservative, Beckenham 10:10, 6 February 2001

I draw the Minister's attention to a situation that has arisen in my constituency. In Beckenham we have St. Christopher's hospice, which was the first hospice created by Dame Cicely Saunders, the founder of the modern hospice movement. St. Christopher's is very important within the constituency and funding raised locally is key to its success--a matter to which all hon. Members who have spoken have referred. It is significant that there is such a measure of agreement across all political parties about the future of hospices. All 659 Members of Parliament probably give generously to hospices and will continue to do so.

On Saturday morning I went out campaigning for the Conservatives in West Wickham high street and spotted three yellow Liberal Democrat rosettes. I thought, "Oh good, I will meet my opposition challenger"--whom I have not met, having heard only the announcement of his selection. However, I discovered that those Liberal Democrats were seeking names for a petition to help the hospices. Hospices are completely non-party political and it concerns me that they could be hijacked by one political party. It would certainly not help their funding if they were seen to be the creatures of a particular political party. It is also not very clever for any political party to get tied up with such a non-party political organisation. I therefore wanted to warn colleagues and the hospice movement that difficulties could be created for them if they were seen to become the flavour of the month of any political party--no matter which one.

Photo of Mr George Stevenson Mr George Stevenson Labour, Stoke-on-Trent South

Order. I understand the hon. Lady's point, but I am seized by her comment that we should not make this a party political issue. I am sure that she would not want to do that.

Photo of Jacqui Lait Jacqui Lait Conservative, Beckenham

You are right, Mr. Stevenson. I have no intention of making it a party political issue. I hope that the future of the hospices will be guaranteed by firing that warning shot across the bows of any political party that might be trying to hijack the hospices. I want to ensure that the future of hospices is guaranteed, not just by increasing Government funding from the 30 per cent. to the 35 per cent. that it was three years ago, but by encouraging the British population to continue to fund the hospices in the same generous way that it always has.

Photo of Tony Baldry Tony Baldry Conservative, Banbury 10:13, 6 February 2001

I am glad that the debate is taking place. Around 1985 Jack Ashley and I set up the all-party hospice group, which is still going. With the Duchess of Norfolk, we had numerous meetings with the then Secretary of State Mrs. Bottomley. Our concern at that stage was to get some regularity and evenness into funding for hospices. At the time, some hospices were in the independent sector--historically they had been almost totally funded by public money--and received no funding whatever from the NHS. There was no rhyme or reason as to who was funded or why they were funded in a particular way. The Government introduced a measure of underpinning, with the aim of ensuring that all hospices received some state funding. It will always be accepted that hospices are part of the voluntary movement. Rightly, a large proportion of their money comes from the voluntary sector. We have heard of considerable fund raising efforts. It is no different in north Oxfordshire, where many people support the excellent Katherine House hospice.

Hospices want just two things from the Government. First, they want to be able to predict what the funding arrangements will be, not just for one year, but for a number of years. They do not expect to be 100 per cent. funded. Indeed, they would not want to be, but they do want predictability. Secondly, hospices want certainty in their relationships with local NHS hospital trusts, primary care trusts and the Department. If the Minister can provide the hospice movement with predictability on the level of funding over a range of years and with certainty in its relationships with the rest of health care provision, it will get on and provide an excellent palliative care service.

Cancer is now a larger killer than heart disease. Ironically, advances in medical care mean that, inevitably, more of our constituents will require the help, support and care that the hospice movement provides. The movement is a great tribute to a huge number of people. It will not require much for the Government to provide both predictability and certainty. I hope that the Minister can do that today.

Photo of Gisela Stuart Gisela Stuart Parliamentary Under-Secretary (Department of Health) 10:16, 6 February 2001

I congratulate Mr. Drew on raising this issue. It is clear from the contributions that it is important to many of us. I take Mrs. Lait that it is not a party political issue. I hope, therefore, that she will forgive me if I sometimes refer to the extra funding from the Labour Government. We know that we all support the hospices. I agree with the hon. Lady--it is questionable to campaign on the issue. People should be careful when they do their campaigning.

Mr. Pike rightly paid tribute not only to the work of volunteers, but to their fund raising. The issues in relation to hospices include our relationship with the voluntary sector. That is an important issue. Several hon. Members made the point about the concordat and the type of relationship that we have with the sector. I hope that most of the specific questions raised will be covered in the speech itself.

Mr. Ruffley paid tribute to Mr. Darvill, most of us learned about hospices through the good work that is being done on our patch. It is therefore understandable that, when we return to our constituencies and see that good work, we will make the case for that particular institution. Although we welcome extra money to deal with the inadequacies in some areas, we do not want our own areas to be punished. We hope that a balance can be struck between dealing with areas where there is no provision and supporting existing provision. It is a balancing act; it is not a question of either/or. Both those things must be done at the same time. I congratulate Mr. Baldry on having had the foresight all those years ago, with Lord Ashley, to set up the all-party hospice group.

Like my hon. Friend the Member for Stroud, I put on record my appreciation of the work by Cotswold Care. He has invited me to visit the hospice, and I am happy to accept that invitation, provided diary requirements can be met. I should like to come very soon.

The hospice movement in the United Kingdom is widely recognised as the world leader. It is committed to working with the voluntary sector. It delivers something extremely valuable in a very challenging area.

A Government's relationship with the voluntary sector should be complementary. We should work in partnership; one should not take over the other. It is widely recognised that the voluntary sector is often capable of doing things that the NHS could not do on its own. The sector has been the driving force for many innovations. It was determined to move into areas which the NHS had not covered. I would not want to lose that innovative drive.

We need partnership, but it is a two-way process. We need to ensure that health authorities have an agreed strategy in place and the voluntary sector needs to ensure that the service developments that they are planning are developed and agreed with the local health authority and meet the agreed priorities for the area. The concordat that we signed with the independent sector was of that nature--it established a strategic long-term relationship. I hope that some of the other arrangements that we have in place in the hospice sector will convince hon. Members that we wish to have a long-term sustainable strategic relationship with hospices.

Hospices have shown many of us how care for patients who are approaching the end of their life and how support for them and their families should be provided. That involves both adult and children's services.

I focus initially on what we are doing for adult services. For too long, the NHS has regarded palliative care as an optional extra. Hospices have suffered from a lack of long-term stability for too long. I know that some health authorities are aware of hospices facing particular financial pressures and have invested some short-term funding to ease current pressures. We also know that many hospices have only one-year, not three-year, agreements with health authorities. Two thirds of health authorities do not have an agreed palliative care strategy, despite guidance from the Department that states clearly their responsibilities in that area.

It is small wonder that the hospice movement feels that it has been taken for granted and has helped, as it puts it, to bail out the NHS by providing high-quality care at low cost. We do not think that that is good enough. We need and are determined to make rapid progress. I know that my hon. Friend the Minister for Public Health is working to ensure that health authorities take action and meet the guidance set.

As my hon. Friend the Member for Stroud said, funding is a real issue for hospices and some are facing financial difficulties. That is why we will invest an additional £50 million in adult hospices and specialist palliative care services to end the inequalities in access and to make a more realistic contribution to hospice costs.

The issue was raised as to whether some of the £50 million will go in preference to NHS hospices. It is a question of looking at the cancer networks, the strategic plans, who the providers are and how the provision fits in. Within that, I expect that significant amounts will go to the voluntary sector. It is a question not of the status of the organisation, but the care provided and the needs of the area. We have ensured that that is a priority within the NHS plan implementation project for 2001-02. We have asked the cancer networks to have costed, strategic plans for palliative care in partnership with the voluntary sector.

The £50 million invested in palliative care will ensure that the NHS makes a realistic contribution to the costs that hospices incur in providing agreed levels of service. Realistic funding must be based on a firm footing. That is why we need costed plans, benchmarking, performance indicators and standards. We will therefore monitor plans for palliative care strategic investment very closely. I am sure that all hon. Members will agree that, although we want partnerships, which we underpin by funding, it is not a question of taking control. We must ensure that minimum standards are met and that services fit in with the overall strategic provision.

A particular concern has been raised by the hospice movement relating to keeping pace with NHS inflation uplifts. The £50 million that is going into the system will help to deal with that. That will be performance managed through service and financial framework processes monitored quarterly.

As I have said, the NHS has relied on the good will of the voluntary sector for too long. With the launch of the NHS cancer plan came the announcement of additional funding for hospices and specialist palliative care services. That move has been warmly welcomed in some quarters, but I acknowledge that there have been cries of too little too late in others. The additional money, however, is only part of the solution. As I see it, the future for hospices and cancer networks is in working together to identify current specialist palliative care provision and in planning for future investment.

There are several ways of achieving that. Hospices should not only play a full role in cancer networks, but establish a firmer strategic footing with health authorities. Funding will also be provided through the new opportunities fund. A total of £23 million will fund a new programme of partnership schemes for community palliative care projects for adults and children, including respite care breaks. I take the point about access to new opportunities funding in some areas, but all the other things that are being done must be considered, too.

I urge hon. Members to be careful when they talk about ethnic minority needs. In my Birmingham constituency, by 2005, in educational terms, white working class estates will be classified as minority groups. Therefore, we should not make assumptions about minority group in a particular setting. Groups need to be supported wherever they are. It is not an urban versus rural areas issue. We must consider the networks and the level of provision.

Hospices contribute immense support, training and advice to colleagues in primary care. My hon. Friend the Member for Stroud raised the issue of how the service fitted in with primary care. We are making £2 million available to support training district nurses in the general practice and principles of palliative care. We believe that that will enable more people to stay at home for longer.

It is worth mentioning the beacons programme for 2000-02, which supports eight palliative care beacons throughout the country. Those projects are examples of a partnership between the voluntary sector and the NHS and demonstrate good practice and innovation within particular aspects of palliative care services. The beacons are about sharing good practice. Although a lot of good work is being done throughout the country, we must ensure that the sectors learn from each other and share their experience.

Similarly, my hon. Friend will be aware that the forthcoming national service framework for older people will build on the supportive and palliative care strategy that was set out in the cancer plan. That will provide a framework for delivering further improvements in the care of older people

Children's services are often mentioned in such debates. Much of the driving force for improving those services--we have had little understanding of the needs of the children and their families--has been provided by the forceful work of the hospice movement. In future, the NHS will work with those families and provide quality support.

The movement to support children has grown considerably in recent years. Much of the driving force has come from painful personal experience, and I pay tribute to those concerned. New nurse-led teams have been established to care for children with life-threatening and limiting illnesses in the community. They are known as Diana community children's nursing teams. They commenced in March 1999 to fill gaps in the provision of care for children with life-threatening illnesses who were living in the community and to support their families.

That was a much-needed new provision. Those teams work in partnership with other statutory and voluntary agencies to provide holistic--physical, social and emotional--support to children and their families in their homes and in surroundings that are familiar to them, as an alternative to hospital-based care. It has long been recognised that children with such conditions often prefer to have care and support in the family home. The Diana teams offer a lot of help and are much valued by all parts of the NHS.

Provision has been made for funds for children's hospices to come from the NHS. I briefly mention the work done on health improvement programmes and the general funding that is available. Again, palliative care services and voluntary health care providers play an important part in the development of Himps. Further to that general provision, we are making available additional sources of funding from the new opportunities fund.

We all sign up to the principle of providing compassionate care and service for patients in the last few days or months of their lives. That is why all agencies must work together. We deeply appreciate the contribution of the hospice movement. We want a long-term strategic relationship that supports them and the NHS in the interests of the patients and their families wherever they may live.