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Hospices (Funding)

– in Westminster Hall at 2:30 pm on 30th January 2008.

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Photo of Bob Spink Bob Spink Conservative, Castle Point 2:30 pm, 30th January 2008

You will be deeply saddened to hear, Mr. Williams, that hospice funding is compromised. Unless action is taken, it will need a life support system. We all know that hospices provide high-quality, innovative care and that their services are free to patients and their families. The NHS has a commitment to providing palliative care to people with life-threatening illnesses. However, charitable hospices play a vital role by providing 80 per cent.—that is four out of five—of the UK's adult in-patient palliative care beds, as well as important day care services and care in people's homes. Every UK hospice has to raise, on average, £4,500 a day to provide that care, and £500 a day to maintain and develop their buildings.

The hospice service is growing, but the percentage of annual expenditure funded from Government sources in England has been falling for the past three years. It is now 32 per cent. for adult hospices and 4.5 per cent. for children's hospices, which are a different case. We can see the results of that fall: in 2005, 43 adult hospices in England were in deficit, whereas a year later that figure had risen to 52. Members will be deeply concerned about that, and no doubt we will hear about specific cases from the excellent Members who are present. Clearly, we need to understand what is happening and to find sustainable solutions. Hospices need to redouble their efforts to secure charitable funds, which are under increasing pressure in the current economic climate, but we must also take action on the provision of public funding.

Photo of Andrew Turner Andrew Turner Conservative, Isle of Wight

Like many Members, I should like to pay tribute to the excellent care that hospices provide. I refer in particular to the Earl Mountbatten hospice on the island. It needs £3 million a year to continue providing the excellent care that it provides. Many of my constituents go to great lengths to raise funds for it. Last year, 5,000 people walked the Wight, which is more than 26 miles, raising more than £200,000. Does my hon. Friend agree that hospices such as the Earl Mountbatten provide an invaluable service?

Photo of Bob Spink Bob Spink Conservative, Castle Point

I anticipated correctly that Members would want to talk about their local hospices in this debate, and that is absolutely right, as there are some fantastic hospices around the country. I know that my hon. Friend has not only fought consistently and diligently for his local hospice, but has supported the hospice movement nationally, and I commend him for that.

The whole House will want to pay tribute to the hospice movement, including staff, volunteers and fundraisers. They are all stars and all deserve recognition for their efforts on behalf of people who are going through an unbelievably traumatic time.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I congratulate the hon. Gentleman on securing the debate. I think that there is unanimity on the contribution that hospices make. We want more to be spent on hospices and for them to have a more secure future. I shall talk about that later. Does he accept that we need to consider the amount that has been invested in hospices in the past few years, which has increased, and the amount by which we want to increase it, rather than talking about the overall share of hospice funding? The share of funding depends entirely on the amount of money that hospices might have raised through charitable and other means. It is therefore slightly misleading to compare the share of overall resources.

Photo of Bob Spink Bob Spink Conservative, Castle Point

I accept what the Minister says, and he will make his case in his own way. However, I add that we have to consider whether the outputs that hospices deliver are appropriate and whether those that are met by the public purse are correct, auditable and delivered properly. We need to understand that the demands on hospices are increasing all the time because people are living longer and choosing better ways in which to end their lives—I know that the Minister agrees with me on this—so hospices might spend more money and replace more of what should be done in the NHS. They should be recompensed for that.

People go through an unbelievably traumatic time during their own death or the death of a family member. It is only those who go through such times who can really understand it. My beautiful sister Yvonne passed away just before Christmas, and her funeral, in Bradford, spoke volumes: it was attended by 800 people. She was a star, a wonderful mum and a great youth worker at her local church, hence the big attendance at the funeral service. She had been a district nurse for 30 or 40 years in Bradford, doing superb work, and she was just the same age as me. So, I do understand what families are going through when they have to fall back on hospice services.

I am grateful to Mr. Speaker for selecting this debate and to Members present for coming along and supporting it. I am particularly grateful to Havens hospices in Essex, whose representatives are here in force today, and to Help the Hospices and the UK hospice movement for providing me with information. There is no party political edge to this debate. The Government have made remarkable efforts to support hospices, and the Conservative Front-Bench team rightly sees hospice funding as a priority, so I warmly congratulate both sides. No doubt the Minister will set out the Government's achievements later.

Photo of Bob Spink Bob Spink Conservative, Castle Point

I shall give way to the hon. Gentleman, who has always been a great supporter of the national hospice movement and his local hospice.

Photo of David Taylor David Taylor Labour, North West Leicestershire

I am grateful for that comment. I declare an interest as a member of the Hospice Hope campaigning organisation in North-West Leicestershire. The hon. Gentleman said that there is no party political edge to this debate, and there really is not, either in this place or in wider Parliament. Does he agree that hospices, particularly children's hospices, are so embedded in the emotions, culture and lives of their local communities that they get huge and widespread support? The Rainbows children's hospice in Loughborough, which serves the whole of the east midlands and south Yorkshire, is currently seeking to raise £4 million under its building for the future appeal. The local radio station, Radio Leicester, which is in its 40th year of operation, set itself a target of raising just £400,000 for that appeal, but it soared past that target and the £500,000 mark and is now almost at £600,000 as the appeal year ends. That is a measure of the support for hospices and children's hospices, and I am sure that the Government will want to reflect on that. What they did a few years ago in giving a short-term boost was very popular electorally, and could be so again.

Photo of Bob Spink Bob Spink Conservative, Castle Point

The hon. Gentleman is right to raise the issue of children's hospices, which are a very special sector of the hospice movement. It is much more difficult for the adult sector to raise funds. Donations and legacies to the adult hospice sector provide only 52 per cent. of adult hospice funding, whereas in the children's sector they provide 79 per cent. Clearly, there is a difference, which the hospice movement wants to resolve.

In the early 1990s, the children's hospice movement started to emerge strongly in this country, and the Little Havens hospice was built in my constituency. Children's hospices are different from adult hospices in many ways. However, both share the ethos of providing care during terminal illness and through bereavement, and of treating the whole person, addressing their unique physical, emotional and spiritual needs, as well as supporting those who love them. In addition to providing palliative care, they dispense cheer, optimism and fun in equal amounts. In the early 1990s, I secured the first debate in the House specifically on children's hospices, in which I highlighted funding issues. Since then, Little Havens has become an outstanding exemplar of all that is worthy and wonderful about all UK hospices. It serves a wide area and is much loved. It is part of the Havens hospice group, which includes Fair Havens in Westcliffe. Our local hospices are equally cherished, and we must ensure that they are equally well funded.

Photo of Bob Spink Bob Spink Conservative, Castle Point

I shall just finish this point. I very much welcome the Essex Havens hospices initiative, which includes and overarches Fair Havens and Little Havens and brings them together. They are not in competition; they are equally wonderful and worthy.

Photo of Annette Brooke Annette Brooke Shadow Spokesperson (Children, Schools and Families), Shadow Minister (Education)

I declare an interest, in that I am a patron of Julia's House, which is a children's hospice in my constituency. Its chief executive is concerned about Government funding from March onwards. Does the hon. Gentleman agree, bearing in mind all the wonderful work that hospices do, that such great uncertainty—right up to the wire—makes their work more difficult than it ought to be?

Photo of Bob Spink Bob Spink Conservative, Castle Point

The hon. Lady is extremely wise. She works in this area, and anticipates a point that I shall come to shortly.

Over the years, I have made many interventions and held debates on hospices. Last year, I took the Association of Children's Hospices and the indefatigable Andy Smith of Little Havens hospice to see Tony Blair. The then Prime Minister was magnificent. He tossed aside his bureaucrats' objections and gave the £27 million that we requested to fill the three-year funding gap that had emerged for children's hospices. He set up a review of funding not just for children's hospices but for the whole children's palliative care sector, which supports some 20,000 life-limited children and their families each year. His courage and decisiveness were remarkable.

Subsequently, during business questions, the Secretary of State for Justice and Lord Chancellor, who was then Leader of the House—a great man, indeed—promised me a debate in Government time on this issue. It will cover the review set up by Tony Blair, the new Government strategy that has since been developed, and the solutions needed to protect the children's hospice movement's voluntary ethos while protecting the public purse. It will also cover how we can ensure that statutory sector providers such as the wonderful Diana teams are not driven out of existence for lack of funding. The new strategy must deliver fair play in funding for children's hospices, and for the children's palliative care sector as a whole.

I understand that the strategy has been finalised, yet no date has been given for its launch. I urge the Minister to reassure the House today that the strategy will be launched without further delay. Equally, can he state exactly how much money has been made available from the Department of Health to primary care trusts for short breaks for disabled children, which children's hospices provide, and for children's palliative care in general? The Department for Children, Schools and Families has stated that it is giving more than £280 million to local authorities for this purpose, and we believe that the Department of Health may have matched that funding, but we do not know. As yet, nothing has been confirmed. May I ask the Minister to tell us today—or, if he cannot, to write to me later—how much PCTs will actually get?

It would be wonderful if, starting today, we could see much-needed major funding increases for adult hospices. Let me give some general background. Hospices and palliative care were started by the superb and innovative British voluntary sector, which characterises Britain and helps make it great. Volunteers contribute massively to the hospice sector, which would not exist as it does without them. The Government now have a commitment to providing palliative care, but hospices have never, under any Government, been fairly funded for the services that they deliver. Hospice funding is locally negotiated on an annual basis with PCTs, so funding varies widely across the country and often changes from year to year. That makes it difficult for individual hospices to plan future services.

The Government have agreed that voluntary organisations that deliver public services should be paid the full cost of providing those services, including a proper overhead element. That goal was to be met by April 2006 but it was not achieved, and it is still not clear how the Government will ensure that PCTs deliver on the promise.

The Parliamentary Secretary to the Cabinet Office, Phil Hope, replied to my parliamentary question of 21 January. He stated:

"It is legitimate for third sector organisations to recover the appropriate level of overhead costs associated with the provision of a particular service. Third sector organisations are not expected to deliver a public service contract for which they are not reimbursed on a sustainable basis. We recognise the added contribution that some third sector organisations bring over and above the core requirements of public service contracts, for example, through the use of volunteers."—[Hansard, 21 January 2008; Vol. 470, c. 1545W.]

That certainly applies to the hospice movement.

Despite Government commitments to a level playing field for organisations that deliver public services, charitable hospices face extra costs that statutory providers do not. There is no mechanism to help hospices meet staffing costs or regulation costs such as Healthcare Commission fees. I ask the Minister to agree today that he will review the practice by which charitable hospices are charged the same amount of regulation fees as NHS or private sector health care providers. I hope that he will challenge the health care commissioner's decision, which is patently unfair. Hospices cannot recover the cost but other organisations can. Hospices raise cash to care for terminally ill people, and, in so doing, take a massive burden off the state. It is rubbing salt in the wounds for the state then to demand payment from the hospice sector for the privilege of delivering that service and taking that burden off the state. A bit of joined-up government is required, and I am sure that if the Minister can—he may have constraints—he will look at that. The NHS does not pay regulation fees out of its budget, and the private sector can and probably does bill its clients in full for its regulation costs. I hope that the Minister will give an undertaking on that.

From 2008-09, fairer funding for palliative care was to be achieved through payment by results. That system should be based on agreed national costs for specific services. It should be auditable to protect the public purse, and it should ensure that hospices are paid for providing services. However, the timetable for implementing the system is no longer in place. While hospice funding will be considered as part of the Government's forthcoming end-of-life care strategy, it remains unclear how the Government will meet the cost of care provided by hospices on behalf of the NHS. I respectfully ask the Minister to clarify the policy on that.

I shall try to rush through, Mr. Williams, as many Members wish to speak. The public cherish our hospice movement, as I know you do, sir. An independent survey found 97 per cent. satisfaction among people whose loved ones had received hospice care. Would that the NHS had such satisfaction levels, although I praise and congratulate the hard-working and dedicated doctors and nurses in the NHS.

May I quote The Guardian—I do not often do that—of 9 April 2007? It stated:

"An Ipsos MORI poll commissioned by the charity"—

Help the Hospices—

"found more than three-quarters of respondents said the government should pay at least half the cost of hospice care."

I accept what the Minister said about arbitrary and unfair funding and not protecting the public purse. We have to find a formula to provide funding on a rational and fair basis. The quote to which I referred continued:

"But adult hospices in England receive on average just a third of their costs from the government, with some receiving much less. Most are suffering a real-terms cut in funding."

Let me cut to the bottom line. Hospices are not asking the Government to meet all their costs, but just to give fair payment for services that the NHS would otherwise have to provide. As the current Prime Minister promised when he was Chancellor—he made the promise to me personally—

Photo of Bob Spink Bob Spink Conservative, Castle Point

A great man, yes. I am tempted to bring in other promises that the Prime Minister made. The European Union debate is going outside this place.

The gap between what hospices in England spend on NHS patients and what the NHS contributes is estimated to be £150 million to £200 million a year and it is widening, according to the National Council for Palliative Care's submission of 1 August 2006 to the end-of-life care strategy. The Government have indicated that they will undertake funding for hospices as part of the end-of-life care strategy announced in July 2006, but we still need to see the colour of the money. We need urgent action to ensure that hospices, which are now sinking faster and deeper into deficit, can at least maintain current levels of service. We do not want to see cuts. We must all accept that the services that hospices provide will probably grow in future, and that is what we want to see.

There can be no doubt that the hospice movement needs Government action now. The Government must provide full, fair and nationally consistent payment for the care that is delivered by charitable hospices on behalf of the NHS. They must ensure that future funding arrangements are flexible enough to enable hospices to provide high-quality sustainable services, whether in a hospice building or in the patient's home. The Government must continue working with all palliative care providers to determine how they will meet the costs of core hospice services, as part of their commitment to patient choice at the end of life and as part of the anticipated end-of-life care strategy.

We would like to see the Government back their commissioning guidance with stronger enforcement to ensure, for instance, that PCTs always offer hospices funding contracts for at least three years, that funding is agreed before the start of the financial year, and that payments are met on time to enable financial planning and security and to prevent cuts.

Photo of Mark Francois Mark Francois Shadow Minister (Europe)

I am grateful to my hon. Friend for giving way. I apologise to him and to you, Mr. Williams—I am involved in the debates in the main Chamber on the energy elements of the Lisbon treaty, so I am just nipping in to make a point and then nipping out. I mean no discourtesy and I hope that other Members in this Chamber will understand what I am trying to do.

I support my hon. Friend, particularly regarding the point that he just made about primary care trusts supporting hospices. I hope that the South East Essex primary care trust will do more to support Fairhaven hospice, which is local to my hon. Friend and to our colleague, my hon. Friend Mr. Amess. Fairhaven is an important hospice that does good work. I hope that the PCT will take that into account, even though it is under financial pressures of its own, in helping that hospice to do so much good work for people who so desperately need its help.

Photo of Bob Spink Bob Spink Conservative, Castle Point

I am grateful to my hon. Friend and parliamentary neighbour for supporting this debate. We had a meeting with our local hospices just a week ago, and we both know about the superb work that they do locally. I will come to that in my concluding remarks.

I hope that the Minister will agree to meet a delegation from the adult hospice movement to discuss these issues and share a cup of tea. I suspect that he will; he is a highly distinguished Minister and a caring man. After I have said that, he can hardly deny me the meeting. We must ensure that solutions continue to be developed to the adult hospice funding problems, just as we are doing for the children's hospice sector.

I thank Members for their patience in listening to me today and for their support, and I thank all those who work with or raise funds for the Havens hospices in Essex, which my hon. Friend Mr. Francois has just mentioned. He will agree that they are all true stars.

Several hon. Members:

rose—

Photo of Hywel Williams Hywel Williams Shadow PC Spokesperson (Education), Shadow PC Spokesperson (International Development), Shadow PC Spokesperson (Work and Pensions), Shadow PC Spokesperson (Health)

Order. I remind Members that we intend to start the wind-ups at 3.30 pm. I therefore appeal for contributions to be brief.

Photo of Ian Stewart Ian Stewart Labour, Eccles 2:53 pm, 30th January 2008

First, I congratulate Bob Spink on securing the debate. He and I do not always agree, but on this issue I fully support him and the comments he made during his contribution. He must be congratulated on his sustained and powerful advocacy on behalf of the hospice movement.

I wish to recognise the wonderful work of the hospice movement in general and specifically the work of the staff both at St. Ann's adult hospice and at Francis House children's hospice. I am conscious that time is limited so I will mention only St. Ann's adult hospice, but my comments apply equally to Francis House children's hospice.

I welcome the Government's investment in hospices, including the recent £50 million for refurbishment, and for their end-of-life care strategy. However successful our preventive health strategies may be, there comes a time when we have to deliver for the people both the choice of where, and the way in which, they die. That is vitally important for those of us who have gone through the hospice system with our loved ones who have come to the end of their lives. It is only when we go through that process personally that we fully understand just how wide and deep the provision is in the hospice movement. That applies not only to the patient—the person coming to the end of their life—but to other family members' experience of a hospice, which is equally important because it sets the attitude of families about the hospice movement and the contribution that it makes to health and end-of-life care. The hospice movement helps to deliver dignity and respect and a death that is as pain-free as possible. That is a significant challenge for any health care provider.

Although many people express a preference to die at home, we all know the high regard that patients and relatives have for our hospices, which are a source of expertise and solace. They offer outreach work for those who are dying at home and they also offer training, both of which are greatly valued.

I would like to mention the work done by St. Ann's hospice and I am sure that my neighbour, Mark Hunter, will also support it. He has actively provided excellent support for the hospice movement, particularly St. Ann's. I try, in my own way, to help co-ordinate information going to all Greater Manchester MPs from all parties. Although this is a very political issue, it is a non-partisan one.

St. Ann's hospice, under the excellent stewardship of its chief executive, Terry McDonnell, serves my constituents and all residents of Greater Manchester. St. Ann's is one of the largest adult hospices in the UK with 60 in-patient beds. Although cancer-related conditions account for about 95 per cent. of all hospice admissions, St. Ann's services are available to patients with any life-threatening illness. The hospice provides care free of charge to more than 3,000 people each year across three sites. Some 42 per cent. of patients admitted to St. Ann's Hospice return home after treatment. Patients are involved with their personal plan of care, which is tailored to meet their needs.

St. Ann's was voted the second-best company to work for in Britain in 2005—not only the second-best hospice—and has been listed by The Guardian as one of Britain's top employers in 2007. On my regular visits to St. Ann's I am always struck by the dedication and expertise of the staff and the atmosphere of serenity and, perhaps strangely, conviviality, experienced by my family and others.

The hospice movement leads the way in palliative and end-of-life care. It needs more Government assistance, but it must remain independent to be free to develop innovative practices from which the NHS can learn and benefit. Like other hospices, St. Ann's needs to raise £16,000 a day, every day, through voluntary contributions to offer its wide range of services. It costs £8.75 million to run the hospice annually and 35 per cent. of that comes from the Government. More than 80 per cent. of every pound of its income is spent on patient care. Good quality care does not come cheap. For example, £97 pays for one out-patient session; £63 will cover the cost of one session with a bereavement counsellor; £265 is the cost of looking after an in-patient for one day; and it costs £500 to run one of the hospital's ambulances for two months.

Briefly, there are still problems. I congratulate the Government, as Opposition Members have done, on the improvements that they have made. However, my constituent, Frances Green, lost her husband Denis recently. She knew that he was dying and had to be taken to St. Ann's hospice. St. Ann's tried to get an ambulance to take him from home to the hospice but could not, so the family had to ring the normal ambulance service and explain that the hospice required him to be taken there. For them to be told that there would be no ambulance available from the time they phoned, around 1 pm, until 12 midnight is unacceptable. We must look not only at the hospices, but at the surrounding services that families need to call on.

Needless to say, St. Anne's is as inventive as anyone in raising funds, but it believes that the Government should give more money to hospices, and I support that view. Our hospices offer a wonderful service, but they could do even better if they knew that their funding was secure, and could channel all their energy into delivery of care for patients and their families. The way in which we treat family members of someone who is receiving end-of-life care and palliative care is a measure of our society and decency. I know that the Government, particularly the Minister—we have been together to the Rainbow Trust and other hospice movement events—are sincere. We must turn that sincerity into an identification of how we can improve the situation and the relationship between the hospice movement and families, and the hospice movement and the NHS. I hope that the Minister will listen carefully to the points made by the hon. Member for Castle Point, and I hope that he will address the issues that I have raised. I know that he will try to do so.

Photo of Sir David Amess Sir David Amess Conservative, Southend West 3:01 pm, 30th January 2008

I congratulate my hon. Friend Bob Spink on securing this timely debate, and I agree with everything that he said. I am delighted that my hon. Friend Mr. Francois was able to intervene. My hon. Friend James Duddridge would have been here, but his wife has just had a baby, so I am sure that hon. Members understand why he is not.

No hon. Member this afternoon will say that hospices are not wonderful, and the Government think that they are wonderful. All that is understood, but I want to ask the Minister for something. There is no point in hon. Members having Adjournment debates if we just read out our speeches and send out press releases, and they are then forgotten about. I like Adjournment debates that achieve something tangible. I achieved something tangible when I raised the subject of St. Luke's hospice on 24 May 1985. The then Minister who responded, now Lord Patten, listened to me and delivered.

The Minister will gather that there is a particular crisis in funding in Essex, which I raised in a pre-Christmas Adjournment debate. The conscientious deputy Leader of the House referred the matter to the Secretary of State for Health, and a letter arrived from him two days ago, which I am pleased with. However, as the Minister said during his intervention, the answer is: "Yes, the Government support hospices; yes, the Secretary of State is getting more money from the Treasury, but at the end of the day it is down to the primary care trust."

I am looking the Minister in the eye and saying that that is a cop-out. The Government say that they are giving more money to the primary care trust, which is responsible for deciding how it allocates it, and that is technically correct. I ask the Minister to listen to what I and other hon. Members have said, and to give a message, at least to my primary care trust, that it should be supported and receive more share of the cake. I am sure that if he gave that message, my local primary care trust would listen to it.

Dame Cicely Saunders was responsible for developing the hospice movement in the 1960s at St. Christopher's hospice in south London. That inspirational lady said that

"you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die."

Until I became a Member of Parliament, I had no experience of the hospice movement. I witnessed a miracle in Basildon, because we had a plot of land and we built a hospice with no wealthy benefactors and no largess from this Parliament or the European Parliament. The Duchess of Norfolk opened it—

Photo of Sir David Amess Sir David Amess Conservative, Southend West

—and Princess Diana came to launch a strategy that we enjoyed in the hospice. St. Luke's hospice in Basildon has become an enormous success.

My next point for the Minister is that the role of hospices has changed enormously. They are no longer add-ons. They provide core services.

Photo of David Taylor David Taylor Labour, North West Leicestershire

The hon. Gentleman is absolutely right. The service has developed to include day care, essential respite care, which is the most crucial of all, and terminal care, for which hospices are well known. Because of the value that hospices provide, we should be close to the last days of their finances depending on weekly raffles, cake stalls, and collecting tins. Important as those are, they should not provide core funding; they should provide add-ons to improve the quality of service, not the fundamental day-to-day, week-to-week funding of £50,000 a week that the Rainbows children's hospice in Loughborough needs merely to survive. That must not be allowed to continue.

Photo of Sir David Amess Sir David Amess Conservative, Southend West

The hon. Gentleman, as always, makes an excellent point. Fair Havens hospice in my constituency receives 72 per cent. of its funding from charitable giving, which is huge. The hon. Gentleman also made an excellent point earlier about children in hospices. We found locally that everyone will give to children's hospices, but it is a great struggle at the moment to raise money for hospices for older people. I represent the area with the most senior citizens in the country, and we have a particular crisis.

To return to the point that I want to make to the Minister, I have spoken about St. Luke's hospice in Basildon. He could not resist making his little gibe, but I just smiled broadly at his little joke. When I became the Member of Parliament for Southend, West, I was delighted to find that it already had a hospice—Fair Havens—which was founded 25 years ago by Dr. Michael Stuart and Mrs. Daphne Hall, two wonderful people. But 25 years on, it can no longer survive just on charitable giving. We have a real crisis.

The range of services is first class, as was the most recent Healthcare Commission inspection report. Fair Havens provides day care, community Macmillan nursing, home care, spiritual and pastoral support and diversional therapy treatment. When I think of those heady days in Basildon, I remember the founder of St. Luke's hospice. Trudy Cox was a district nurse who, when out nursing once day, went into a lady's bedroom and found her dead with the children gathered around the body, not even realising that their mother had died. She resolved that she would never, ever allow anyone to die in such circumstances again. That is why she became so involved with the hospice movement, as did Cicely Saunders.

We have a crisis of funding. I have any number of testimonies to Fair Havens hospice's wonderful work in Southend. It costs £2.6 million a year to run with only £600,000 provided by the Government. During 2007, Fair Havens has experienced progressive difficulties in fundraising. I am not being party political, but the worldwide economy is in difficulty, so we are finding that it is not as easy as it used to be to raise money locally, and that trend will continue.

The hospice receives a sizeable grant from the primary care trust, but it simply is not enough to cover costs. Fair Havens will experience a funding deficit of £250,000 in the period to 31 March 2008 and another £250,000 shortfall soon after, bringing the total deficit to £500,000. Although the funding that it receives from the PCT has increased by 8 per cent. in cash terms over the past four years, that funding has decreased by 6.8 per cent as a proportion of total care costs.

The reasons for that are clear: increased demand, the negotiated contract with doctors, increasing salaries for nurses—a number of things have added to the financial crisis. At a time when Fair Havens has been increasing its services and stepping in to help plug the gaps that have been opening up in the publicly funded sector, it has suffered a real reduction in its funding from the PCT. Staff costs, have risen from £135,000 a year and will reach an anticipated £243,000 this financial year, which is an 80 per cent. increase. Without the staff, one can hardly run a hospice.

If the situation is not addressed, the number of beds at Fair Havens will have to be cut, the at-home service will be halted, the hospice's Macmillan nurses will find that they cannot be employed and the bereavement and family support services will also have to be cut. The hospice immediately launched a funding campaign and is trying to raise £250,000 by 31 March. The appeal has raised £32,000 and hopes to raise £100,000 by Valentine's day, and all local Members of Parliament will be supporting it.

To conclude, I repeat that there is no point hon. Members having an Adjournment debate if we simply smile at one another and share platitudes, but nothing happens. I ask the Minister please to send a message to my local PCT asking it to support Fair Havens hospice.

Photo of Mark Williams Mark Williams Shadow Minister (Innovation, Universities and Skills), Shadow Minister (Wales) 3:12 pm, 30th January 2008

It is a particular pleasure to serve under your chairmanship, Mr. Williams. I pay tribute to Bob Spink for securing this important debate. I know that he feels strongly about the issue and has a fine record of campaigning on it.

When I looked at the World Health Organisation's definition of palliative care, I was struck by the size of the issue. The definition referred to

"the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families."

In practice, that involves a huge range of services, including occupational, physical and complementary therapies, as well as core medical services. It is a vast area, but care, by its very nature, must be tailored to the needs of individual patients, their families and carers.

In discussions with the hospice movement, all hon. Members will be clear that there must be a partnership between the national health service and the hospice movement. The movement strongly feels that it is best equipped to deal with the innovative practices that we need to develop, and I shall come later to how that work will be resourced.

Let me start, however, by paying tribute to the hospice movement, which has been at the forefront of developing special services and raising the profile of the care given to the dying. In my constituency, we are privileged to be served by the charity Beacon of Hope, which was set up in 2000 by Mrs. Elizabeth Murphy. The charity provides immediate comfort and ongoing practical support to people in Ceredigion with terminal and life-limiting illnesses. It subscribes to an holistic package of care, which complements nursing care and supports carers, and includes a volunteer service to help with respite, which is crucial, as the hon. Members for Castle Point and for Eccles (Ian Stewart) said. The charity also provides bereavement counselling and runs a limited benevolent fund.

Mrs. Murphy told me that the problem facing Beacon of Hope—the experience of many hospices across the UK—is that a range of possible funders will not fund capital or revenue costs. When asked what they fund, people say "Projects", but projects must surely involve a capital or revenue-cost dimension. Other funding streams, such as the lottery, are laudable, and I do not denigrate them in any way, but they have often changed their criteria for awarding grants. Some changes have hit hospices hard and caused immense frustration in the sector. Beacon of Hope secured a three-year voluntary community and sector grant of nearly £250,000 from the lottery, but that has now come to an end. The lottery's criteria have changed, and funding now comes through the people and places programme, which has new criteria, based on revitalised communities, improved community relations and enhanced local environments. That has not helped the charity to secure the kind of funding that it requires.

I was slightly surprised when the hon. Member for Castle Point talked about the proportion of funding that he was looking for, and I understand what the Minister said in his intervention. In the Welsh context, Beacon of Hope wants core funding in the region of 50 per cent. and is confident that it can continue to raise the sums it requires from its local community.

Photo of Bob Spink Bob Spink Conservative, Castle Point

I was trying to say that there should not just be an arbitrary percentage. The figure might be 40, 50 or even 70 per cent., but the point is that there should be funding from the public purse for the core services that the hospice sector provides and that the NHS would otherwise have to provide.

Photo of Mark Williams Mark Williams Shadow Minister (Innovation, Universities and Skills), Shadow Minister (Wales)

I am pleased that the hon. Gentleman made that point, particularly given that some charities are looking for an upper threshold.

The sad reality for adult hospices in Wales is that only 36 per cent. of funding comes from the Government, and I gather that the figure is little more than a third for hospices in England. Beacon of Hope's running costs next year could amount to £400,000, not least because there is renewed demand for its work, which it hopes to expand much further.

That is not a criticism of the Government—I applaud what they have done, in so far as they have done something—but Government policy in Wales has been characterised by a series of not insubstantial yet, critically, one-off announcements that have not addressed core funding. Last October, funding of £2 million was announced and £10 million was announced in 2003, but the kitty is very limited and will not address concerns such as those expressed in Essex, which Mr. Amess mentioned.

I want to draw a distinction between hospices in urban and rural settings. Alarmingly, a 2005 report dealing with mid-Wales identified no palliative care service that met the definition of specialist levels of service across the whole of Powys and Ceredigion. That shortfall is now being partly met by charities such as Beacon of Hope and by the excellent Ty Geraint facility at Bronglais hospital in Aberystwyth, which was named after one of my predecessors in the House, and provides some palliative services.

I want to focus, however, on the challenge of providing hospice services in a rural area. The hon. Member for Eccles talked about the outreach work of St. Ann's in his constituency, but outreach work is hospice provision in rural Wales. Mrs. Murphy of Beacon of Hope told me that it is highly unlikely that there would ever be one dedicated building to provide services in a big rural area such as Ceredigion. Schemes such as the charity's palliative hospice at home service are much more responsive to the needs of community, and it is for such services that the charity needs its core funding. Beacon of Hope has recognised the importance of those services and last year set up a three-month pilot scheme, with two contracted nurses and 10 bank nurses responsible for 350 hours of care in some of the most remote rural communities that one could imagine. That is very important in areas such as mine.

As hon. Members have said, we are talking about lifting the burden from the national health service, which is why core funding is so important. In Wales, as in England, a review is being undertaken. The palliative care planning group set up by the Assembly is looking into the issues.

Photo of Mark Williams Mark Williams Shadow Minister (Innovation, Universities and Skills), Shadow Minister (Wales)

Thank you, Mr. Williams. It is particularly appropriate that you should remind me of that. I was complimenting the experience of Wales and its interface with England. The message is the same. From whichever side of Offa's dyke we function, the issue is much more than the laudable shaking of collection tins on street corners; the need for core funding is something that Governments on both sides of the border must address. I wish the reviews the best of luck in both England and Wales.

Photo of Angus MacNeil Angus MacNeil Shadow Spokesperson (Work and Pensions), Shadow Spokesperson (Culture, Media and Sport), Shadow Spokesperson (Environment, Food and Rural Affairs) 3:20 pm, 30th January 2008

I congratulate Bob Spink on securing the debate, which highlights the real and valuable work that hospices undertake. I am aware that Mark Hunter is anxious to contribute to the debate as well, so I will be brief.

I want to highlight some of the difficulties that are faced by people who carry out valuable work, and in some cases good Christian work. The Bethesda care home and hospice in Stornoway on the Isle of Lewis is one such great example. It is a charitable institution that provides excellent and conscientious care. Based in the heart of the community, the hospice raises a lot of money locally for its vital work. I would not be surprised to hear that relatives of the Chancellor of the Exchequer, whose mother lives on Lewis, had benefited from the hospice's professional compassion. The funding and the services provided by the care home and others like it help the Government. Unfortunately, the help is not always reciprocated, although I am sure that is something the Government will try to rectify in the best way they can. I see that I have the Minister's attention on that point.

To meet the requirements of new legislation, the already excellent Bethesda care home and hospice has to upgrade its facilities and build an annexe, for which, unfortunately, it has to pay VAT. Although the institution already reduces the burden on the state, it will have to pay an extra £94,000 as the construction takes place. It has to pay VAT because there has been no decision from the relevant VAT office. I have a letter from the Financial Secretary to the Treasury, which starts, "Dear Angus" but then vacillates a little about the decision. In the last paragraph, as far as I and the chief executive of the hospice can make out, the Treasury seems to indicate that zero VAT would be appropriate.

Surely, when tax collectors vacillate, there is no case for raising the tax at all. The current indecision is costing £94,000, which should be used for patients. Worse, it will not be possible to claim or debit the VAT through the contractor, and the hospice will have to go through the long and tortuous process of VAT reclamation, if it is determined that zero VAT is the correct decision.

Should charitable institutions spend money, which has been raised through hard work and community good will, on VAT? I urge the Minister to use his powers and influence to push for the correct decision. We cannot continue with the current limbo that is costing us so much money. It is a scandal that such charitable institutions have to pay VAT. I am not asking for changes in VAT designations, I simply want to ensure that Bethesda is in the correct classification.

We do not want Bethesda to be taxed to a standstill. We want it to continue its good work. The hospice is valued in my constituency of Na h-Eileanan an Iar and provides a tremendous service on the Isle of Lewis. I commend it to all hon. Members as a great example of what can be done when the will is right. I hope that the will of the Government—the Minister is nodding—is to achieve a zero rating and to help the hospice continue its good work.

Photo of Mark Hunter Mark Hunter Liberal Democrat, Cheadle 3:23 pm, 30th January 2008

It is pleasure to contribute to this debate under your chairmanship, Mr. Williams. I congratulate Bob Spink on securing this important debate on hospice funding. I would also like to thank him for being one of the first MPs to sign my early-day motion, tabled last year, on St. Ann's hospice in Heald Green, in my constituency. This issue is very close to my heart and I and other Members feel very strongly about it.

I have visited St. Ann's hospice on many occasions and have seen for myself, in both a public and personal capacity, the truly exceptional work that hospices do and the difference that such provision makes for those in need of palliative care and their families. I continue to be genuinely shocked by the lack of Government support for all the hospices that play such a vital role in the national health service. Despite Government assurances that the voluntary organisations that deliver public services should be paid the full cost of providing such services, hospices still receive, on average, only one third of their total costs.

St. Ann's is a case in point. As Ian Stewart pointed out, it receives only £3 million out of the £9 million that it needs each year, so it has to find the other £6 million itself. That equates to a whopping £16,000 a day. Surely the Government want such hospices to spend more of their time providing the excellent care that the NHS needs, rather than having to spend time and energy raising so much money each and every day of the year.

Charitable hospices provide 80 per cent. of adult in-patient palliative care beds, yet their funding has dropped in real terms over the past few years, leaving 28 per cent. of independent hospices in deficit in 2006. Palliative care is a core service for patients—it is not, and never has been, an optional add-on. If independent hospices cease to exist, the NHS will have no option but to pick up the slack. The Government should be acutely aware of that fact and address the funding shortfall while there is still time. We do not want excellent hospices such as St. Ann's and the others that have been mentioned today to be unable to continue because of short-sighted funding arrangements.

We are all aware that hospices ask only for a level playing field; they want to be treated in the same manner as other NHS service providers. Hospices such as St. Ann's fulfil a necessary function in a society in which debilitating and life-threatening diseases such as cancer are sadly on the rise, and they do so in a manner that is truly laudable. They provide a unique and personal service that improves the quality of thousands of patients' lives. They also support patients' families and carers. When the Minister responds, I hope that he can tell us what action the Government intend to take to put right this desperate situation, and to ensure that hospices get the stable funding regime they so desperately require.

Photo of Greg Mulholland Greg Mulholland Shadow Minister (Health) 3:28 pm, 30th January 2008

I congratulate Bob Spink on securing this debate, and I pay tribute to him for his consistent commitment to hospices. I also pay tribute to all the other Members who have contributed; they have provided powerful accounts of their experiences of the hospice movement in their constituencies. We are all very aware of the wonderful work that hospices do in dealing with those who have a terminal illness. Hospices provide not just palliative care but a whole range of services—a point that often does not come out—including not only skilled nursing care, pain relief and counselling, but activities such as art, music and physiotherapy. Of course, hospices offer services not only for patients but for their families, as other Members have made clear.

The key issue is, and the purpose of the debate is to discuss, the consistency of funding across the hospice sector. Members on both sides of the House have related some very interesting and concrete examples. Each and every hospice faces a struggle month on month, year on year, to secure the funding that it needs to continue doing its vital work. We have heard from Help the Hospices that, on average, just 34 per cent. of funding comes from Government—a little over one third. I think that we heard a slightly lower figure for Wales from my hon. Friend Mark Williams. Of the £1.2 million needed by hospices every day, only £360,000 comes from the Government, so every day hospices have to find an extra £840,000 to carry on their work.

Inequality of funding—I am referring to the proportion of money that hospices receive—has been touched on. For some, it is potentially as high as 62 per cent.; for others it is considerably lower. My hon. Friend Mark Hunter made the point, which was clearly not acknowledged by the Minister, that funding for hospices has dropped in real terms in recent years. That is putting considerable extra pressure on the hospice movement.

In speaking on behalf of my party from the Front Bench, I point out that I am proud to have a hospice in my constituency—Wheatfields hospice, in Headingley. Like the other examples that we have heard about, it does wonderful work in dealing with patients and their families in the tragic situation of the end of life. Wheatfields needs about £2.25 million every year to keep going, and the Wheatfields fundraising team has to raise approximately £1 million a year for it to continue its work. I have visited Wheatfields and seen the amazing fundraising operation—the remarkable and professional sales that it organises all week, and the twice-weekly public sales. It runs a joint lottery with the equally excellent St. Gemma's hospice, in the constituency of my neighbour, Mr. Hamilton. Together, they run a lottery and do so much for that area of Leeds.

The key point that has been brought out, particularly by the hon. Member for Castle Point but also by my hon. Friend the Member for Cheadle and others, is that we do not have equity with other areas. My hon. Friend said that there is not a level playing field, and the hon. Member for Castle Point referred to unfair treatment. The message is clear: there simply must be equity for hospices and other partially funded sectors of the health service. The reality is that we are talking about mainstream NHS palliative care. Unfortunately, David Taylor has left his place, but he put it very clearly when he said that fundraising should provide add-ons to core services, not the core funding itself. Many people in this Chamber will feel that that was an astute analysis.

Sue Ryder Care has estimated that the state receives about £200 million-worth of palliative care from the hospice sector at no cost to itself. That is the level of contribution that the sector makes. Sue Ryder, which runs the Wheatfields hospice, estimates that it subsidises primary care trusts and social services up and down the country to the tune of £7 million, and that is one organisation. Clearly, this is a real concern for the hospice movement, which I am sure the Minister will acknowledge. I am conscious that the Government are considering the issue, which is why this debate is particularly timely. I hope that the Minister will accept that there are real concerns, and that several questions are being asked in the hospice movement about funding, equity and the differing proportions of funding for some hospices.

Liberal Democrat Members welcome the grant that was announced to refurbish hospices, but as I am sure the Minister will acknowledge, that is not a long-term answer to the questions being posed. In the new strategy, will he commit to an increase in hospice funding not only overall, but proportionately? Will the Government seriously consider that? Will he address the issue of equality of funding across the hospice sector? Will he comment on the idea of a tariff-based system for hospice care, which has been mentioned by Sue Ryder? Given the Government's commitment to full cost recovery and closer partnership with the voluntary sector, the simple question is: why does that still not apply to hospice care, and when will it?

I again pay tribute to all Members who have taken part in this most important debate; I look forward to the Minister's contribution. One thing that Members on both sides of the House are absolutely committed to and 100 per cent. behind is the view that we must do whatever we can to support the wonderful work done by hospices.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health) 3:35 pm, 30th January 2008

I, too, congratulate my hon. Friend Bob Spink on securing this very important debate. He is a tireless campaigner on behalf of hospices both in this place and outside it, in his constituency and beyond it. I applaud his priority in campaigning and seeking to hold the Government's feet to the fire on this issue. His speech and, indeed, securing the debate itself is a touching and fitting tribute to his sister, to whom he paid a tribute in which we all join. I dare say that as a district nurse, she was as inspired as my wife—who is a district nurse by training—by the example of Dame Cicely Saunders and the work that she did in Sydenham. I am sure that that has been an inspiration to all those who have given their lives and careers to nursing and caring for others.

All the speeches today have shown the deep care and genuine compassion that we have as elected representatives on behalf of all our constituents, particularly those who dedicate themselves to the excellent work of hospices. Notwithstanding the fact that health is a matter for the devolved Administrations, we heard speeches from Mark Williams about Wales, and from Mr. MacNeil, whose constituency I regard as the highlands and islands when I enjoy my holidays there.

I pay tribute to the hospice in my constituency. St. Luke's hospice—another St. Luke's hospice—in Winsford is absolutely wonderful and it is close to my heart. I spend a lot of time at and have a great deal of concern for that hospice, particularly because my wife has been nursing there as a volunteer over the past eight years.

I echo the concerns expressed by my hon. Friend the Member for Castle Point about the financial stability of hospices throughout the country. He noted that on average every UK hospice has to raise £4,500 a day through fundraising just to continue providing care, and a further £500 a day to fund building expenditure. Of course, those figures can vary from hospice to hospice. He also noted that the number of hospices in deficit rose from 43 in 2005 to 52 in 2006. Against those background facts, a National Council for Palliative Care survey last year found that about 60 per cent. of hospices were experiencing a decrease in the value of the funding contribution from the NHS, in part because of the constraints on NHS cash that applied.

I hope that the Minister will shed some light on why the number of hospices in deficit appears to be rising as we speak. Many people—mainly those who are thinking about continuing to contribute to hospices—are saying to me that they do not understand whether that has to do with financial mismanagement or inefficiency at hospice level, in which case they would lose confidence in that being the right place to send their money, or the Government failing centrally. It would be helpful to have the Minister's view, to ensure that we send what messages we can from this place and give reassurances.

The remarks of my hon. Friend the Member for Castle Point, who was characteristically gentle with the Minister, were slightly short on emphasising where things have got to. I hope that my attitude will be seen as unaggressive and all-party, but it is fitting that we should be debating hospices in this Chamber when in the main Chamber, a debate is taking place on the Lisbon treaty. There is a great problem in respect of that treaty because one has a real sense—if one is not a Government Member—that one is dealing with a broken promise. We all expected, as a result of the Labour party manifesto, that there would be a referendum.

In contrast to that, here in Westminster Hall the Minister has an opportunity to take the opposite approach, and I am confident that he will take it, given that some 40,000 people per annum receive palliative care in hospices and 120,000 receive some sort of palliative care, and considering the 300,000 people—around two thirds of whom will die each year—who would benefit from some sort of palliative care in the last year of their lives, according to Professor Irene Higginson, head of palliative care policy at King's college, London.

The Government have promised to double funding for palliative care and to introduce payment by results. We need to examine those commitments. The 2005 Labour party manifesto said:

"In order to increase choices for patients with cancer we will double the investment going into palliative care services, giving more people the choice to be treated at home."

That promise to double investment—we take that to mean spending, from the way the Government use the word—was repeated in the 2006 White Paper, "Our health, our care, our say". However, there is a problem with that: to double anything, one needs to know the number that one is starting with.

Photo of Stephen O'Brien Stephen O'Brien Shadow Minister (Health)

I was being non-aggressive.

The Government have said that they do not know how much is currently spent on palliative care. The former Health Minister, now a Transport Minister, Ms Winterton admitted that the

"Department does not routinely collect data on palliative care".—[Hansard, 14 July 2006; Vol. 448, c. 2170W.]

Will the Minister explain the basis for the Government's claim that they will double investment? Is that still their position? When can we expect to see the figures?

The Government's 2005 response to the Health Committee report on palliative care said:

"We remain on course to implement Payment by Results (the national tariff) with respect to palliative care in both the NHS and the voluntary sector by 2008/9", which is almost upon us. It went on to say:

"In palliative care the national tariff will, in effect, provide the full cost recovery recommended by HM Treasury's Cross Cutting Review on Voluntary and Community Sector in Public Service Delivery."

However, in a letter to me, the former Health Minister, who is now the Secretary of State for Culture, Media and Sport, admitted the following:

"Since this statement was made"— the statement to the Health Committee—

"our priorities have changed".

He also said that the Government intended to publish

"proposals for a consultation" on the future of payment by results, and said:

"This will include discussion of whether and how we can expand the current range of services and providers covered by PbR".

The use of the conditional "whether" is obviously very significant.

The Minister is here, live, as it were, and we will welcome his answers to those points in couple of minutes. Let us not, on this vital matter, have the normal knockabout by saying "Labour and Health Ministers have broken their promises", as my hon. Friend Mr. Amess so invigoratingly suggested. However, let us examine the context in which the Minister will, hopefully, stand up to give us some welcome news.

The Government response to the Health Committee was issued when the current Prime Minister was Chancellor of the Exchequer. As I said, it stated:

"In palliative care the national tariff will, in effect, provide the full cost recovery recommended by HM Treasury".

The Treasury gave a commitment in "The Role Of The Voluntary And Community Sector In Service Delivery: A Cross Cutting Review", which arose out of the 2002 spending review, that by April 2006, full cost recovery funding should be in place. It stated:

"Funders should recognise that it is legitimate for providers to include the relevant element of overheads in their cost estimates for providing a given service under service agreement or contract...All departments will incorporate the review's funding recommendations fully into their procurement policies by ensuring that the price for contracts reflects the full cost of the service, including the legitimate portion of overhead costs"— core funding—by April 2006.

Those principles were reflected in the compact with the voluntary sector, so I am sure that the Minister will not be content to allow the voluntary hospice sector to continue to subsidise the NHS, two years after such arrangements were supposed to come to an end. The official Opposition promise to implement the national tariff with respect to palliative care. In effect, that will mean offering full cost recovery to voluntary sector providers. I hope that the Minister will join us by doing likewise.

Will the Minister also explain the second delay in the publication of the end-of-life care strategy, which was originally due to be published in the autumn of last year? In response to a parliamentary question on the issue, the Minister told me that publication had been deferred until after the publication of Lord Darzi's next stage review, but in the noble surgeon's interim report, no mention was made of end-of-life care, other than to flag up a talking shop on the issue. Will the Darzi review bring forward concrete proposals that will deliver on the Government's previous promises?

The Government will require the Healthcare Commission and all other regulators in England to recover the full costs of regulation from fees by the 2008-09 financial year, which is almost upon us. In the past, fees for hospices have been at discount rates. The commission works from the principle that the fees should reflect the actual costs of regulation, not what establishments can afford to pay. The commission said:

"We believe that if a special case were to be made for voluntary organisations' fees, it would be for democratic Government—not the regulator—to decide that public funds or other establishments' fees should be used to subsidise them...We do however acknowledge that voluntary organisations and small business feel the impact of a fixed overhead such as regulatory fees more acutely than large businesses. Our fees scheme takes this into account".

The commission has proposed charging increases for 2007-08 of £2,376, which is a frozen fee, for hospices with four or more beds. A hospice with, for example, three in-patient beds, would see the burden of costs rise from £907—that includes a registration fee plus a flat rate for inspection costs—to £2,213, which encompasses the doubling of the registration fee for small hospices, plus the new, increased flat-rate inspection fee, plus the removal of the exemption from the per bed charge for hospices with fewer than four beds. The impact on smaller hospices will be disproportionate, but it also seems to run counter to the commission's stated goal of

"finding a balance between full cost recovery and affordability for voluntary organisations".

I hope that the Minister will take a serious look at that.

The Royal College of Physicians has reported that terminally ill patient's access

"to palliative care services...is inadequate and inequitable".

I hope that the Minister will commit to the meeting with the delegation asked for by my hon. Friend the Member for Castle Point in his outstanding speech, and ensure that commitments are made in Lord Darzi's review and in the end-of-life care strategy—whenever that is published.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services) 3:47 pm, 30th January 2008

I congratulate Bob Spink on securing this important debate and on the passionate and authentic way in which he goes about championing the cause of hospices. Parliamentarians often do not focus enough on how we can make a major difference. There is no more important issue than this, frankly, and we can make such a difference to it.

The hon. Gentleman paid tribute to a number of organisations, and I join him in doing so. He mentioned the Association of Children's Hospices, the Rainbow Trust, Help the Hospices, and Sue Ryder Care, and there are many other individual hospices to which we should pay tribute in a debate such as this. He also described the current Prime Minister, the previous Prime Minister, and the Secretary of State for Justice as great men. I can tell the hon. Gentleman that an application form is in the post.

More seriously, he dedicated his contribution to his beautiful sister Yvonne, as he described her. He spoke movingly about the experiences that she went through, and those of himself and his family. I had a similar experience last year when, unfortunately, my mum Gloria, who was only 64 years of age, died in April. It was one of the most difficult experiences that I have ever had to cope with. More importantly, I shall never ever forget my mum's dignity and courage towards the end of her life. As the hon. Gentleman said, unless one has been there, the emotional rollercoaster that the person concerned and their immediate family inevitably go through is incredibly difficult to describe. I pay tribute to the hon. Gentleman for personalising the debate.

The hon. Gentleman was right to say that end-of-life care is a growing issue—inevitably so. Because people are living longer, because people's aspirations and expectations are different from what they once were, because of medical advances and technological change, and because of our public service reform agenda and vision, we now have the capacity to offer end-of-life care that is very different from that offered in the past. I shall return to the hon. Gentleman's speech—he raised a number of issues—but I want first to deal with some of the specific issues raised by other hon. Members.

Mr. O'Brien—he was not described by the hon. Gentleman as a great man, but I am sure that that was an omission—paid tribute to St. Luke's hospice, and I join him in that. More important, he spoke of his wife. She must be a wonderful woman for all sorts of reasons that it would be inappropriate to put on the record. She is a volunteer at a local hospice. We should remember that thousands of people give of their time selflessly in order to make hospices work, working alongside some incredibly dedicated and skilled professionals. In paying tribute to Mrs. O'Brien, not only for living with the hon. Gentleman but for the tremendous contribution that she makes to the hospice movement, we pay tribute to many.

I do not know of any evidence that hospices are poorly managed. Of course it would be inappropriate to generalise, and I am sure that like any other public service sector some hospices could be better managed, but on the whole the hospice movement can be proud of its record of management, prudence and governance.

My hon. Friend Ian Stewart spoke movingly about St. Ann's, a hospice that I know because it is not that far from my constituency. He also mentioned Francis House. He rightly spoke of dignity and serenity, but the most important point that he made was that a crucial measure of civilised society is the way that it treats people towards and at the end of their life. My hon. Friend was right that there can be no more important measure.

Mr. Amess mentioned Cicely Saunders, and he will doubtless have read my right hon. Friend the Prime Minister's recent book on heroes, in which he identified Cicely Saunders as one of those who have made the most difference to our society.

The hon. Gentleman was uncomfortable about my body language at the mention of Basildon, so I shall pass over the subject rather quickly. However, it is good that he keeps in touch with his former constituents. He also challenged me on his local hospice and I shall respond to that challenge in the following way.

It is best practice for every primary care trust to sit down with the hospices and to seek three-year commissioning agreements in order to give the hospices a sense of long-term stability. That will be based on the needs of the local community. I urge the hon. Gentleman's PCT—indeed, every PCT—to adopt that approach. To be fair, at the moment they have a one-year allocation, but within the next few months they will know their allocation for the next three years. Best practice will give them an opportunity, and I believe that they should take it. I hope that the Exchequer Secretary to the Treasury who has joined us, agrees with that principle.

Most of these issues are devolved, but Mark Williams raised the important issues of specific project funding when hospices need core funding and their importance in rural areas. Mr. MacNeil—it is difficult to pronounce—raised the question of VAT. That, of course, is a matter for the Treasury; I would have said that anyway, but I shall stick to my script given who has just joined us.

I return to the contribution made by the hon. Member for Castle Point. It was he who raised most of the substantive issues—and he did so most appropriately. Hospices are part of a network of palliative care in every community. Sometimes, however, the whole of palliative care is presented as hospice treatment. We have to remember that an increasing number of people choose to end their lives at home. In that context, we should pay tribute to Macmillan and Marie Curie nurses, and others who do such a remarkable job. There are also residential nursing homes and hospitals.

My view is that we should not be neutral about the matter. Given a choice, the vast majority would choose to end their lives in a hospice rather than a hospital. That has implications for some of the commissioning decisions that PCTs have to make. If people want to die at home, unsupported, they should be allowed to do so. If the choice is between hospital or hospice, I believe that the vast majority would choose the hospice, because it is personal, sensitive and intimate. Primary care trusts should accept that fact.

We have made £27 million available for children's palliative care, as the hon. Gentleman said. We have conducted a review, and I can tell the House that we will be publishing a national strategy for children's palliative care in the middle of February. That is confirmed today. The hon. Gentleman was right to speak about Diana nurses, who do an important job. We are looking at ways to support and develop their continued contribution to children's palliative care.

I turn to the end-of-life strategy. It is very simple. One of the major streams of Lord Darzi's review of the NHS is end-of-life care. When considering world-class end-of-life care, every strategic health authority area is talking about what it should offer people. It would be nonsense to produce a strategy in advance of that process being concluded. When Lord Darzi publishes his final report on the future of the health service, which will be this summer, we will publish the first national end-of-life strategy. That is a clear commitment, but we want to get it right, and it is worth each strategic health authority spending the coming months discussing the subject.

The question of funding has been raised. The Government's record is excellent, relatively speaking, but a tremendous amount remains to be done. Help the Hospices shows that NHS funding for adult hospices in 2004 was £97.8 million, an increase of about 50 per cent. over 2000. Funding increased further to £113.7 million in 2006.

The only partisan contributions made during the debate were made by the hon. Members for Cheadle (Mark Hunter) and for Leeds, North-West (Greg Mulholland). They turned it into a party political issue. They talked about a real-terms cut in the amount of funding for hospices based on those figures. That was absolutely opportunistic and disgraceful.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

Will the hon. Gentleman be writing a blank cheque to the hospice movement? Is he saying that if the Liberal Democrats ever formed the Government, they would meet all the hospice costs at 100 per cent. recovery? Of course not, but that is the impression that Liberal Democrat Members always give when contributing to debates.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

We are all fed up with it. I return to the substantive issues.

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I will not give way.

On regulation costs, I shall consider the question of the consultation that the Healthcare Commission is undertaking—

Photo of Greg Mulholland Greg Mulholland Shadow Minister (Health)

He's an a*******.

J

The man, the legend.

Submitted by James Kerry Read 2 more annotations

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

—and the nature of regulation costs. That was not very parliamentary language, Mr Williams.

On the question of—

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

No, I will not.

On the question of future funding, let us be clear. As part of coming up with an end-of-life strategy that is fit for purpose, we have to resolve a fundamental issue. What is the appropriate balance of responsibility between the state and other forms of funding for hospices? We also have to consider the relative contribution of hospices to palliative care in every local community. Those are the fundamental issues that we have to resolve. We then have to take account of the fact that every locality will make different decisions, depending on population need and historical provision. We must also take account of the fact that the hospices want to retain some independence from the state, which is quite appropriate.

As part of the publication of that national strategy, I commit to seeking once and for all a final settlement that is clear about the respective responsibilities of the state, the voluntary sector and other forms of contribution for the funding of the hospice movement in the context of how palliative care is funded on a long-term basis. When we have come to that settlement, it will be transferred into the policies and actions applied by PCTs.

Photo of Bob Spink Bob Spink Conservative, Castle Point

Will the Minister speak with the delegation and will he repeat what he said about regulation costs?

Photo of Ivan Lewis Ivan Lewis Parliamentary Under-Secretary (Department of Health) (Care Services)

I am willing to look at the consultation that the Healthcare Commission is currently engaged in on the regulation costs. I will, of course, be willing to grant the hon. Gentleman a meeting.