Health Bill

moved Amendment No. 82A:"After Clause 32, insert the following new clause—" ““PALLIATIVE CARE SERVICES (1)   The appropriate national authority shall undertake an assessment of the nature and extent of palliative care services provided within the health service and, in conducting that assessment, shall have particular regard to the provision of— (a)   paediatric palliative care; and (b)   hospice facilities for children and young adults. (2)   The appropriate national authority shall, within 12 months of the passing of this Act, conclude the assessment referred to in subsection (1) and prepare and publish a report on that assessment which shall be laid before each House of Parliament and, in respect of Wales, before the National Assembly for Wales.”” The noble Earl said: I hope that in moving the amendment, the Committee will allow me to spend a brief time considering an issue that is of considerable and growing salience in our national life: hospices and palliative care. The choice agenda has many facets, but bringing choice to people at the end of their lives is something in which we as a nation have been pioneers ever since Dame Cicely Saunders started her wonderful work at St Christopher’s in the 1960s. Indeed, the hospice movement has sprung up largely through her example and through the efforts of communities. Nowadays, two-thirds of adult in-patient palliative care beds are in units run by local charities. National charities, such as Mary Curie Cancer Care and Sue Ryder Care, as well as the NHS, run the remaining third. It is a mark of the strong public support hospices enjoy that the movement continues to grow. It needs to grow if the high proportion of people who are terminally ill and do not have access to palliative care is to receive it in the future. Of patients who access adult hospice care, 95 per cent have cancer. It is estimated that 300,000 people who die from progressive diseases other than cancer need palliative care but do not receive it. We are a long way from being able to provide equality of access to such care across the country and across all disease conditions. It was therefore a source of encouragement to many in the hospice movement when, at the most recent election, all the main political parties pledged to improve the level of hospice funding from the NHS. It is no longer tenable for us to expect hospices to shoulder as high a proportion of their costs as they have in recent years, especially during the late 1990s. It is to the Government’s credit that a further £50 million per annum of NHS money has been channelled towards specialist palliative care over the past four years or so, but there is more to be done. In their manifesto, the Government promised to double their expenditure on palliative care in England. That recognition of underfunding in the sector was decidedly welcome. However, nowhere is the extent of underfunding more marked than in children’s hospices. Whereas the NHS currently contributes about 34 per cent of the costs of adult palliative care, the equivalent figure in the case of children is a mere 5 per cent. I am not alone in regarding that as shameful. We have to improve on it. Payment by results for palliative care will not be introduced until 2008-09, so it would be helpful if the Minister could tell us what additional amount of funding the department believes will be needed in order to do this, bearing in mind that the level of the tariff is still an unknown quantity. All we have at the moment is NICE guidance describing the type of service that should be available, but the gap between what PCTs are currently funding and what they may have to be fund appears to be sizeable. In fact, I am not clear why the PCTs are not doing more. It is already a Treasury requirement that government departments ought to pay the full costs incurred by voluntary organisations in providing public services. That clearly is not happening with hospices. This amendment, along with Amendment No. 96A, tabled in the name of the noble Baroness, Lady Finlay, to which I have added my name, are designed to focus the minds of both the Government and the NHS on a set of issues that may be in danger of receding from the ministerial radar because of more pressing imperatives. I hope that is not true, but it would be helpful to hear from the Minister how the Government plan to deliver on their manifesto pledge in this area, and how in particular the needs of children’s hospices are to be factored into those plans, as well as how in the longer term the introduction of payment by results is likely to affect the way in which palliative care becomes more readily available to more patients who need and want it. I beg to move.