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Speech by Paul Burstow MP, Minister of State for Care Services, 16 November 2010: Help the Hospices Conference

  • Last modified date:
    20 December 2010

I’m very pleased to be here – not least because I wanted to thank you for the unique and precious work you do within our communities.

The hospice movement has a rich and distinguished past: always at the heart of our communities, always centred on values of compassion and care, always searching for new ways to improve the quality of life for those you support.

I have close links with St Raphael’s Hospice in my own constituency, which provides some wonderful care for the people of Sutton.

In fact, just before the election I did a fire walk to raise funds.

I can say quite literally there were no cold feet here about joining the Coalition.

As I say, hospices have a distinguished past. And I believe there have a bright future ahead of them, both as providers of services and as a source of expertise and advice to others.

And so it’s fitting that your conference and your Report coincides with our new vision for social care.

It’s a vision built on the principles of partnership and mutuality – principles that already lie at the heart of the hospice movement.

A plan that’s all about changing the relationship between the State and the individual – shifting more power away from politicians like me, and into the hands of the people and families who use your services.

We want more personal budgets, more join-up between health and social care, and more variety and innovation in the organisations delivering care.

Earlier in the summer, the NHS National End of Life Care Programme, produced a framework talking about how social care should get more involved in planning and delivering end of life care.

Too often social care staff don’t have the confidence to discuss end of life care with services users, and yet their training in assessment and advocacy can mean they’re perfectly placed to have those conversations.

And hospices can help them. We absolutely want you to be at the heart of this new approach, working hand in hand with the NHS, and the wider care sector, to deliver better results for families.

Capital Funding for Hospices

But to achieve it, I know you need the right funding.

One of the first things the new Government did, nearly six months ago now, was to dispel any concerns about capital funding allocations to hospices.

We confirmed £40 million to support valuable projects around the country to renovate and improve facilities, many of them helping to support people receiving care in the community.

The decision was a mark of our support for hospices and for the valuable work you do – and I’ve seen how this money has transformed surroundings of St Raphael’s, which had been showing its age.

Palliative Care Funding Review

We also recognised from the off, that we need a sustainable funding system for the longer term.

The Coalition Document made it clear that we’re committed to per patient funding model for palliative care.

And back in July, we asked Tom Hughes-Hallett to begin an independent review.

Our aims are straightforward. We want a funding system that’s sustainable. That provides stability and security to plan for the long term. And that actively encourages community-based palliative care, to help people stay at home or in a care home.

Tom is looking at a range of options to make sure funding for hospices and other palliative care providers is fair.

He will be looking at both adults and children services – the first time the two systems have been considered together – with Professor Sir Alan Craft lending his expertise on children’s palliative care.

To give you an idea of the timeline: an interim report is expected shortly, the final report next summer, and we hope to announce the final decisions by the end of 2011.

Spending Review

And just recently, of course, we’ve had the Spending Review. Another clear sign that the Government is serious about defending health and social care.

Protection for NHS spending – a real terms increase over the next four years.

And protection for social care. Funding rising in line with need. Up to an additional £2 billion a year by the end of the Spending Review period – half of it from NHS.

And with it, clear instructions for the NHS that this £1 billion must go on social care.

No absorption, no hoarding within PCT baselines.

The money is there to invest in services that keep people independent, and out of hospital.

And it should act as a catalyst bringing health and social care services much closer together.

Commissioning

The Spending Review should be a platform for accelerating the pace of reform across health and social care.

The recent Demos report prepared for this conference shows there’s plenty of room for improvement in end of life care.

It’s really a riposte to those who respond to our reform proposals and say ‘if it ain’t broke, why fix it?’

The figure that stood out for me is this one, from the National Audit Office:

That four in every 10 patients who died in hospital had no medical need to be there.

That figure is based on a local study, and it means in one month alone, in just one city, 120 people died in hospital when they could have been at home.

I share your frustration, and your belief – that we can and should do better than this.

The palliative care review will look at the funding issue, but I’d suggest this is a question of outlook as much as resource.

We need more imagination, more radicalism, more courage in commissioning. Shifting the landscape of end of life care in favour of the service user.

And we need an energetic and confident third sector to help us do this.

The best commissioners are already challenging old conventions, already finding new ways of designing services, and new ways of bringing in hospices and other community organisations together to meet patients needs.

And hospices are often at the heart of it all.

Like in Oxford, where Sue Ryder Care is working with the local PCT to fund a specialist community matron to support people cared for at home.

Or in Wiltshire, where the Dorothy House hospice has developed a carers’ support group to help those looking after people at home.

Or in the South West, where NHS teams are working with hospices on education and training plans to support the End of Life Care Strategy.

GP Consortia

Now I know some of you are worried about how the new GP consortia will work, and what that will mean for future commissioning.

I’ll be looking very closely at how these new arrangements are working for end of life care.

But I would say, here and now, that I think GP commissioning have clear advantages over the current model.

GPs have a better understanding of patient needs, and better connections with the local community – more knowledge of what’s available locally to support patients at the end of life.

I firmly believe General Practice consortia will be advocates, not enemies, of hospices.

But I’d also say this: don’t sit back and wait.

Now’s the time to start having those conversations, sowing the seeds with local GPs – and with local authorities, who will play an increasingly important in co-ordinating care.

Many PCTs and councils are already moving toward joint-commissioning and planning through Health and Wellbeing Boards – and it’s vital the hospice sector is making its voice heard through these channels.

So my advice to you is: Step forward, don’t shrink back. Get to grips with the new structures. Understand the local agenda.

Above all, look outwards, not inwards. Look at how you can join-up with other services to meet patient needs, and create a compelling offer for local commissioners.

These are difficult financial times – but this is no excuse for slow progress.

Good end of life care can save money, and poor quality care can squander it.

I heard just the other day about motor neurone disease patients who couldn’t get respiratory support.  It would have cost a few thousands of pounds. 

And the result? Six months in intensive care costing a million pounds.  This is the extreme, but it’s a salutary comparison. 

Linking up EOLC and LTCs

And it brings me to an important question of joining up end of life care with the management of long term conditions.

Dementia is the most obvious case in point. We’re focusing on earlier diagnosis, because this gives people the chance to plan for the future.

And planning for the future does mean making choices about end of life care.

So diagnosis should be a trigger for discussions. About how you want to be cared for. How you want to live. Where you want to die.

We need these kind of open discussions between patients and doctors as an integral part of long term care planning.

Cultural barriers

Easy to say, harder to do.

Among public and professional alike, there is still a real reluctance to talk about death and dying.

And that needs to change.

A 21st century health service has to be more open and willing to talk about death.

Society itself needs to be more open and willing to talk about death.

So yes, I think we need to lift the veil again, and I absolutely support the work of the Dying Matters coalition to stimulate more debate about this issue.

I’m also pleased that the National Council for Palliative Care is one of the signatories to the National Dementia Declaration for England, published last month, which should help give voice to these important issues.

Conclusion

Ultimately, how we care for people towards the end of their lives defines us as a society.

The work you do – in helping people, and families, to share in a peaceful, dignified and pain-free death – is the finest expression of the compassion, respect and goodness we want to see in all our communities.

Helping someone to die well is the most precious thing we can give an individual and their family.

I appreciate and acknowledge your valuable work, and I hope we can continue working together to allow more people in future to experience a good death.

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