Dr Dan Poulter MP and Stuart Carroll: Strengthening Britain's hospices

Dr Dan Poulter is the Conservative MP for Central Suffolk and North Ipswich, and a member of the Health Select Committee. Stuart Carroll is a senior health economist and Chairman of the Bow Group Health and Education Policy Committee. Here they summarise their research paper, which they will be publishing next week, that calls on the Government to develop a new framework to support the hospice movement.

As the old aphorism goes, nothing is certain but death and taxes. Given the current economic climate and the UK’s eye-watering budget deficit, the latter could hardly be less true even with George Osborne as Chancellor.  The former remains not just an inevitability of life, but a key policy consideration for any society.  Dignity in death and the provision of proper end of life care remain amongst some of the most emotive and important issues topping the priority list of many individuals and their families.

It is from this critical perspective that the role of the hospice movement, and hospice care, can be considered a central policy issue.  Just like the UK’s pension “time bomb”, there is significant scope for a “healthcare time bomb” as more and more people require end of life care.  Moreover, it is an economic imperative as governments of all colours and persuasions continue to grapple with the basic health economic problem – infinite healthcare demands but finite healthcare resources – which is now evermore acute in the current age of financial austerity.  Ensuring people spend less time in hospital and more time in home, social and/or hospice care does not simply constitute good health and social policy, but also sound economic policy.

Hospice care is open to all helping people with cancer and other life-limiting illnesses such as neurological conditions, HIV, and heart and lung conditions.  Hospices also provide care and support for children and young people who have life limiting or life threatening conditions.  In our forthcoming research paper, we review arrangements pertaining to palliative and end of life care in the general sense to examine the role of hospice care and how this can be better integrated and improved.  The purpose of our research paper is to provide a clear overview of current landscape and to provide recommendations on how policy can best be shaped in future.

We believe our research comes at a crucial time with the Government currently considering the future of social care funding, with a White Paper on social care reform due in April 2012 followed by legislation in the next parliamentary session. We ask that when developing a new funding system Ministers should ensure there are appropriate incentives for commissioning integrated care packages which stimulate community services.  We would also like to see the introduction of an integrated end of life care framework that explicitly includes hospices.

Using expert interviews with hospices and other relevant organisations, key recommendations from our report will include:

• An ongoing challenge for the delivery of healthcare services is a lack of integrated care and patient choice.  This has particular consequences for the commissioning of services and is relevant to hospices.  It is therefore vital that there is a pooling of the health and social care budgets to ensure integrated patient treatment pathways and to overcome existing deficiencies in commissioning.
• There should be a Hospice and Social Care Charter codifying the Government’s minimum responsibilities and to outline the Department of Health’s plans for hospice care in the future.   
• The introduction of a national tariff for hospice/palliative care based on need to overcome problems of costing and to ensure better funding streams. 
• NICE to develop Quality Standard focusing on reducing hospitalisations and promoting home care and community care for patients with emphasis on local planning for hospices to support this practical policy objective.  
• The Government should commission an evidence based review to ascertain the actual demand for hospice care given the current lack of data on national and local resource needs.   

The hospice movement should also be utilised as a flagship example of David Cameron’s Big Society.  It is a sublime example of volunteering and is consistent with the Prime Minister’s “mission in politics”.  As the population ages and a greater burden is placed on hospices, the need for voluntary contributions and volunteer action will inevitably intensify. The Government must therefore recognise these increasing pressures and ensure that tax and regulatory systems – especially those relating to health and safety – are structured to enable those willing to commit finance and personal time to hospices are able to do so, minimising associated hurdles and barriers.

Dignity in death is a basic human right and a key policy imperative.  Although an instinctively uncomfortable subject, it is important policymakers do not overlook the importance of end of life care of which the hospice movement plays a seminal and critical role.  We therefore earnestly hope the Government will take on board our findings and recommendations when we publish our paper next week.