Andrew Lansley – 2011 Speech on Hospices

Below is the text of the speech by Andrew Lansley, the then Health Secretary, given on 26th September 2011 at Help the Hospices.

Thank you Michael [Howard].

There are few people better qualified than you are to talk about the relentless cut and thrust of British politics.

We all know what we’re getting into, of course, but there are still times when all the press, the interviews, the meetings and policy documents can feel like a bit much.

But there was a reason why I first asked you if I could be health spokesman for our party eight years ago.  It’s because nothing is more important than the care we give to people when they are at their most vulnerable; and nothing more inspiring than the people who give that care.

As the Secretary of State in charge, it’s important never to lose sight of that.  That’s why I visit the NHS and other health and care providers every week.  I recently visited three hospices in one day up in the North West.

Each of them had received funding from the Department of Health’s £40m capital grant scheme.  So I went up to see how it was being put to use.  A proper thing to do from an accountability point of view …but it was also very moving personally as well.

I saw places where the hospice workers give excellent levels of care and support.  Where patients, their families and their carers get the best experience that their circumstances allow.

For me, the quality of the interaction and relationships between patients and the professionals who work with them defines good healthcare.

I know how important hospices are to local communities and what excellent work they do.

In 2007/8, hospices in England, Wales and Northern Ireland cared for around:

– 41,000 new adult in-patients,

– 18,000 new day care patients

– 102,000 patients at home

– as well as supporting 110,000 patients in hospital.

In every single case, they play an essential role:

– providing specialist care to those who need it,

– educating health and social care professionals,

– innovating in service provision,

– and supporting services for people who want to get their care in the community.

Hospices play a valuable role in giving people choices.

They’re well placed to provide, or be a part of, many of the community-based end of life care services set out in the End of Life Care Strategy.

They’re essential in ensuring that the needs of patients and their families are met, whatever their circumstances.

That’s why I – and the coalition government as a whole – want to see hospices flourish and develop.  We have already taken action to support that, and we’re going to do more as well.

End of life care

It’s said that you can judge the civility of a society based on how well it treats its most vulnerable citizens.  On the basis of some cases that have recently come to light, we need to do a lot better.

There’s more work to do to develop better end of life and palliative care services, to make sure that all of the people that need that care always get it.

Care that is compassionate, appropriate and a high quality. And care that always takes account of patients’ choices and their personal preferences.

Quality

The health reforms currently being put in to place will put improving the quality of care truly at the heart of the NHS.

We are developing a new indicator for end of life care, to help assess its quality and to inform the improvement of services.  It will be based on a national survey of the bereaved, who will report on the deceased’s, and their own, experience of care, so that developments will be based on the evidence of those who know.

And NICE is developing a quality standard for end of life care.  Due in November, it will set out – based on the evidence – the characteristics of what a high quality services.  It will help commissioners and providers see what the best care looks like.

Already today, end of life care comes from a range of providers, including hospices.  As we move into the future, with an NHS based around patients rather than process, I want to encourage new partnerships and more organisations to get involved.

Because I believe that, where it’s appropriate, patients should be able to choose from a range of groups, all offering services that are high quality, consistent, and delivered in a way that the patient likes.

We are asking the NHS to listen to patients, and if they hear a strong call for more choice about who provides care at the end of life, then commissioners should make that happen locally.

If providers meet strict qualifying criteria, and if they’re ready, it’s right that they should be allowed to offer care to people who want that choice.  It will mean more innovation in the sector, which will benefit patients, because their care will keep getting better, and it will benefit the best providers who will then attract more patients.

To secure continuing improvements in quality, we must empower people with information, shared decision-making, and choice.  “No decision about me, without me” is, I know, already integral to hospice care.

I really can’t overstate how important choice is, particularly when it comes to end of life care.

We want to make sure the wishes of the patient and the family come first.  Moving towards a system where everybody is supported in how they want to die.

The recent report from Cicely Saunders International on local preferences and place of death told us yet again that most people would prefer to be cared for and to die at home.

But sadly, it also found that for many people, it just doesn’t work out that way.

For some, Hospital will continue to be the appropriate place to die.

But many more people could be cared for and die at home or in a ‘home from home’ such as a hospice…

– if the system allowed it.

– if money was available,

– if services could be provided where and when they were needed,

– and if some of the red tape could be cut back.

I want this to happen.

People need more choice and control about the care they get when they are dying. In particular, services should be set up to help people who want to die where they live, including in a care home if that has become their usual home.

We want to introduce a right that will make this happen.

And if it is going to happen, we need to fully implement the End of Life Care Strategy, particularly around delivering improved services in the community.

Children

Hospices have a particularly important role to play for children

When it comes to palliative care, their can differ greatly from those of older patients.  It’s not just a matter of end of life care, but also helping children with life-threatening or terminal conditions to live as full a life as possible.

We are working with children’s hospices to improve palliative care for children and to develop a more sustainable and patient-centred funding system.

This year, the Department of Health gave £10m to forty children’s hospices in England through the children’s hospice and hospice-at-home scheme.  The grant, introduced 5 years ago, has now provided £57 million to children’s hospices.

Last year, we also give up to £30 million to support local projects to develop children’s palliative care services, bringing together local commissioners and providers, including voluntary sector organisations.

Time

Altering the system to allow more choice can’t be done overnight.  Everything must be re-aligned and that takes time.  For example, commissioners need to be sure that the right services are available to support people to be looked after at home.  Effective co-ordination of care will also be essential.

To support this, we have piloted End of Life Care Locality Registers, also known as Electronic Palliative Care Co-ordination Systems, as a way to ensure that all professionals involved in a person’s care at the end of their life have access to key information about a person’s care and their care preferences. And we are now working with partners to help this practice become more widespread.

There’s a lot of work to be done.  In 2013, we’ll review our progress and see how we’re doing.  See how close we are to giving everyone greater choice.

Palliative Care Funding Review

A huge part of all of this is getting the system of funding right.

The coalition’s Programme for Government says we will introduce a new per-patient funding system for all hospices and providers of palliative care, for both adults and children.

It’s right there, in black and white, on page 26.

I’m sure you all have a well-thumbed copy on your bedside tables, so have a look when you get home.

To help drive forward our commitment to innovative, integrated services, I set up the independent Palliative Care Funding Review.

In a nutshell, the Review’s job was to develop funding options that would be fair.  Fair to patients, ensuring that they have access to the care they want, where and when they want it. And fair to all providers of dedicated palliative care, including hospices, giving them the means to make it happen.

Per-patient funding should be sustainable; it should provide stability; and it should actively encourage palliative care to be given in the community, so people can stay at home or in a care home if they want.

But for it to be a viable option, it also has to be affordable.  Fair to the taxpayer, if you will.  Particularly when you look at the financial situation at the moment.

I have welcomed the Review’s final report, which has made a really positive start at looking at what is an incredibly complex issue.

Data

It came up with a range of significant proposals.  They now need detailed consideration, and, crucially, they need to be backed up with new information and data.  One key conclusion of the review is that “There is a stunning lack of good data surrounding costs for palliative care in England.”

For example, at present there is no data on individual patients receiving specialist palliative care.  Work is underway to change that, but it may well need to be extended to include the points recommended by the Palliative Care Funding Review.

The pilots, the next stage in taking this forward, will collect a range of data covering different age groups, different diagnoses, and different settings.

And they will be designed to consider questions that are central to the development of per-patient funding.

Questions like:

– Can clinicians classify patients easily and reliably?

– What care did patients receive during each phase of their illness?

– And what will their treatment cost?

I’m under no illusions about the scale of that task.  But at the same time, I know it’s a hugely positive step.  We’re going to work out how it might best be carried out, and then there will be extensive engagement through piloting.

A key outcome of the pilots will be to develop the building blocks – the currencies, as the jargon has it – that we’ll need to construct a tariff – a set of NHS prices for services delivered.

A national tariff will provide a clear and transparent method of reimbursing service providers.  The introduction of a tariff for most acute services has helped to shift discussions between providers and commissioners onto quality and away from price.

Linking payment to better patient outcomes drives improved quality, encourages efficiency and supports patient choice.

I’ve been hugely encouraged by the numbers of organisations already offering to help with the pilots.  Already, over 25 had said they want to be involved, and we’re always on the lookout for more.

Getting per-patient funding off the page and into practice is not going to be easy.

But without losing sight of the practicalities, we should all recognise the potential benefits.

We have an opportunity to give people the best care at the end of their lives.  We need to push forward with reform and I want a new system in place by 2015.  Moving forward faster than the review proposed.

We also want to get people’s opinions about what our priorities should be when we reform the care and support system.

On 15 September, the Government launched Caring For Our Future: Shared Ambitions For Care And Support, an engagement with those who use care and support services, carers, local councils, care providers, and the voluntary sector about the priorities for improving care and support.

Both the National Council for Palliative Care and the National End of Life Care Programme will organise events where you can give your views on how to improve end of life care through social care reform.

As part of this, we would also value views on the Palliative Care Funding Review.  In particular, we’d like to be able to explore in more detail its recommendations on free health and social care at the end of life.

Conclusion

As progress is made, we need to move forward together.

Today we published the Third Annual Report on the End of Life Care Strategy, which provides more information on work and developments over the past year.

It’s available on the Department’s website and it’s a good and encouraging read.

Of course, there is much more to be done.  But if patients are to receive the care they deserve at the end of their lives, then hospices are going to be central in delivering improved care, providing an expanding range of vital, high quality, compassionate services in the community.

I look forward to continuing our partnership with all of you in the hospice movement.

Thank you.