Covid-19: Charitably Funded Hospices

Lord Howard of Lympne Excerpts

Wednesday 28th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the noble Lord is right that 70% of hospices are funded through charitable income with only 30% coming from CCGs. That is why we put in more than £150 million during the first wave and why we have a discussion about future support on the agenda. I reiterate absolutely the points that he made about the contribution of hospices during the first wave and the innovation that many of them brought to the response. I have before me tributes paid to the Mary Ann Evans Hospice in Warwickshire and the St Elizabeth Hospice in Ipswich, which were case studies in bringing in fresh thinking and changes to work practices to support people during the Covid first wave.

[Lord Howard of Lympne (Con) [V]]

My Lords, I declare my former interest as the chair of Hospice UK. Does my noble friend the Minister agree that, even in the crude terms of value for money, because of its extraordinary ability to attract a huge amount of volunteer effort, the hospice movement is almost certainly the most effective sector in our entire healthcare system? Can he assure me that the Government will give full weight to that factor when they consider the urgent need of hospices for further support during this crisis?

[Lord Bethell (Con)]

I completely endorse my noble friend’s comments. Hospices are often the hubs for huge community efforts to raise money and to create volunteer support for those who are at the end of their lives. They are hugely valued in the healthcare system. The challenge that they face at the moment is recognised and we will meet our responsibilities to them.

Hospices: Impact of NHS Pay Increases

Lord Howard of Lympne Excerpts

Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord is quite right; the Agenda for Change pay deal obviously applies to NHS staff who are on the Agenda for Change contract. The deal was agreed and happily has been approved by the unions, precisely to reward NHS staff for the fantastic work they do, and to make sure that we can recruit and retain more. Clearly, as we go forward, for non-NHS providers, be they in social care or hospices, it is important that we do not cannibalise one workforce for the other. That is why we will look carefully at the conclusion of the pay review body’s report with regard to hospices.

[Lord Howard of Lympne (Con)]

My Lords, I declare my interest as chair of Hospice UK. Would my noble friend agree that the greater the extent to which hospices can discharge their functions, the greater the extent to which the pressure on NHS beds will be relieved? Is that not therefore a compelling reason for ensuring that a pay increase is met with regard to hospices?

Access to Palliative Care Bill [HL]

Lord Howard of Lympne Excerpts

Friday 23rd October 2015 Lords Chamber

[Lord Howard of Lympne (Con)]

My Lords, I declare my interest as chairman of Hospice UK, the umbrella organisation for all hospices in the United Kingdom.

The concept of a good death has, in recent years, been increasingly recognised, and recognised as something that should be available to all. This Bill will go some way towards achieving that objective in this country, and I add my thanks and congratulations to the noble Baroness, Lady Finlay of Llandaff, for bringing this forward.

The Economist Intelligence Unit survey, which placed the United Kingdom top of the 80 countries surveyed in terms of the quality of their palliative care provision, has already been referred to. It is worth noting that the previous survey carried out by the Economist Intelligence Unit, in 2010, five years ago, reached a similar conclusion—the United Kingdom was again rated as the best in the world. I hope that I can be forgiven for emphasising the contribution of hospices to that achievement, and I am grateful to those who have already spoken in the debate who have expressed their appreciation of what the hospice movement does. It is a movement, of course, that started in this country. People still come from all over the world to see how we do it. I am proud to stand here and say, without any fear of contradiction, that the care provided by hospices, both in hospices and for people who die at home looked after by hospices, is second to none. The recent ONS survey found that 85% of bereaved people whose relatives had died in a hospice or at home looked after by a hospice thought that the care they had received was “excellent” or “good”. The Care Quality Commission has rated more than 90% of hospices “good” or “outstanding”. In yesterday’s debate, the Minister referred to the observation of the chief inspector of the CQC, who said:

“I know from what my inspectors are finding”,

that,

“hospices provide amazing care and support for people at the end of their lives”.

To take up a point made by the noble Lord, Lord Crisp, hospices do not deliver professionalised care. Of course many of the people who work in hospices are professionals, but there are very many volunteers too. To illustrate the difference between hospices and hospitals, I tell the story of a man who was very reluctant to go into a hospice. Eventually, he was persuaded to by his family. When he got there, the first thing they said to him was, “Is there anything you really want?”. He said, “The one thing I would really like is a bowl of porridge”, and, within half an hour, he was provided with a bowl of porridge. With the best will in the world, no one can imagine that happening in any of our hospitals.

The ratings for hospices, which I have mentioned, are far superior to those that hospitals receive. So I repeat today my call to the Minister for help in reducing the number of people who die in hospital. Most people do not want to die in hospital—they do not need to die in hospital and they should not have to die in hospital. It would actually save the NHS money if these people were not in hospital but were transferred instead to hospice care. Many hospices work closely with the NHS trusts in their areas to achieve this. One example was quoted by my noble friend Lord Farmer in yesterday’s debate. We want to evaluate the best way of doing this so that we can put forward to the Government the most effective arrangements for taking the 50,000 people a year who currently die in hospital out of hospital and into hospices or hospice care at home. To carry out that proper evaluation would cost what in this context is the paltry sum of £250,000. I repeat my call to the Minister to make that available.

I particularly welcome the provisions in the Bill which would place a duty on clinical commissioning groups in relation to the funding of palliative care. Three-quarters of hospices have had their NHS funding, which on average provides only a third of their costs, either cut or frozen in 2014-15. The record of hospices in meeting the shortfall from charitable sources is breathtaking. Collectively, 200 charitable hospices in the UK raise £1.9 million a day from local charitable sources. It is an extraordinary achievement, but if that shortfall is increased, as it has been, it will be increasingly difficult for hospices to continue their successful work.

Finally, I draw attention to the briefing that we have received—I hope, in time—from Together for Short Lives, which looks after babies, children and young people with life-threatening conditions and is affiliated to Hospice UK. It has asked for some amendments to the Bill which no doubt we will return to and which I hope will receive sympathetic consideration when we get to Committee stage.

The Economist Intelligence Unit survey quoted the words of the national director for hospice care at Hospice UK. She said:

“The things that make a better death are so simple … It’s basic knowledge about good pain control and conversations with people about the things that matter”.

This Bill will help bring about a better death for many people. On behalf of the hospice movement, I whole- heartedly welcome it.

Health: Palliative Care

Lord Howard of Lympne Excerpts

Tuesday 23rd June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord describes a truly tragic situation and I am very sorry for him and his family that this happened. I am afraid that variation is at the root of this. There are many parts of the country where good local care is delivered. The noble Lord’s story illustrates the fact that it is not just where people die but how they die that matters. It is clearly preferable that people should die in their own home with their loved ones, surrounded by the love that the noble Lord described, but symptom control, pain relief and everything that goes with palliative care are just as important. Indeed, most of the stories in the ombudsman’s report are about a lack of symptom control for people dying in pain. That can happen at home, as in his father-in-law’s case, but it can equally happen in hospitals. NHS England is reviewing this whole area and will come to some final views towards the end of this year, when I might report back to the House.

[Lord Howard of Lympne (Con)]

My Lords, I declare an interest as chairman of Hospice UK. Is the crux of this issue not the fact that most people do not want or need to die in hospital, and that not enough help is given to allow and help those people who do not need to die in hospital to leave hospital and get the palliative care which can be provided in hospices or elsewhere? Is my noble friend the Minister aware that Hospice UK has put forward a plan to the Government which would enable 50,000 people a year to leave hospital before they die so that they can get the proper palliative care that they need? That would save the Government money, and all we need is a modest sum to carry out an evaluation exercise to see what is the best way of achieving this eminently desirable objective. Will he go back to the department and urge his colleagues to make this modest sum available?

[Lord Prior of Brampton]

I thank my noble friend for that question. Perhaps I could suggest that he and I meet outside this Chamber, along with some colleagues from NHS England, to discuss his proposal in more detail.

Health: Deprivation of Liberty Safeguards

Lord Howard of Lympne Excerpts

Monday 16th March 2015 Lords Chamber

[Lord Howard of Lympne (Con)]

My Lords, I support the noble Baroness, Lady Finlay, and declare my interest as the chair of Hospice UK.

In view of the limited time available to me, I shall bite my tongue hard and resist the temptation to comment on what the noble and learned Lord, Lord Hope, referred to as the juridical aspect of the problem that faces us and concentrate on what I think will be of most help to my noble friend the Minister when he considers the need for urgent action to deal with the issues to which the decision of the Supreme Court, and the legislation which lay behind it, have given rise. I entirely agree with what the noble and learned Lord, Lord Hope, said in that regard. Therefore, I shall concentrate on specific examples of difficulties which hospices have faced.

The first concerns a hospice that instigated an urgent deprivation of liberty application and applied for a standard authorisation. The urgent deprivation of liberty was put in place for seven days. On the sixth day, the social services DoLS team had made no contact, so the hospice contacted it for advice on how to proceed as the urgent deprivation was due to expire the next day. The team asked the hospice to implement an extension to the urgent deprivation for a further seven days, as they had a backlog of referrals and no best interest assessors available, which the hospice did. Six days later, still nobody had been to assess the patient, so the hospice contacted the DoLS team again and asked what it should do. The team confirmed they had a backlog of applications and would not be able to assess the patient prior to the urgent deprivation of liberty expiring, and explained that there was nothing else the hospice could do as it had done all that it was legally required to do. The hospice raised its concerns that this meant that it would be depriving a patient of their liberty without the appropriate authorisation and confirmed that it would be contacting the Care Quality Commission. The DoLS team agreed that the situation was not acceptable, but confirmed that there was still nothing it could do.

I give another example from another hospice which had a patient transferred from its local hospital who had metastatic cancer and had suffered a stroke. He was not responding or understanding when he was admitted, but did not appear to be in the last days of life. An urgent application and standard application for DoLS were made. An assessor came to see him from the local authority who seemed at a complete loss as to why she was there and what she was supposed to do. The patient died three days later.

A hospice has provided a series of examples of the kind of situations with which it is confronted. The first example is:

“An actively dying hospice in-patient placed on a Palliative Care Plan, who has lost capacity/consciousness, and is receiving sedative medication to manage symptoms of their terminal phase”.

The second example is:

“The delirious hospice in-patient who is receiving medication or support to manage this state”.

The third is:

“The wandering cognitively impaired patient at risk of falls (in an in-patient or day care setting) who has a nurse call system that activates when the patient starts wandering in order to alert nursing staff to return the patient to their area of care”.

These are all very specific examples of the problems that hospices now face on a daily basis as a result of the situation that has arisen.

Reference was made in an earlier debate in your Lordships’ House today to the unintended consequences of legislation. I submit that it is impossible to come across a better or, indeed, worse example of the unintended consequences of legislation than the situation in which we find ourselves. I suspect that it can ultimately be resolved only by fresh legislation; but at least, when one contemplates the prospects for such legislation, it ought to be free of party political difference, so there ought to be not a great deal of difficulty in building a consensus. I am not sure that it is necessary—the noble and learned Lord, Lord Hope, suggested that it is not necessary—to await the Law Commission’s recommendations. Perhaps it can be asked to expedite its work, but the problem is urgent and I urge the Minister to take urgent action to resolve it.

National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013

Lord Howard of Lympne Excerpts

Wednesday 24th April 2013 Lords Chamber

[Lord Turnberg]

I am delighted to be able to follow the noble Lord, Lord Owen. He puts his finger on it. It is hard not to think that we are coming up against some rather polarised views lying behind this debate about how far we can go with the use of private providers in the NHS. On the one hand there are those who believe that private providers will drive up quality and efficiency by the competition that they introduce, and on the other those who see private providers in it for the profit that they will make from the NHS.

Clearly I cannot go into this tonight but I want to say two things. First, we have an NHS for which everyone pays through tax for the common good and which distributes resources to those who need it so that society as a whole can benefit. By opening up the NHS to private companies we are increasingly using that taxed income to provide for, among other things, their profits. When we go down that route we have to be sure that we are getting something that is worth while for society and that we have the balance right. Secondly, I have the feeling that instead of the welfare state, to which we are all signed up, being regarded for the common good, it seems to be increasingly regarded, in some quarters at least, as a cost to society and an onerous subordinate to economic policy. This is not a debate for today, although we need to have that sort of debate. It does, however, colour my views about this contentious set of regulations.

According to the wording of Regulation 5, as we have heard, commissioners are legally obliged to go out to tender unless they are satisfied that services can be provided only by a single provider. Despite the reassurances by the Minister and his colleagues, the wording here is so unambiguous that a number of distinguished lawyers tell us that there is no way out of having to tender for everything else. The fact that the Government’s lawyers are able to come up with a different conclusion, as I am sure the Minister will tell us, suggests at least that there is room for confusion and for something that would have to be tested in the court, and no doubt the courts will pray in aid the EU competition law.

I am most concerned about the problems that this tendering process will cause, as are the many organisations that have written to us. For example, if we look at where the most severe difficulties lie in the health service and try to think what tendering from a variety of providers might do to resolve them, we come up against a major barrier. It is in the care of the elderly, of those with long-term multiple illnesses and of those with mental illnesses that we are clearly failing in the NHS. Yet those are the services that private providers as well as insurers are least likely to want to take on. They are much more interested in aspects of care that come in neat packages—short-term items such as cold-planned surgery or investigation that are readily costed and charged for. But these are the sorts of care that by and large the NHS is pretty good at. It is here where the cherries lie and which private providers will try to pick, leaving longer-term care for the less glamorous, chronically ill elderly and the mentally ill to the NHS. It is not a future that many in the NHS are likely to welcome.

This says nothing about the administrative costs of this tendering and contracting, which will not be trivial. It says nothing about the barriers that it will throw up to the integration of care across several disciplines, which is already quite difficult to achieve. Will multiple providers make it easier or more difficult for integration? I cannot see it.

For these and the many other reasons that other noble Lords have raised, these regulations are a distraction designed to maximise private sector involvement and leave far too little room for commissioners to be sensible and flexible in their approach. They should be removed entirely, and if that is not possible they should be reworded to make it absolutely clear to commissioners and everyone else that what Ministers are telling us is also written clearly on the tin.

[Lord Howard of Lympne]

My Lords, I declare my interest as chair of Help the Hospices, and in a moment or two I shall put the remarks of the noble Lord, Lord Owen, in context. However, I shall begin by correcting a report that appeared in the Financial Times last week, which said that Help the Hospices and other charities regard these regulations as a fresh attempt to privatise the National Health Service. I cannot speak for the other organisations, but that is not the way that we at Help the Hospices look upon these regulations.

The original regulations gave rise to considerable concerns, and I pay tribute to the Government for being prepared to listen, to think again and to revise the regulations. The revised regulations go some considerable way towards allaying those concerns. They do not go the whole way, and the noble Lord, Lord Owen, identified some of the concerns that remain, but we believe that those concerns can be met not by annulling these regulations as the noble Lord, Lord Hunt, seeks to do this evening, but by ensuring that the guidance which the Government intend to provide removes any ambiguity and removes the dangers to which the noble Lord, Lord Owen, referred.

The noble Lord and I have long experience in different contexts of the difficulty of covering every contingency in the wording of regulations, of getting the wording of regulations absolutely right and avoiding any degree of ambiguity. The previous speaker, the noble Lord, Lord Turnberg, recognised that the Government’s legal advice was such that the fears that have been expressed simply would not arise if these regulations were properly interpreted. Monitor, which is to give the guidance that we await on the way in which these regulations are to be interpreted and implemented, has a very important role in that respect and will consult before issuing that guidance. We at Help the Hospices intend to take full advantage of the opportunity which that consultation affords to ensure that Monitor gets the guidance right, removes any ambiguity and ensures that any lingering concerns that we may have do not turn into reality.

It is true that the changes that are taking place in the National Health Service in the way in which we provide health services in this country pose a certain danger to voluntary organisations such as the hospice movement, but not because the Government intend to do any damage to the hospice movement, as was made clear to me and some of my colleagues from Help the Hospices when we had a meeting with the Secretary of State very recently. The danger lies in the law of unintended consequences, so it is right that we should be vigilant to ensure that those unintended consequences do not damage hospices that do such wonderful work and provide such remarkable care to those who are near the end of their life and benefit from the care that hospices provide. I am satisfied that that danger in this context can be averted by sensible and proper guidance from Monitor, and I hope that at the end of this debate the Minister will give the House some assurances about the nature of that guidance which will put to rest any lingering concerns that might exist.

[Lord Walton of Detchant]

My Lords, I shall speak briefly because I am faced with a major dilemma, not least because of the high regard in which I hold the two principal protagonists speaking on opposite sides of this debate. In this bout of unarmed combat, we have in the red corner the noble Lord, Lord Hunt of King’s Heath, a former chief executive of the National Association of Health Authorities and more recently director of a foundation trust, whose contributions to health matters in this House have been in every way outstanding. In the other corner we have the noble Earl, Lord Howe, who, without a scientific background or training, has demonstrated in opposition and in government a most extraordinary breadth of knowledge, interest and capability, invariably tackling issues relevant to health with courtesy, knowledge and authority.

I have received a veritable torrent of correspondence from organisations and individuals, many of whom I respect and know personally. These organisations include at least three royal colleges and the BMA, of which I have the honour to be a past president. Almost all of these letters have suggested that these regulations would result in compelling commissioners to put all health service activity out to tender—in other words, they would result, as has been suggested, in the ultimate privatisation of the entire National Health Service. Having studied these regulations with great care, I find it exceptionally difficult to see how they could conceivably come to that conclusion.

I am a firm believer in and supporter of the NHS, in which I am proud to have spent the greater part of my professional life. If I felt that that case had been made and if I felt that the regulations would result in privatisation of the NHS, I would unhesitatingly vote for their annulment. But having studied the regulations, I do not believe that that is the case. I have never made any secret of the fact that I believe that a component of contribution by the private sector in the NHS, properly considered, controlled and approved by Monitor, can make a very important contribution to healthcare if it is in the interest of patients. I am satisfied from the debates we had during the passage of the Health and Social Care Act that there is an obligation on any private provider contributing to NHS services to maintain, approve and provide all the facilities that the NHS already provides for education and training of healthcare professionals and contributing to research. I am satisfied that that remains the case. Paragraph 7.5 of the Explanatory Memorandum to these regulations says:

“Regulation 5 provides for commissioners to award a new contract without a competition where there is only one capable provider. There has been no change in policy from the requirements of the Principles and Rules for Cooperation and Competition and the supporting procurement guidance”,

guidance which was established under the previous Labour Government. I find that immensely reassuring. Paragraph 7.6 says:

“The 2012 Act has established Monitor as an independent regulator … with a duty to protect and promote the interests of people who use health care services. Part 3 of the Regulations provides for Monitor to investigate potential breaches of the requirements and to take action to ensure that patients’ interests are protected”.

I could say very much more but I am satisfied, after the most earnest and careful consideration, that these regulations do not produce the prospect of privatisation of the NHS.

I am involved with many medical charities and I learn also that the role of charities can be enhanced. They can under these regulations make more contributions than they already do to the work of the NHS. For these reasons I strongly support the regulations.

NHS: Death at Home

Lord Howard of Lympne Excerpts

Thursday 8th November 2012 Lords Chamber

[Lord Howard of Lympne]

My Lords, I begin by declaring my interest as chairman of Help the Hospices, the national charity for the hospice movement, supporting more than 240 hospices across the United Kingdom. I congratulate the noble Lord, Lord Warner, on securing this debate. I find myself agreeing with much of what he says and, as best I can, I shall endeavour to avoid repetition.

Of course, we all bring to our consideration of this question our personal experiences. My father died more than 50 years ago at home, looked after by us his family and by the most wonderful of nuns from the nearby convent, of whom I have never been able to speak too highly. My mother died much more recently at the age of 98 in a care home in which she had spent the last few weeks of her life. They looked after her very well, assisted in the management of her pain by help from a nearby hospice. My mother-in-law died in hospital. I have no doubt at all that the best death, if one can use that phrase—and I believe one can—was that of my father; and the worst death was that of my mother-in-law. There is no doubt at all that far too many people die in hospital. That is the central truth of this debate. The central fact of this debate is that 63% of people say they would like to die at home and a far smaller proportion actually does so. This is what needs to change and I hope that the Minister will give us hope that the Government intend to help bring about this change.

In the time that remains, I want to say some words about the role of hospices in caring for people as they approach the end of their life. I referred in my declaration of interest at the outset of these remarks that there are a number of hospices in the UK. In your Lordships’ House, I need hardly pay tribute to the extraordinary work which the hospice movement carries out. I regard it as an enormous privilege to be associated with it in the way I am. However, there is a misconception about the role of hospices which is highly relevant to this debate and which I want to try to correct. I suspect that when they think about hospice care, most people—certainly very many—think about the care provided to in-patients in our hospices. Yet most hospice care is not so provided. Fully 70% of hospice care is provided for people living in their own homes. Indeed, “hospice at home”, as it has become known, is the fastest growing part of hospice care. So if, as we all hope, more people are going to die at home, the role of hospice care in looking after them is likely to grow significantly. That brings me to my last point. Hospices collectively have to raise £1.5 million a day from charitable sources if they are to keep going. On average, only about a third of their costs are met by the state.

I am sure that the Government do not want to do anything to damage that extraordinary movement, which is the subject of so much admiration both here and abroad and which has been held up by the Prime Minister himself as a superb example of the big society, but the new arrangements for the National Health Service have—I am sure, accidentally—introduced a considerable and unwelcome element of uncertainty into the continuation of even that very modest level of government support. The absence of end-of-life care from the draft NHS mandate, to which the noble Lord, Lord Warner, referred, has, I fear, increased that uncertainty and aroused a good deal of concern.

I wrote to the Secretary of State some time ago to ask for a meeting to discuss all that and, sadly, it has not yet been possible to arrange such a meeting. I do not expect the Minister in his reply to offer me a date, but I hope that he will be able to say something about the future of public funding for hospices that will provide a degree of comfort to those involved in that wonderful work and will enable them to continue to play a growing role in helping those people who wish to die at home to do so.

Care and Support

Lord Howard of Lympne Excerpts

Wednesday 11th July 2012 Lords Chamber

[Earl Howe]

My Lords, my provisional understanding —and I stress that—is that pre-legislative scrutiny will begin in the autumn, probably in November. Between now and then, plans will be put in place to decide the composition of the pre-legislative scrutiny committee so that the process will conclude by the end of this Session of Parliament. In principle, there is no reason why enabling clauses should not be inserted into the legislation. As I have emphasised before, it would be preferable if they were clauses on which we could all agree.

[Lord Howard of Lympne]

My Lords, I declare an interest as chairman of Help the Hospices. I welcome both the extra money that the Government are making available for the palliative care pilot projects and the Government’s acceptance in principle that end of life care should be free at the point of delivery. Can my noble friend give the House some indication of the timetable by which this very desirable objective might be achieved?

[Earl Howe]

My Lords, the short answer to my noble friend is that we need to look in detail at the funding implications. At this stage all I can say is that our intent is to introduce this at the earliest opportunity. However, I am afraid I have not been given the green light to give him chapter and verse at this stage. As soon as I am able to do that, I will gladly do so.

Hospices and Palliative Care Services

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Wednesday 15th December 2010 Lords Chamber

[Lord Howard of Lympne]

My Lords, it is a pleasure to follow the noble Baroness, Lady Masham, and I join in the congratulations to my noble friend Lord Bridgeman on securing the debate. I declare an interest as chairman of Help the Hospices.

Your Lordships have spoken eloquently and in moving terms of the quite extraordinary work that is done in our hospices. It is true, as my noble friend Lord Bridgeman said, that this is an area of care where we are recognised as providing the best in the world. A number of noble Lords have pointed out that the hospice movement is an outstanding example of the big society. I am pleased to place on record that the Prime Minister has acknowledged that there is no better example of the big society than the hospice movement. I feel immensely privileged to hold the position that I do—although I have held it for only a few weeks—and to be able to contribute in whatever small way I can to this outstanding movement. I described it in the debate of the noble Baroness, Lady Finlay, as the jewel in the crown of our healthcare system, and I believe that to be true.

In the short time available I wish to make three points, although that may prove to be a little ambitious. First, as a number of your Lordships have pointed out, although the debate is concerned with the portion of funding that goes to hospices from the Government—we are asking the Minister for some indication of that today—it is true and will remain true that the greater part of the funding for hospices will come from local and charitable sources. It is therefore at least as important for the future of the hospice movement that everything is done to encourage charitable giving and volunteering. As we have heard—I acknowledge the fact—an enormous amount of the work that is done in hospices is carried out by volunteers.

Secondly, I draw attention to the fact that a number of new providers are entering the field of palliative care. This is a healthy development which may well increase the availability of palliative care and support at the end of life. I hope that the new providers will recognise that local hospices can provide a source of experience, expertise and knowledge for the public, private and voluntary sectors in improving care for people affected by terminal illness.

Lastly, as local councils take on a wider responsibility for health and social care within their communities, it is very important that they should recognise that good-quality palliative care can reduce pressure on expensive acute services and deliver personalised care for people in their own homes. It is essential that the palliative care funding review and the coalition Government’s review of social care funding being led by Andrew Dilnot should work together to develop a comprehensive funding settlement that reflects the nature of the care and support for people affected by terminal illness. I hope that the Minister will be able to respond positively to these points and that the Government will take them on board when they come to implementing the review.