Compact in action

Research on Compact implementation between hospices and PCTs finds too much depends on personal relationships.

Hospices. Picture courtesy of Help the Hospices
Hospices. Picture courtesy of Help the Hospices

The Commission for the Compact is commissioning research during this financial year into how well the Compact is being implemented. The first tranche, which cost £21,000 and was published last month, focuses on primary care trusts and hospices.

Hospices derive about one-third of their income from PCTs, which have been widely criticised anecdotally for failing to take the Compact seriously. So the researchers looked at 10 case studies involving local hospices and their PCT funders to see if the criticism was fair, and how the Compact could be used to improve the relationships.

The report, Positive Engagement, Future Practice: Learning for End of Life Care, reveals that the strength of hospice-PCT relationships often depends on personal relationships between staff. It finds good Compact awareness among senior PCT employees, but adds: "PCT staff responsible for direct commissioning generally had little or no knowledge of Compact principles and codes."

The report adds that Compact training is "often not in evidence", and there are concerns that the development of a palliative care marketplace could jeopardise funding. But Ruth Fennemore, policy adviser at the commission, says the overall picture is "not as bad as expected" and that most people felt there was a role for the Compact in resolving problems and improving local relationships.

Sir Bert Massie, Commissioner for the Compact, hopes the findings will "help implement the Compact more effectively throughout the sector".

Jonathan Ellis, director of public policy and parliamentary affairs at Help the Hospices, the umbrella body for 183 hospices, says the emergence of a palliative care market means there is a greater need than ever for Compacts. "Historically, many hospices have not had three-year funding or they have been notified of their allocation of funding late in the financial year," he says. "Implementing the Compact would make a big difference."

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