Opinion: Hospices are being taken for a ride by the NHS

A few weeks ago, the Health Service Journal (17 May) reported that hospices, almost all in the voluntary sector, are to be charged the same fees for regulation and inspection by the Healthcare Commission as NHS or private-sector providers.

Help the Hospices argues this is unfair, given that hospices cannot recover the costs, whereas NHS organisations do not have to pay the regulation fees out of their budgets and private-sector providers can pass on the full cost in their invoicing.

The fault does not really lie with the commission. It has to recover a proportion of its costs, partly from those it regulates. This issue is our old friend, full cost recovery.

A fair amount of hospice work is undertaken for local primary care trusts by block contract. This can lead to a reluctance to admit patients until they are really very ill - because the block contract does not pay a daily rate - or to serious worries when a hospice has had to admit far more patients from a PCT than the original block contract estimated. Indeed, some hospices have argued privately that a system in which they invoice the PCT for the number of days a patient stays might be preferable. It all suggests some of the block contracts are poorly negotiated, mean or simply fail to recognise the considerable successes of hospices.

So hospices take on costs they cannot easily afford, including regulation. Indeed, 60 per cent of hospices have seen a decrease in funding contributions from the NHS in the past year, and only 20 per cent have seen an increase, despite pressure to get hospices into a position where they can admit people suffering from conditions other than cancer.

The Government promised an extra £50m for hospices, mainly for improvements to their buildings, but many are seeing even that funding being eroded - one unit has had its funding cut by £400,000, and the National Council for Palliative Care reports that 35 per cent of respondents to a survey it ran have experienced a decrease in resources in the past year.

So providing services for the NHS means the voluntary sector is out of pocket. That is outrageous, but even this pales into insignificance beside the general lack of funding, especially when it is promised or hospices have to go on providing services while primary care trusts are too busy reorganising to tell the hospices what the following year's funding settlement is to be. There is no good reason why contracts could not be drawn up with at least three years to run, nor why government should not issue the strongest of guidance to the NHS. This approach causes chaos and resentment, and fits badly with a Government that wants to increase such services.

The figures show a gap of up to £200m between what hospices spend on NHS services and what the NHS actually pays for. It might be time for hospices to join the wider sector in demanding better financial systems and more certain funding.

- Julia Neuberger is a Liberal Democrat peer and chair of the Commission on the Future of Volunteering

And while we're on the subject ...

- The Healthcare Commission is the healthcare watchdog in England and Wales responsible for setting the fees in the independent healthcare sector. The Health Service Journal reported that hospices with charitable status are to be charged the same regulation fees as NHS or private-sector providers (17 May).

- Help the Hospices says the Healthcare Commission's decision is unfair because hospices will not be able to recover the cost of regulation fees that other sectors can. NHS organisations do not pay regulation fees out of their budgets, and private providers can invoice for full cost recovery.

- In 2002, Hazel Blears, then public health minister, unveiled the Government's plan to ensure delivery of an extra £50m a year for specialist palliative care services for people with life-threatening and terminal illnesses. She said there would be a central pot of money exclusively for palliative care for three years from 2003/04.

- The National Council for Palliative Care conducted a survey about the pressures on funding of specialist palliative care services for 2006/07. It found that, despite the Government's plan, about 60 per cent of hospices are experiencing real-term cuts in the value of their funding contributions from the NHS.

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