Written - Provision and funding of palliative care services in Wales

Background

Palliative care cuts across all specialities and forms a fundamental part of the total care for patients with long-term progressive or incurable conditions.  It can be provided in a range of settings including in hospital, at home, in a care home as well as in a hospice as an inpatient.  Local Health Boards are expected to assess the need for palliative care services of their local populations and, to plan, organise and deliver services to meet that need. In doing so, they will work closely with other agencies including those in the voluntary sector. The Assembly Government’s overarching policy for palliative care, A Strategic Direction for Palliative Care Services in Wales confirms that the flexibility and quality of services provided by the voluntary sector play a vital role in helping to meet patient need.  

£10 Million Non Recurrent Funding

In recognition of this valuable role which the voluntary sector plays in the provision of palliative care,the Welsh Assembly Government made £10m available non-recurrently over four years to support the development and enhancement of services provided by many of these organisations.  This non- recurrent funding was not designed to meet core running costs and these organisations were urged from the outset to work closely with Local Health Boards, through the Cancer Networks, to assess future service need and to establish sustainable funding arrangements.

Baseline Service Review

Palliative care services vary from one part of Wales to another and have developed in an ad hoc way, often responding to local demand and fund raising efforts.  In order to understand better how and where services are provided, the Assembly Government has commissioned a review of palliative care across Wales.  The purpose of the review is to:

• investigate and identify the total provision of palliative care in Wales, provided by the NHS, by private providers and by the voluntary sector.  
  
• identify what provision is required to meet patient need, respective gaps in that provision and how best they might be filled by the NHS, private and voluntary sectors.
  
• identify current and required total spending on palliative care in Wales by the NHS, private and voluntary sectors respectively.
  
• identify funding streams and whether they need to be better directed to meet patient need.
  
• identify specific action required and by whom, to deliver an integrated approach between all stakeholders (NHS, private and voluntary sectors) on the planning, organisation and delivery of palliative care

Following the review’s findings,  a report will be produced on service provision by the NHS, by private organisations and by the voluntary sector  for each of the three regional areas of North Wales, Mid and South West Wales and South East Wales, together with a list of recommendations for these regional areas.   The review covers both adult and children’s services.

£2 million recurrent revenue funding

As the £10 million funding programme comes to an end, the Welsh Assembly Government recognises the need for continued support for palliative care services. It is, therefore, making £2million available recurrently from 2007-08 for the voluntary sector.  In putting protected recurrent funding into the budget for the first time we recognise that those organisations providing high quality care to meet patient need will benefit significantly from the security of long-term sustainable funding arrangements.  This should not be taken to imply that the voluntary effort to raise funds should be wound down . Nor should it replace existing Local Health Board funding for hospices.  Local Health Boards should  continue to work, through the Regional Cancer Networks, with the voluntary sector to put improved sustainable commissioning arrangements in place.

The outcome of the review, due at the end of April, will help inform the allocation of the £2 million.  This allocation  process, which will be carried out as quickly as possible, will be designed to ensure that this funding is targeted at high quality palliative care services that are needed to meet identified patient need.