Oral - Palliative Care

In October 2007, I established a dedicated palliative care planning group, led by Viv Sugar, chair of the Welsh Consumer Council, to advise me on a range of issues. The group met five times from November 2007 onwards. Its work is now complete and, earlier today, the group published and presented its report. I convey my thanks to this group for its time and the energy with which it has completed a complex task within a limited time. The report was made available to Assembly Members earlier today.

The key task undertaken by the group was to specify the elements of a core palliative care service, including end-of-life care for adults and children. Once established, the core service will be used to inform the funding decisions that the Welsh Assembly Government and local health boards make in this area.

The need for a core specification has become more urgent over recent times because the importance of palliative care services has gained recognition and also because provision on the ground has remained patchy across Wales. As Minister, it has been important for me to secure a shared understanding of what constitutes core palliative care services and to obtain a means for measuring the quality of those services.

Through the work of the planning group, organisations and individuals from the national health service and the private and voluntary sector have been consulted, and the resulting report provides me with an excellent basis on which to take things forward. The report covers adult and children's palliative care, it specifies combined short and medium-term recommendations, it raises concerns about the existing commissioning process and recommends a move to regional commissioning for adult care, with children's palliative care commissioned at an all-Wales level.

The group makes it clear that some of the issues raised with it lay outside its remit, or required deeper analysis than was possible within its time constraints. There are implementation issues that now flow from the report's recommendations, and those will need to be carefully addressed. Therefore, I have asked Baroness Finlay to lead on implementation, and she has agreed to do so. Her wealth of experience, not just in palliative care services, means that she is aware of how services are currently delivered and what gaps and barriers there are to good palliative care provision.

Members of the main group will include patient and carer input from Dafydd Wigley, nursing and GP input from Vivienne Cooper and Helen Herbert respectively, management experience from Paul Williams, chief executive of Abertawe Bro Morgannwg University NHS Trust, and expertise on service planning from one of the regional officers, Marion Andrews-Evans. These people will provide expertise to implement the wide range of recommendations contained in the report.

Baroness Finlay plans to set up sub-groups to take forward specific issues. Clinical data requirements will be led by Dr Andy Fowell, chair of the palliative care clinical advisory group, and the development of a model service level agreement will be taken forward by John Savage, the director of Nightingale House. More widely, establishing service level agreements is an early priority. I have already discussed this with the forum of voluntary hospices. Service level agreements will provide clarity, confirming those palliative care services that should fall to the NHS to fund and those that would be more appropriately funded via voluntary hospices fundraising. These service level agreements need to be established formally from 1 April 2009, ensuring financial stability for hospices and appropriately spent public funding.

Some hospices will find this process difficult, but every effort will be made to support them to ensure that they develop service level agreements and receive appropriate funding for palliative care services that comply with the core service definition, as set out in Viv Sugar's report.

I will not compromise on good quality palliative care and equity of access. If the voluntary sector cannot meet the requirements of a service level agreement, it will not receive central funding.

That brings me to the funding available this year and beyond. A sum of £2 million has been set aside for voluntary hospices. Baroness Finlay's implementation group will provide me with recommendations on the most appropriate use of this central funding for 2008-09 by mid September. Where we can and where timescales allow, I will be happy to establish long-term service level agreements with hospices earlier than 1 April 2009. That will not be quite what the voluntary hospices want to hear. They want a decision now on the allocation of the £2 million and, as Assembly Members, you will be approached by voluntary hospices on this issue.

As Minister for Health and Social Services, if I am to address the inequities of palliative care service provision, I must be sure that public funding is directed where it is needed most, meeting patient need in line with the National Institute for Clinical Excellence guidelines and clinical advice. That will mean that patients and their carers will receive the level of palliative and end-of-life care that they expect to receive, when and where they expect to receive it.

In line with our 'One Wales' commitment to provide more funding for palliative care, there is an additional £1 million in 2008-09, increasing to £2 million in 2009-10 and to £5 million by 2010-11. My intention is to invest that in the NHS and voluntary sector providers of palliative care, depending on where the service gaps exist. Again, recommendations for spend will come from Baroness Finlay's implementation group. The regional planning fora will be able to support her total funding recommendations. My overriding intention is to use the central funding to help meet the gaps in service. I am determined that the funding will be used for services that meet the definition of a core palliative care service, as set out in Viv's report. By sticking to these two fundamental principles, I believe that we can move towards ensuring that we deliver high-quality palliative care for everyone who needs it.