Oral - Palliative Care

Presiding Officer, I am grateful for this chance to update Members on developments in palliative and end-of-life care. I know that this is an important topic in which Members take a close interest. We held a useful debate on the matter here in June, when I promised to keep the Assembly informed of progress.

Palliative and end-of-life care have received considerable attention in recent years. Since 2007, a policy review led by Viv Sugar, chair of the Consumer Focus Wales, has helped the Assembly Government to establish the core elements of a palliative care service for adults and children and a means by which the service could demonstrate quality. Thereafter, a palliative care implementation board was established, under the leadership of Baroness Finlay, to ensure that the recommendations of the Sugar report are being implemented, in order to provide fairer access to high-quality palliative and end-of-life care across Wales.

Since that time, significant improvements in service provision have been seen, with all of the recommendations of the Sugar report either completed or at various stages of implementation, some ahead of the timescales specified within the report. These include consultant-led services across Wales; the development of clinical nurse specialist seven-day working; the development of a core service funding formula to determine allocation of central palliative care funding; the establishment of a 24-hour advice service for both adult and paediatric services; and the further development of current information technology systems for adult palliative care and the establishment of an IT system for children’s palliative care. I am pleased to report that Viv Sugar has agreed to undertake an informal review of the work of the palliative care implementation board in order to provide assurance that the direction of travel set by it is in line with the requirements of her original report.

As Members know the Assembly Government has provided central recurrent funding for palliative and end-of-life care. In 2009-10, this funding has increased to £4 million and has been allocated in line with the palliative care implementation board’s recommendations for funding. Three year funding agreements are in place with 15 of the 18 hospices, receiving a share of the £2 million recurrent palliative care funding. The implementation board is working with the remainder of the hospices to finalise their funding agreements. These agreements ensure that hospices are appropriately reimbursed for the clinical services that they provide on behalf of the NHS. A fundamental requirement is that their services are consultant-led, which is what the implementation board has sought to put in place. These consultants all now have contracts with the NHS, providing the quality assurance that we require.

While the funding agreements will be subject to review each year, they specify the minimum amount of funding that hospices will receive in future years. This allows hospices to plan their services in the knowledge that there will be dedicated recurrent funding for the clinical services that they provide. For those additional services that hospices wish to provide, they will be able to plan appropriately as part of their fundraising process.

In terms of the ‘One Wales’ funding of £2 million in 2009-10, a range of projects is being taken forward at individual-local-health-board and the all-Wales level to address the service gaps and to ensure fairer access to palliative and end-of-life care. These include support for seven-day clinical nurse specialists, training for paediatric specialist palliative care nurses, IT equipment to support the palliative care information and data requirements, sessions for allied health professionals, the evaluation of services by patients, a child bereavement scoping assessment, the establishment of a patient-held card, and the education of primary care staff including those in nursing homes. I am convinced that the significant amount of work already undertaken, as well as the ongoing work of the implementation board as it works closely with the NHS and hospices, will improve the quality and provision of palliative and end-of-life care across Wales.

Baroness Finlay and members of the palliative care implementation board visited all hospice providers in Wales during January 2009. Those visits provided an opportunity to speak to hospice teams and trustees, and to see service provision at first hand. That enabled the board to understand how quality services can be delivered to meet the needs of health communities that have a range of logistical issues to overcome. Following that, all hospice providers were offered the opportunity to meet with the baroness and other board members to discuss the funding agreements being put in place. During July 2009, Baroness Finlay undertook a second round of service visits in mid and south Wales and, this time, also included all statutory sector palliative care providers, including a selection of GP practices in Powys and voluntary hospices in England that provide services for Welsh residents. A similar visit to north Wales is currently being planned and will be completed by December 2009.

This will be the most comprehensive engagement with palliative care providers to date and it provides an invaluable understanding of how future services should be shaped. It informs the allocation of central palliative care funding to meet the needs of those requiring palliative and end-of-life care throughout Wales. My statement today provides a flavour of the continued work of the implementation board. Many of you may wish to have more details of what that work entails and how it will benefit your constituents. To that end, I have asked Baroness Finlay, on behalf of the palliative care implementation board, to undertake an open briefing session for all Members. This has been arranged for 13 October and I will be writing to Members with the details shortly.