Peter Black and South Wales West Liberal Democrats

Palliative Care

Peter Black: As an opposition party, the Welsh Liberal Democrats have a responsibility to be fair and constructive, which means not just constantly bashing the Government for its mistakes but also welcoming moves taken in the right direction. I regularly have to stand here and tell the Government what I think it is doing wrong, and so it is refreshing to say that, in relation to hospices, we think that the Government seems to be heading in the right direction. It is for that reason that we will be supporting the Government's amendment to the motion.

Those working in the hospice sector to whom I and my office have spoken are happy with the direction that the Government is taking. The extra funding in the budget has been warmly received. It is true that some hospices could still do with further funding, but that will always be the case. There is little doubt that this is a step forward, even if further steps may be required.

The sector is keen to see stability. The extra money this year has been welcomed, but no-one wants to have a yearly debate with the Government over how much money it will be getting, particularly when the finances of every sector are under pressure. The Minister needs to look at taking forward as many of the recommendations of the Sugar report as possible and to work as closely as possible with Baroness Finlay and the implementation board.

A great number of the Sugar report's recommendations are to do with the make-up of multidisciplinary teams, ensuring that enough experts are available to deal with the often complex conditions involved in palliative care. That is particularly true of paediatric palliative care, where conditions may be long term and complex. I would be grateful, therefore, if the Minister could confirm what has been achieved so far in taking forward the recommendations on ensuring access to appropriate multidisciplinary teams and on workforce planning, to ensure that specialists are available and will continue to be available for all those who require them. That would include the target of having specialist nurses available 24 hours a day, seven days a week.

It was envisaged that that target would be hit by March 2009. I have been told that almost nowhere has hit that target and it is pretty much ignored by both the charitable and statutory sectors. Minister, when do you think that target will be hit and how much progress is being made? Is it the most appropriate way of meeting the needs of patients, or is it more realistic and effective to instead have the cover of an on-call consultant?

Specialist care is vital for patients, particularly those with complex chronic conditions. This is why having access to a consultant is important. There remain some issues over the training and practices in the charity sector, and there is an apparent overuse of telephone advice, which is far riskier for the patient than being assessed in person. Access to the appropriate specialists is the only way of ensuring that the needs of patients are met and that they receive the most appropriate treatment for them.

The Sugar report is clear that no-one should have to go without care because of where they live. Someone should not expect their care to be compromised because they live too far away from an NHS or independent provider of palliative care. You should be able to have access to the necessary specialist no matter what bed you are in, wherever you are in the country. That is particularly an issue in sparser rural areas, and that is where Hospice at Home is also important. Equity of care is the main issue here and the needs of the patient have to be the most important consideration in all this. I do not believe that anyone would argue with that assertion.

Among the most important parts of funding any service is being able to guarantee the stability of that funding. At present, like many independently provided services, hospices can find that their funding depends on short-term, one-year funding that does not provide any long-term certainty. The Sugar report recommends that service provision be long term, over at least a three-year cycle. That would allow providers to plan the services that they need better, give stability to staff and recruitment, and allow planning for the expansion of services. The report recommends that grant funding should not be used for the provision of core services, and that is the right direction. This is not limited to the hospice sector; it encompasses many other independent and voluntary organisations. Can the Minister confirm that this recommendation will be carried forward? When does she expect the majority of funding to be provided on a three-yearly basis?

Another issue with the current funding arrangement is that smaller charities struggle to compete against larger ones. There is still an element of competitiveness between different organisations, and that does not always serve the needs of their patients. Despite the increase in the budget for hospices, funding is still tight. There are many issues that we need to address as part of this. The direction of travel is the right one, but in responding to the debate, Minister, I hope that you can put our minds at rest that we will continue in this direction, and that we can adapt further recommendations from the Sugar report to deliver the service that I think we would all like to see in the near future.