Wherever you turn at present it’s hard to escape the government’s cuts programme. I confirmed that (again) when I rang my sister at the nursery-infant-and-parenting unit she has worked in for many years. Their budget has been slashed, redundancies loom. Should she volunteer to go, taking decades of experience with her?
This column will try to escape this week, although I don’t expect it to get far without being re-entangled. Since we last met here former health secretary Alan Milburn, as Blairite an NHS reformer as they come, has spoken out to question both the policy and the politics of the Lansley reforms. “I can’t understand how either can work,” he tells me. Ben Goldacre’s formidable Bad Science column has also blasted the health secretary’s evidence.
But even I can see that some criticisms are unfair or plain wrong. Such brickbats still represent a failure of communications: message is central to modern democratic politics, it’s not just spin and PR. David Cameron has clearly swallowed his doubts (I expect a U-turn on the forestry sell-off, but not NHS reform), but has a lot of catching up to do.
How about hospice policy as a restful truce? Last summer, before the white paper exploded, Andrew Lansley asked Tom Hughes-Hallett of Marie Curie Cancer Care to chair a review of palliative care funding as elderly numbers and expectations rise. He also committed to a new per-patient funding system, which everyone knows will be a tricky model to create.
The review team’s interim report in December said it wants to focus on “key services which allow people to be cared for and die in a place of their choosing”, what the core service should be and how much the NHS should fund as a statutory duty. Few could quarrel with that, except that we are talking money again. Ker-ching!
Enter stage right Dr Daniel Poulter, obstetrician, councillor, newly elected Suffolk Tory MP and still only 32. He staged an upbeat Commons debate on hospices the other day, one which drew some cautious thoughts from the coalition’s social care minister, Liberal Democrat Paul Burstow.
As you’d expect, Doc Poulter made a lot of sensible points. The over-85s will double to 3.3 million by 2033 (in theory I will be one of them); hospice care is too much associated with cancer, but many other conditions need the movement’s help; governments provide around one third of costs and it is important that “section 64 funding should not be lost in health reforms”.
He should be pleased because it turned out that £40m of capital funding for his local St Elizabeth’s Hospice has been spared the cuts. Both governments had been making progress, he conceded. But Dr Poulter was also keen to suggest both that the Lansley Health Bill will promote greater integration of social and healthcare - of course - and, bolder still, that it all fits into the Cameron Big Society.
Paul Burstow noted in reply that there have been worries about how effectively hospice funds are spent, “often not used as it should be”, as junior minister Earl Howe recently put it. Ongoing and growing funds for end of life care will be part of the baseline for consortium commissioning, but he stresses ring-fencing such funding is “a retrograde step” which stunts initiative and often proves to be an artificial cap rather than a guarantee. Hospices also suffer too many overlapping regulators, he says.
In the debate’s clamour among MPs to enthuse about hospices, Labour was conspicuously absent. The party is still evolving its policies, but health spokeswoman Emily Thornberry reports cases of old folk being stuck in hospice respite because their care package has been taken away. A bit like my sister, really.