Tony Collins: Investing in helping people to die with dignity

It was initially met with a rapid and positive response from the Health Minister, Paul Burstow.

But what is the problem or problems that it is seeking to address? Why was the report commissioned in the first place?

In addition to the aim of clarity and transparency in the funding system, there are two more declared aims – to provide better value for the NHS and then, sandwiched between the two, to deliver better outcomes for patients.

The report is clear that the current system of funding is anything but transparent and unfair in lottery proportions. Across the country, according to where you happen to live, state funding ranges from £186 to £6,213 per death, which is clearly unfair.

Set in the context of the number of deaths per year due to rise by more than 14 per cent by 2031, something needs to change.

However, behind these symptoms is the root cause that palliative care is significantly under-funded and has been for a number of years. With no centralised direction, funding agreements have been established on local basis with some quite remarkable consequences.

One such consequence has been the independent hospice movement providing high quality end-of-life care supported by less than 30 per cent state funding across the country. That seems to offer some perspective to the aim to provide value for the NHS.

Less than 30 per cent funding means that the funder is not truly the commissioner. It means that the provider becomes the commissioner and is responsible for standards, growth and development.

The report quite rightly tackles the under-funding in the context of the current economic climate, claiming a saving of £180m for the NHS, leading to a redistribution of existing income.

This is not the first time redistribution has appeared to be the solution, but the implementation has never followed the theory. It assumes a known finite need for palliative care, and it totally disregards the sophisticated approach of the funding-stretched NHS to avoid loss of income. Palliative care remains under-funded.

What else has that lack of funding caused? Well, another symptom might be pockets (and some of them fairly large) of brilliant and pioneering palliative care. Britain is well established as a world leader in palliative care. Is that in spite of the lack of state funding or is it because of that lack of state funding?

State funding shortage is something with which palliative care has grown up. It has created an environment within which this particular sector of healthcare has flourished.

Without the money behind it, the state has been neither the power nor the growth behind this innovative and truly patient-focussed provision.

There has been a lack of centralised control and, consequently, a more community driven patient-centred approach. Without the single-point direction, palliative care has avoided having to consider a one-size-fits-all approach.

Without available funding, there has been an absence of competition. The private sector is not interested as there is no profit in it and, consequently, the Third Sector has played a dominant part in the drive to meet the needs and choices of the patient.

Add to that where the gap in funding has been made up, and continues to be made up from – the community – and an interesting picture emerges. We have a vital set of healthcare services being owned and driven by the very communities that are being served. Perhaps this is the long-awaited definition of a Big Society?

There is no doubt that given the changing demographics, the challenge to NHS funding and the reduction of voluntary income, this report is necessary. Redistribution will help but, ultimately, it is more funding that is required.

Just for a moment, let us put funding to one side and forget about better value for the NHS. Let’s focus solely on better outcomes for patients. We should remember just how important this subject is – it is about how we treat real people at the end of their lives. It is about the experience of a good death; with dignity, with control, without pain.

This is a subject that touches us all without exception and we should not compromise. Let us have our cake and eat it – more funding without more centralised control.

There should be greater stability of existing provision and room for even further advances without the introduction of competition that will distract and change the primary drivers. In short, real investments that recognise success and promote even further success.

* Tony Collins is chief executive of Saint Michael’s Hospice and Just B Bereavement Support, Harrogate.