Hospices
We come now to the final item of business, which is a members' business debate on motion S1M-1614, in the name of Trish Godman, on hospices. Members who want to take part in the debate should indicate that now. Members who are not staying should leave very quietly.
Motion debated,
That the Parliament praises the contribution of hospices across Scotland in providing loving care and support to both patients and their families; acknowledges the contribution of staff, volunteers and local fundraisers to the hospice service; believes that the health boards should meet 50% of the running costs of hospices set out in Management Executive Letter NHS MEL (1994) 104, and urges the Scottish Executive to address the funding shortfall for Scotland's only children's hospice, Rachel House in Kinross.
Today we spent some time discussing children's issues in education and children who are being looked after. It is therefore apposite that we should finish today's business by considering hospices, in particular the children's hospice.
It is predicted that in the next 10 years there will be an increase in the incidence of cancer but that, as a result of improvements in treatment, there will be a reduction in mortality. People, many of them frail and elderly, will live longer with cancer, requiring palliative care over a longer period. Scotland's voluntary hospices play a key role in the provision of palliative care for those people and their families and, to an increasing extent, for people with other life-threatening conditions.
What is palliative care? The World Health Organisation tells us that it affirms life and regards dying as a normal process; neither hastens nor postpones death; provides relief from pain and distressing symptoms; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients to live as actively as possible until death; and offers support to help the family to cope during the patient's illness and with their own bereavement.
I want to address three issues: first, Rachel House children's hospice in Kinross, funding and regulation. Rachel House currently receives approximately 9 per cent of its funding from health boards. In general, hospices received funding for their first three years from the Scottish Office, but thereafter they were to negotiate funding with health boards and local authorities. They have been negotiating with local authorities for 12 months. So far, agreement for funding has been reached with 23, three have said no and six have not made up their minds.
There is a great need in Scotland for palliative care among families who have children with life-threatening illnesses. All of us in the chamber will have coped with the death of either a friend or a member of our family. I must be honest. I do not know how I would cope with the death of a child or with the knowledge that my child would not grow up and live to a ripe old age. From birth, we cherish every moment—the laughter, the crying, and the frustrations. None of us would ever be without our child. I am sure that no one in this chamber can begin to understand the anguish of a parent who knows that they may soon have to say goodbye to their child.
I turn now to Rachel House. I want to pay tribute to the Daily Record's campaign to raise funds for Rachel House, to the editor who took the decision to run with the story, to the features writers who did the hard work, and to the real heroes, the Daily Record readers who gave so generously.
It is hard to imagine anyone being able to walk away or turn their back on children who have life-threatening illnesses. We must admire the determination that means that, in spite of all the difficulties, the children's hospice movement in Scotland has announced plans to build a desperately needed second hospice. The six-acre site in Balloch has been chosen, set in Scotland's new national park. The Children's Hospice Association Scotland is mounting a £2 million fund-raising campaign. The Daily Record must be congratulated again for its support of the second hospice, in addition to securing the annual £1.6 million running costs. The new hospice will have a special unit for teenagers, as experience of providing care at Rachel House has taught that teenagers have different needs.
Let me turn now to regulation. Rachel House and other hospices offer holistic care to the whole family. The skills of the multi-professional specialist palliative care team in the hospice can often be brought into play early in a patient's illness to help with the management of pain or to help with the social or psychological effects of the illness on the family. Every member of the family needs support at this time.
I am aware that the Executive will discuss regulation at a meeting with the hospice representatives next week. I appeal to the minister to ensure that Rachel House and all of Scotland's hospices retain the flexibility in service provision that allows them to meet the needs not only of the patient but of the family.
I will speak briefly about my own area. Renfrewshire and Inverclyde have three hospices—the Accord, the Ardgowan and St Vincent's. St Vincent's is situated in Howwood in my constituency. In 1982, it had a visiting service in the whole of Renfrewshire.
A woman from Elderslie was discharged from the Royal Alexandra hospital in Paisley. She was dependent on friends and neighbours popping in to help. It soon became clear that she needed more care because of her deteriorating health and she was moved to St Margaret's hospice in Clydebank, as there was no suitable service in Renfrewshire. That woman's experience was the impetus behind the fundraising campaign that began on 25 January 1988.
St Vincent's hospice is an eight-bedded inpatient unit. It also provides eight day-service places and home respite to 12 patients per week. The only criterion for referral is that the patient have a life-threatening disease. All services are provided free of charge and delivered by a team of 56 staff, 20 relief staff and 80 volunteers. I take this opportunity to thank all those people—the fundraisers, the nurses, the drivers and the people who work in the six fundraising shops—for all that they do.
I turn to funding. We have 15 hospices in Scotland—13 care for adults, Rachel House cares for children and there is a hospice for sufferers from HIV and AIDS. They are independent voluntary organisations with charitable status and are funded mainly by their local communities. Funding is the main issue for St Vincent's and the other hospices throughout Scotland.
As I state in the motion for this debate, management executive letter NHS MEL (1994) 104 sets out 50 per cent as the health board contribution to agreed costs. The sad fact of the matter is that health boards throughout Scotland have failed to meet that target: they provide an average of only 39 per cent of running costs. We have not even reached the point of a formula for agreed costs. Indeed, there are even differences in the hospice movement as to what should included in agreed costs. For the less-well-off hospices, such as St Vincent's in my constituency, it is important that expenditure such as fundraising and education is included in agreed costs. The situation puts enormous strain on hospices and makes it difficult for them to plan and develop services.
Rightly, the Executive has made fighting cancer and investing in treatment and services for that a priority. I would be interested in hearing where the minister sees hospices fitting into that strategy.
On the cost of drugs, an area of concern that hospices have raised is the anomaly that exists when patients require to have drugs prescribed during their stay. The cost must be met by the hospice if it employs a doctor; if it does not employ a doctor it does not have that additional cost. The real anomaly is that many of the patients would not be paying for their prescriptions if they were at home. I ask Malcolm Chisholm to address that issue. Hospices deal with a cinderella area, which traditionally has been, if not ignored, underfunded and isolated. It would be tragic if we lost some hospices because of funding difficulties.
Hospices want two things from the Government. First, they want to be able to predict what funding arrangements will be, not for one year but for several years. They do not expect to be 100 per cent funded—they would not want to be—but they want predictability. If the minister can provide the hospice movement with predictability on the level of funding over several years and certainty in its relationships with other health care provision, it will get on and provide an excellent palliative care service.
It takes a special person to care for the special people who find themselves in need of hospice care. How we treat the sick is a reflection of our society. As I have said, it would be tragic if we lost some hospices because of lack of funding; we cannot let that happen. Time is precious for the residents of hospices—we must find the time to address the issues that we debate this evening.
I congratulate Trish Godman on securing this very important debate. All members will recognise the sincerity and emotion with which she has addressed the issue. It is an issue that many of us do not want to face up to; however, hospices in all their forms are a huge asset to patients, families, friends and relatives. I am glad to see our colleague Dennis Canavan, who has experienced the loss of a child through cancer. To anyone who is listening to or will read this debate, I must say that hospices are wonderful places to go to and are a joy to behold. If ever I were in that situation, I would want to be taken to a hospice.
The immediate, and very important, issue raised by Trish Godman relates to children's hospices. As I live in the Balloch area, I cannot think of a better place for children and I hope that the second hospice will become a possibility.
I should tell Malcolm Chisholm, who will be summing up, that I recall discussing this issue in the House of Commons, and it was said at the time that the Government would match every penny that was raised by local communities. Those communities spend much time fundraising for hospices. Although Malcolm Chisholm might not regard Michael Forsyth as a hero, he might take him as an example. A penny-for-penny match would be very helpful for the situation in Balloch.
A day hospice campaign that has been running in my constituency for more than six years has attracted huge support across the whole spectrum of life in Moray, and we are hoping to have the day hospice in operation by 2003. However, one difficulty that the minister might address in his summing-up is the VAT levy on new build for hospices. Last year, I wrote to the Chancellor of the Exchequer about VAT relief on hospices. Although taxation is a reserved matter, perhaps the Scottish Executive and the Scottish Parliament could put a little bit of pressure on Westminster as far as this issue is concerned.
The relevant provisions are contained in section 30(2) and schedule 8, group 5—as substituted by SI 1995/280—of the Value Added Tax Act 1994. Removing that burden from the hospice movement in Scotland would also remove the possibility of a bill of £250,000 in my area for the build and running of a hospice. As the chancellor appears to be in a good mood and is looking forward to delivering his budget on 7 March, he should not only phone a friend, but listen to the audience of this Parliament. It would be a simple act, but it would be hugely kind to all those who are suffering.
Finally, will the Executive have a role in new opportunities funding? Furthermore, will that funding include a budgetary aspect to ensure that hospices in Scotland receive moneys that will enable them to provide this much-needed facility in all of our communities?
I thank Trish Godman for giving us the opportunity to raise awareness of and debate the hospice movement in Scotland. Furthermore, I commend her for her compassionate and extremely competent proposal that we are debating tonight. I also want to commend the cross-party group chaired by Michael McMahon in the work that it has done, is doing and is planning to do about raising awareness of palliative care in this Parliament.
In the light of the Regulation of Care (Scotland) Bill, members had the opportunity this week to question the Deputy Minister for Health and Community Care on whether the hospice movement would come under the regulation of care. I ask Malcolm Chisholm to tell us, in winding up, whether a hospice will come under the title of independent hospital in section 55 of the bill, as that would be helpful.
Trish Godman has mentioned a few points that I was going to raise. I shall quote from the Scottish health plan. It says that the Scottish Executive
"will ensure that effective palliative care services are supported"
and
"will expect NHS Boards to work closely with hospices to ensure that people's care needs are met".
None of us would disagree with that. However, it is difficult to pinpoint where the 50 per cent funding will come from. I have been in touch with Trish Godman today. She perhaps has documents that I do not have. We need clarity on that issue, not only for this year but to plan for the future.
In Inverness, the Highland Health Board currently meets only 27 per cent of the Highland hospice running costs, which is the lowest percentage of any health board in Scotland. The current running costs are £1.7 million and there will be substantial salary increases. That is a very worrying situation, and the focus should be on care rather than on expending time and energy on finances and fundraising.
The funding is not to stand still. Members know what has been said about our hospices in Scotland: they want to move forward and develop their services. The Highland hospice has also raised the issue of the hefty increases in water charges that organisations face. That increase was 43 per cent last year and will be 12 per cent this year. My colleague John Scott has reminded me that the water charges for the Ayr hospice are currently nil. However, the hospice will have to pay £20,000 on a transitional basis, over five years, starting with £4,000 next year. That is a crippling bill for a hospice to face, given its remit.
MEL 104 originally applied only to adults, which fact has created difficulties for the children's hospice movement. Although adult hospitals tend to be regional, the children's hospice movement is undoubtedly national and a special case. Rachel House receives only 17 per cent of its funding from statutory sources. The remaining 83 per cent comes from fundraising and endowment interest. I ask the minister to give us further clarification on whether the 50 per cent funding is a target and the agreed level of funding. Although I am sympathetic and compassionate, I do not think that the hospice should simply send the Executive a bill for 50 per cent of its costs each year. I agree with the point that is made in the directive, that there should be an agreed level of costs, and we have a responsibility to clarify what constitutes agreed costs and core funding.
As with all care and treatment services, there is no doubt that greater integration of the hospice service would benefit all, including the patients, and lead, as Trish Godman said, to a much more compassionate approach to the end of life.
I congratulate Trish Godman on securing this debate and commend her on the extremely eloquent way in which she introduced it.
Of all the constituency visits that I have made as an MP and an MSP, few have been as impressive or as moving as the morning that I spent at Rachel House in Kinross. It is impossible to exaggerate the value of the care and support the hospice gives children with life-limiting, life-threatening and terminal illnesses, and to their families. It is impossible to overestimate the importance of the respite care and short-term breaks that Rachel House provides for the parents and the brothers and sisters of those children who are so ill.
On a personal note, I only wish that Rachel House had existed just over 40 years ago during the tragically brief life of my younger sister. I know how much my late mother, herself a doctor, would have valued the support given to parents by Rachel House during the appalling trauma of caring for a dying child. Rachel House is a home in the truest and warmest sense of that word. However, we face a paradox: it is impossible to place a value or a price on that home's caring and supportive role yet it has had to struggle constantly to find enough money to cover its running costs. I understand that the current level of statutory funding for adult hospices in Scotland is 40 per cent.
Last year, as Trish Godman said, Rachel House received only 9 per cent in statutory funding and had to raise the rest from voluntary donations. I understand that this year, as Mary Scanlon suggested, the situation has marginally improved and that about 17 per cent of Rachel House's income was statutory funding, thanks to the increased contribution from local authorities. However, Rachel House's statutory funding has never been higher than 25 per cent—half each from health boards and councils.
I not only endorse, but passionately support, the belief expressed in the motion: that at least 50 per cent of the running costs of hospices should come from health boards—in other words, from general taxation. That is crucial if a second children's hospice is to open in Scotland as soon as possible. CHAS recently announced that it has acquired a site at Balloch, as Margaret Ewing mentioned. It has already reached the half-way mark in its campaign to raise £10 million towards the construction of the hospice and an endowment fund to cover its running costs. It is only right to pay tribute to the admirable campaign run by the Daily Record in support of that attempt.
The Scottish Government must do everything it can to support the wonderful work that hospices do. That is not only the right thing to do; it is the just and honourable thing to do. As a former member of the Finance Committee, I know the many and heavy demands on the Scottish block and on the NHS budget in particular, but—and I hope that the minister will agree—there can be no worthier cause and there should be no higher priority than this one. The true mark of a civilised society is how we care for those in greatest need and there can be no greater need than that of a dying child.
A number of members want to speak in this debate so I ask members called from here on in to restrict their comments to about three minutes.
I congratulate Trish Godman on securing this debate and pay tribute to the hospice movement throughout Scotland. We have a duty to ensure that hospices are adequately resourced and I wholeheartedly support the point that Margaret Ewing made about VAT relief.
The motion refers to a Scottish Office letter of 2 November 1994, which recommended that health boards meet 50 per cent of the running costs of hospices. I recall vividly when that letter was sent out because I was the vice-chair of the all-party hospice group in the House of Commons. I assure members of this Parliament that colleagues south of the border were envious of the settlement in Scotland as contained in that letter. They still are envious, as there is no such provision south of the border.
I understand that a few hospices in Scotland are 100 per cent funded by the NHS, but most are dependent on voluntary donations. I recall speaking to people in the hospice movement some time ago about whether that figure of 50 per cent of the running costs should be higher. To my surprise, some were not keen on the idea, arguing that if the hospices were 100 per cent funded by health boards, the health boards would control them and the hospice would have to compete with other NHS services for adequate resources and that the link with local communities could be weakened because part of the link is forged by voluntary giving, whether of money, time, effort or all three.
I attended the inaugural meeting at Strathcarron hospice, in my constituency. It was set up by the late Dr Lyon back in the 1980s. I can vouch for the fact that Strathcarron is very highly thought of by the local community, not just in Denny but throughout that part of central Scotland, which the hospice serves.
My youngest son spent his last days there, as did many of my dearest friends. Finally, I would simply like to place on record my thanks to the staff at Strathcarron hospice for the support that they have given to me and my family, and to many other families—I am sure that there are many other families throughout Scotland who could tell a similar story.
I congratulate Trish Godman on prompting today's debate. As the convener of the cross-party group on palliative care, I cannot commend enough the work that is done by the hospice movement. I thank Trish for giving us another opportunity to highlight its work.
Hospices are essential for the provision of quality of life to adults and children who suffer from a host of illnesses. Having visited a number of hospices, including Rachel House, I am aware of the high level of commitment and dedication among staff, and I take this opportunity to pass on my full support and thanks to them for that. The dedication of the carers, volunteers and fundraisers is remarkable and must have the Parliament's support.
As independent voluntary organisations with charitable status, hospices receive an average of 39 per cent of their running costs from the NHS. They are highly dependent on funding from their local communities and I commend all the fundraisers who give their time, effort and money for this important cause. I am aware of the high quality of service offered by the hospices and of the expertise that has been built up over the years by skilled multi-specialist professionals, carers and volunteers, who not only care for the sick, but attend to the social and psychological needs of the families who are affected by having individuals with illness.
The range of services that is offered by hospices is tremendous and includes not only terminal care and pain control but palliative respite care, combination therapies and post-acute and respite care for social, emotional, psychological and spiritual needs.
The hospice movement has come a long way, but much more still has to be done to meet the ever increasing complexity of palliative care needs. I join Mary Scanlon and other members in calling for the minister to provide details on the Executive's intentions to ensure that health boards meet their target for the provision of 50 per cent of the running costs of hospices. Will the Executive give a commitment to address the funding shortfall for Scotland's only children's hospice, at Rachel House?
In my discussion with the Scottish Partnership Agency for Palliative and Cancer Care, I understand that it is the minister's intention for hospices to be regulated by the proposed Scottish commission for the regulation of care, the setting-up of which is of course welcomed by the hospices. At present, hospices are regulated in the same way as nursing homes. The hospices feel that that is totally inappropriate for the care and service that they provide. Can the minister confirm what the Executive's intentions are in this regard?
It is important that the terms of the Regulation of Care (Scotland) Bill make it clear where hospices fit into the new regulatory system and that hospices' future regulation by the Scottish commission for the regulation of care be undertaken against standards that are developed specifically for hospice care. Ideally, that would be done by a commission team with particular knowledge and understanding of palliative care. Hospices should have the opportunity to contribute to the development of the standards against which they are to be regulated.
I understand that hospices, like other charities, currently enjoy relief from water charges. The Minister for Environment, Sport and Culture announced last Friday that that relief was to end. I ask the Executive to note that hospices provide their services free of charge and would find it difficult to pass on such costs to the patients and families for whom they are trying to provide. I request that the Executive reconsider that recent measure.
I again congratulate Trish Godman on securing the debate, which has allowed me to raise those points, which the hospice movement hopes will meet with a positive response from the minister.
I congratulate Trish Godman on introducing such a very important motion for debate today.
I first went to a hospice—Strathcarron—on a school visit when I was in my teens. Some of us were apprehensive about what we would find there—I think that children have a fear of death. We found a warm place with caring staff. We realised that it was a place of life rather than death, as so much was going on and it had a calm, safe atmosphere. That feeling has stayed with me. Such visits should be encouraged as they allay fears and are very positive experiences for young people.
I will address a couple of the issues relating to the hospice movement that Trish Godman outlined. The question of funding has to be resolved, as stable funding is required. We must ensure that health boards fully meet their commitments to provide 50 per cent of the running costs of hospices. From speaking to people in the hospice movement, I know that hospices want to retain their independence. If health boards meet that commitment, hospices will be able to be independent and have the stable base that they need so that they are not in constant fear of funding crisis. I hope that the minister will tell us that he will act on that point.
The problem of annual negotiations with local authorities also has to be addressed. Perhaps we should consider a requirement for local authorities to contribute rather than a voluntary arrangement. At the moment, the situation is one of treatment by postcode and hospices may be unable to continue to operate in a particular area. That cannot be allowed to happen.
Finally, I will address the issue of prescription drugs, which Trish Godman outlined clearly. We cannot have hospices being required to pay for prescribed drugs while people are staying with them. That requirement takes away a sizeable chunk of their scarce resources, which they have worked so hard to raise. I hope that the minister will address that point.
I end by paying tribute to the Daily Record readers who have contributed so much to the funding of Rachel House, and to the thousands of other people who contribute regularly and ensure that our hospice movement continues.
I, too, congratulate Trish Godman on securing the debate. The children's hospice is in my constituency and I, too, have visited it and found it to be a place of great warmth and support to families. I congratulate CHAS on finding a site at Balloch for its second home, which I hope will be funded and supported.
In a week in which I have had my troubles with the Daily Record, it may seem strange for me to say that on this matter I think that the newspaper got it right. I congratulate its readers on raising funds for Rachel House.
The funding of the children's hospice has been a different issue from funding for the national hospice movement. I think that it needs to be treated differently. I suggest to the minister that the children's hospice is a national resource and should remain so, even when the second site is established. It was a mistake to make it the subject of negotiations with 15 health boards and 32 local authorities. That is a waste of time that could be applied to clinical work. I ask the minister to consider making it a national resource and to reach a separate agreement with the children's hospice.
On hospices generally, I congratulate the minister on reaffirming at the recent annual general meeting of the Scottish Partnership Agency for Palliative and Cancer Care that the 50 per cent funding arrangement which, as Dennis Canavan pointed out, is unique to Scotland, has been continued. We need a national framework of agreed expenditure. The hospice movement needs to bite the bullet. No department can afford to write blank cheques.
My local hospice in Strathcarron—of which I was chair for some time—believes that there are some areas of care in which the health board wants to develop palliative care in a particular way. The health board rather than the hospice should be 100 per cent responsible for such funding.
Equally, there are elements that the hospice wishes to develop and that the health board is not keen to develop. They should be 100 per cent hospice developed. For those areas that are agreed service developments, however, the 50 per cent level should be applied. I urge the minister to consider that.
The cost would be £3 million if all the current Scottish hospices were moved to a 50 per cent funding basis. That is £1 million additional funds each year over the next three years, rising to £3 million if funding were made over a three-year period. That does not seem to be a lot to pay for a resource which, in its connections to the local people in each area—to which Dennis Canavan has alluded—is fundamental to the sort of support that we need for our public services.
I want to finish with a brief case history. When I was practising psychiatry, I was faced with a patient who presented at the age of 37 with profound depression that came out of a clear blue sky. There was no evidence of any reason for that depression. As we gradually discussed the situation, it emerged that when the patient was 12, his father had died at the age of 37. The child had been excluded from the process of that death; he had been sent to live with an aunt away from the prolonged cancer death that his father suffered in considerable discomfort at home.
His father wanted that because he wanted to remain in the child's memory as strong, fit and active and because he was ashamed of the weakness associated with cancer death. The child was sent away for perfectly good reasons, to protect him from the process. The depression, however, told me that we cannot protect people from the realities of life; that death is part of the reality of life; that medicine can stave off death only for a period.
The hospice movement has reawakened the basic knowledge that death is part of life. In reaffirming life for as long as life goes on, the hospice movement pays a major contribution to our culture and attitudes. We need to support it.
My speech will be brief. I, too, wish to congratulate Trish Godman on securing the debate.
In Ayr, we are lucky to have two hospices. The Ayrshire hospice is a terrific institution and the Malcolm Sargent House in Prestwick is brilliant. Malcolm Sargent Houses do tremendous work, not only in Scotland but throughout the UK. They take children and their families for what is often a final holiday, allowing the family to be together. I cannot commend that organisation strongly enough to the chamber.
I back up comments made by other members about water charges. If the charge for the Ayrshire hospice is £20,000, I assume that a similar charge will be imposed on the Malcolm Sergeant House. Funds are hard enough to raise without having to pay for water charges of £40,000.
I also add my voice to those who seek 50 per cent matched funding for those venerable institutions and I support the request for VAT relief for hospices.
We must also applaud the good work, which I have seen at first hand, of those who raise funds, those who work in hospices and those who make life better and more bearable at the end for people who so desperately need hospice services.
I have no hesitation in endorsing a motion that praises the contribution of Scotland's voluntary hospices—a motion that Trish Godman spoke about so movingly. No one can be in any doubt about the magnificent job that those hospices do. I welcome this opportunity to place on record the Executive's appreciation of the fine work that is undertaken by hospice staff. The Executive acknowledges the outstanding contribution of the many volunteers in our hospices, whether providing services to patients or helping to raise funds.
If the voluntary hospices are to remain in the vanguard of service development, they need to be sure about their funding. They need to know that their funding will allow them to provide agreed services and to provide services of the very high quality that we associate with them. They need security if they are to plan future developments. That is what the hospice funding agreement is intended to provide. The basis of that agreement is management executive letter MEL (1994) 104, to which the motion refers specifically. Although that letter is now nearly seven years old, its terms are still in force today. That is something that we can all be proud of. In spite of the political and constitutional changes that those years have seen, we as a country have remained staunch in our support of our voluntary hospices and what they stand for.
We expect NHS boards to work closely in partnership with hospices to ensure that people's care needs are met. As Mary Scanlon reminded us, that is reaffirmed in "Our National Health: A plan for action, a plan for change". The target of health boards meeting 50 per cent of agreed running costs remains in force.
Changes in the types of service that are provided by hospices have meant that, in some cases, what the hospices are keen to do has got out of kilter with the range of services that health boards are willing to fund.
Will the minister give way?
In a moment.
I appreciate the concern that, on average, health board funding of hospices' annual running costs stands at 39 per cent. I also appreciate that that average masks a fairly wide variation. The Executive therefore welcomes the joint efforts by the health department and the Scottish hospices forum to review the baseline—the agreed level that Richard Simpson referred to—against which the 50 per cent target should be calculated.
I am pleased that my intervention was delayed, because the minister may have answered my question. I was going to ask how we can make progress towards achieving the 50 per cent target. What sort of sanctions can be applied, or encouragement given, to health boards such as Highland Health Board, which contribute only 27 per cent to Highland hospice?
I am glad that Mary Scanlon has acknowledged the continuing work of the forum and the department in terms of the baseline. She will realise that the autonomy of health boards in making funding decisions often comes up. The significant thing is that the target is still in place.
We are keen to work with the Scottish hospices forum to develop a framework that, while promoting consistency for hospice funding across Scotland, will be flexible enough to take account of local circumstances. We want to promote a partnership between health boards and hospices without inhibiting innovation on either side.
Before I talk about specific issues relating to the Children's Hospice Association for Scotland, I want to respond to a couple of specific points. On the Regulation of Care (Scotland) Bill, I repeat what I said to the Health and Community Care Committee yesterday. There is a commitment to establish a separate division within the Scottish commission for the regulation of care to cover independent health care. That will include the regulation of hospices.
Will the minister give way? My question is about water charges.
I have only seven minutes and I may run out of time. I will take Dr Ewing's intervention in a minute, but I want to stay on the issue of quality. Not only the commission will work on quality: the Scottish partnership agency has agreed to establish a joint specialist palliative care group to develop national standards for palliative care. It is also preparing a plan with the health department for managed clinical networks in palliative care. On quality, a lot of work is going on.
I must move on to the children's hospice. Susan Deacon visited Rachel House in December 1999 and was extremely impressed with the quality of the facilities and the dedication of the staff who provide such a wonderful service there. I am pleased to be able to take this opportunity to congratulate CHAS on its outstanding work in what is now widely recognised as a centre of excellence.
When Rachel House was being set up, the former Scottish Office provided a grant of £750,000 to help with the building costs. It also gave a grant of £500,000 to cover the first two years' running costs, to make sure it got off to a secure start. The grants were on condition that further public funding would be based on agreements that CHAS would negotiate with health boards and local authorities. CHAS accepted that condition and began negotiations with health boards through the good offices of Tayside Health Board. Those negotiations have been on the basis of £125,000 as the overall contribution from health boards. I have had no indication that CHAS is unhappy with that negotiated figure. The problem may lie with the local authority negotiations. Perhaps that explains the unacceptably low figure of 9 per cent to which Trish Godman referred.
I understand that it has not been possible to devise a mechanism that allows CHAS to negotiate with one local authority on behalf of all. CHAS has therefore been pursuing agreements with each local authority and I believe that it is close to achieving agreement, but the consequence so far has been that it has had no funding from local authorities. I am pleased that local authorities have recognised their responsibility and the benefits offered by Rachel House. I hope that the agreements will be concluded in the very near future.
I am concerned that the motion's reference to a funding shortfall may create the impression that CHAS does not have the money to meet the running costs of Rachel House. I am not aware of any such suggestion by CHAS. We all know that such facilities are expensive to run, but thanks to the great generosity of the people of Scotland, the overall income of CHAS is secure. Along with Trish Godman and Shona Robison I congratulate the Daily Record on all the work it has done.
As Trish Godman said, the situation will radically alter in the near future as a second children's hospice is established on the banks of Loch Lomond at Balloch. I understand that it will focus on the needs of adolescents and I wish CHAS every success with that new venture.
I am out of time, but I know what point Winnie Ewing was going to make—and other members have made it. I will convey to Sam Galbraith the opinions that have been expressed on that matter today.
Meeting closed at 17:57.