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Mr. Evans: When people say that to me, I know full well that it will happen. Anyway, if any hon. Members wish to make further representations, I shall be delighted to listen.
Mr. Eric Clarke: I raised the question of retrospection because a letter that I received suggested that there was to be no retrospection. Is the Minister now opening the door to discussion about the matter? In the example that I gave, someone died of the disease.
Mr. Evans: The fact that I am always prepared to listen to an argument should not lead to the supposition that I necessarily accede to that argument. As I made clear to the hon. Member for Normanton, what is being demanded goes further than any Government have traditionally gone under this scheme. Nevertheless, if anyone wants to put a particular case to me, I am prepared to listen to it carefully. I will have it assessed carefully, and I will have it costed carefully. I give this warning, however: although I am prepared to listen, we are being asked to go much further than the scheme has previously gone.
I should make it clear to the hon. Member for Stoke-on-Trent, North that there is an issue of administration. I was asked specifically how long the arrangements would take to implement were we to make such an announcement. The 1993 scheme took five and a half months to implement, and serious questions of administration are involved in any such implementation; but the Government are attending to all matters.
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I shall be kinder to the hon. Member for Bolsover than he was to me. IIAC is, of course, a quango, but I think that even the hon. Gentleman will agree that, if there is such a thing as a quango, it is the best of all possible quangos. It is an expert body: it contains medical experts of the highest repute, as well as representatives of both the TUC and the CBI.
The hon. Member for Sherwood mentioned the Nottingham Evening Post interview with my right hon. Friend the Secretary of State. I regret to say that that newspaper read rather more into off-the-cuff remarks than was justified, although I appreciate that the interview excited considerable interest in Nottinghamshire at the time.
Criticisms have been made of the 1993 scheme, quite apart from those addressed by IIAC. The hon. Member for Wentworth (Mr. Hardy) seemed to be saying that in 1993 we had somehow frustrated everyone's intentions by devising a scheme that was tighter than the one for which they were campaigning. As I understand the position, we simply implemented what IIAC then recommended.
Having--I hope--dealt with most of the points that have been made, I will not reintroduce a discussion with the hon. Member for Cynon Valley (Mrs. Clwyd) on reduced earnings allowance, or on any of the other matters that she mentioned. The debate focuses, very properly, on a particular matter.
Mrs. Clwyd:
It is an important issue.
Mr. Evans:
I know that it is important, but it is separate and distinct from what we have been discussing today.
It is important to define the role of IIAC, and the conditions that must be satisfied before a disease may be prescribed. That will explain why the terms of the prescription of chronic bronchitis and emphysema were drawn up in the way that they were in 1993, why the council reviewed the criteria this year and why it reached the conclusions and made the recommendations contained in its report.
No doubt everyone will be encouraged by the fact that the opinions expressed in both the 1992 and the 1996 IIAC reports on the subject were unanimous: there was agreement among all representatives on the body, including the medical experts.
Mr. Evans:
I hear that argument, and will give careful consideration to what it involves.
The statutory test is important. It is of fairly long standing, having existed throughout my lifetime. It has worked so far, although I appreciate that whether it is too strict, and whether it is drafted in quite the right way, are matters of argument.
This is a slightly unusual scheme. It is a compensation scheme, not a benefit scheme. It is distinct from, for instance, the arrangements for disability and incapacity benefits. It is a scheme of compensation--in the tradition of workmen's compensation that goes back to 1897--which is not based on proof of fault: it is a tax-free, no-fault compensation scheme. Therefore, it requires criteria that are clear and well established: no doubt that is why they have remained in their present state for a long time.
Mr. Clapham:
The payment of compensation is normally connected with the fact that someone has been subjected to an unnecessary risk. Here we are talking about the loss of a faculty, either mental or physical, following an injury sustained at work. The benefit that is payable from the scheme is for that loss of faculty, and
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Mr. Evans:
Traditionally, that is not so. I do not think that the hon. Gentleman's analysis is correct, although I suspect that at the end of the day it does not matter.
As the hon. Gentleman will know, between 1897 and 1946, when a Labour Government reformed the scheme, people had an option, although not a very comfortable one. Either they accepted no-fault payments under the scheme's predecessor, or they sued at common law and had to prove negligence or breach of statutory duty, which was difficult and expensive. At its inception, the scheme was perceived as an alternative to suing at law. When the 1946 reforms came in, instead of either/or it became both.
Mr. Skinner:
Under a Labour Government.
Mr. Evans:
I know what the hon. Gentleman says. I accept that the scheme has remained in that state since 1946 and of course it was a Labour Government who imposed it, but the point is that, in its modern form, the scheme remains one of statutory compensation and is distinct from benefits. We have been talking loosely in terms of benefits, but the scheme is not like the welfare benefits generally administered by my Department, but a form of compensation for a type of injury.
Mr. Skinner:
Will the Minister give way?
Mr. Evans:
I have about half a second. I will give way to the hon. Gentleman.
Mr. Skinner:
Yesterday in the handgun debate, as a result of representations about money, the Secretary of State for the Home Department said that he would consider finding extra money to resolve the gun lobby arguments. Will the Minister give the same guarantee on this matter when he has considered all the questions that have been asked by my hon. Friends?
Mr. Deputy Speaker (Mr. Michael Morris):
Order. We must now move to the next debate.
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Mr. Tim Rathbone (Lewes):
I welcome the opportunity to raise this issue in the debate, which comes, by good chance, this morning. First, I will remind the House about some characteristics of the hospice movement, although I doubt whether any Members are unaware of them.
Through its in-patient facilities, the hospice movement provides specialist care for people in advanced stages of serious illness. Through day care, it provides opportunities for expert help with symptom control, for counselling and for other therapies, as well as mental and physical refreshment for patients living at home and for their carers. Home care is provided by qualified hospice staff to support community nursing services, to assist patients and carers in daily nursing routines and regular assessment, and to maintain an open door to in-patient respite care.
I mention all those services because they are less well known than the major and best known hospice service, which is in the treatment and care of people whose condition cannot be cured, particularly to reduce, if not eliminate, patient discomfort and to improve patients' quality of life. Specialists are there to allay fear, to prescribe possible treatment and to provide holistic support to improve the quality of life.
Time never stands still and the needs of people suffering terminal illness will always become greater and require increasing support. That is the function of marvellous hospices such as St. Peter and St. James's home and hospice at Wivelsfield Green in my constituency. The Minister's colleague, Baroness Cumberlege, who visited the hospice recently, can vouch for the impressive quality of its work. I must say immediately, however, that the benefit from the hospice's care and service covers adjacent constituencies as well as my own and is almost equally provided to patients from East Sussex and West Sussex, which causes part of the funding problem.
Hospice funding does not depend entirely on health authorities. Like other hospices, St. Peter and St. James's depends to a large extent on charitable donations. It is only through such generous public support that the hospice survives and can continue to give vital assistance so marvellously. It devotes much energy and innovation to fund-raising activities and local people are continually wonderfully generous, but health authorities also must contribute from the funds provided to them by Government to do so.
The Minister will know--indeed, his colleague has told me--that until last year Government funding was specific and had risen from £8 million in 1991 to £48 million in 1994-95, which is to be welcomed. Since then, funding has been built into health authorities' general allocations, with an aim to meet hospice needs on a 50:50 basis. The Department of Health guidance states specifically that removal of separate identification from funding for specialist palliative care--for hospices--should not be viewed in any way as representing a reduction in priority for that sector. That was confirmed by my hon. Friend the Minister for Health in his letter to me on 14 August.
The East Sussex, Brighton and Hove health authority's contract with St. Peter and St. James's is for three years--its last year is next year--at £50,942 per year. I am told
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The picture is even bleaker with regard to funding from West Sussex. Patients from West Sussex, just across the nearby county border, represent approximately 50 per cent. of the hospice's work, but the authority provides only £10,550 per annum--an invidiously small remuneration for the wonderful services provided to many people for whom it is responsible. It is not prepared to pay for any day care services, thus forcing patients requiring those services from St. Peter and St. James's to pay for them themselves.
The net income from both East Sussex and West Sussex health authorities of just about £60,000 leaves St. Peter and St. James's with the need to raise between £400,000 and £500,000 each year. That is far removed from the 50:50 funding guideline goal and shows a dramatic reduction in priority for palliative care funding, contrary to the Government's guidelines.
I will give one dramatic illustration. Recently, an East Sussex AIDS patient in a West Sussex hospital was moved to St. Peter and St. James's with the promise of necessary funding to come with him. The money never appeared. The hospice became the pig in the middle between health authorities and social services. Eventually, money was agreed only under threat of having to move the patient elsewhere and receiving negative publicity for that action. Sadly, the money was paid only after the patient had died.
That was a human tragedy. The hospice charges for that AIDS patient are approximately one third of the cost elsewhere and the hospice's services for such a patient are infinitely better--indeed, unmatched. Professional and dedicated people are trying to do their best for a desperately ill and dying patient and for many others like him, but they are not being provided with the basic funds to do so. That is one illustration of an omnipresent problem which has threatened St. Peter and St. James's literally with closure, so desperate is its financial position. But for one generous and substantial donation out of the blue last week, the hospice would probably have been closing as we pursue the debate.
Mr. William O'Brien:
When my hon. Friend the Member for Pontefract and Castleford (Sir G. Lofthouse)--now Deputy Speaker--introduced his Bill, he had in mind the regulations to which the Minister referred. Although the Bill was accepted, my hon. Friend's experience in the mining industry--which was included in it--was not taken into consideration by the review body. We are asking for the changes to be implemented without further delay, and for other matters that we have mentioned today to be taken into account. I hope that the Minister will consider all the facts that have been presented, because further changes must be made.
12.30 pm
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