A message about changes to capacity at our Telford hospice following a reduction in funding from Telford and Wrekin Clinical Commissioning Group.
Severn Hospice has been trying over many months to engage with Telford and Wrekin CCG to discuss a proposed £250,000 cut in the support it gives us.
Sadly, despite our efforts to make clear the potential impact its decision would have on families living with incurable illness, we have been unable to influence the CCG to change its mind.
This means we will have to reduce our capacity at our Telford hospice, the equivalent of removing two beds. This will take effect from the start of April and means that any patient we cannot accommodate in the remaining seven beds at Telford will be referred automatically to the Princess Royal Hospital.
Our community services in Telford and Wrekin – Outreach, day services and Hospice at Home – are unaffected by this change.
The hospice’s leadership team – volunteer trustees and senior managers – is extremely disappointed that the CCG has cut its hospice funding because everyone will be made worse off by the decision, and in real terms the CCG will not make the savings it is seeking.
The CCG’s contribution of £1 million has not increased with inflation for more than a decade and has therefore decreased in value year on year. We can no longer absorb – or expect our supporters to absorb – these continued reductions in core funding and maintain the current level of service.
The hospice is not part of the NHS but it is part of its healthcare network and everyone we care for is an NHS patient. We believe therefore that the CCG has a responsibility to contribute to the funding of care for its patients, a cost it would have to bear wherever this care took place.
Hospices exist because healthcare professionals recognised the value of a holistic approach to palliative and end of life care, helping not only those living with an incurable illness but also their families.
Under a hospice, clinical care is only one element of palliative care; in a hospital it is the primary focus. This means the overall quality of care available to someone in a hospice setting is better than in a hospital. This is what hospices were created to provide and it is why clinical commissioning groups in Shropshire and Telford and Wrekin, and the health boards in Wales contribute to our funding; it is a strategic investment in healthcare provision for the population.
Everything about a hospice is completely different to a general hospital. Most importantly, we provide specialist, focused care within consultant-led wards, staffed with the right number of specially trained nurses. Our therapists, chaplains and social workers contribute to this holistic care approach which includes patients and those close to them.
In addition, all our patients have their own room with en suite facilities for their privacy and dignity and all rooms look out onto our tranquil gardens with direct access to the grounds. Families can visit whenever they want, they can even bring their pets if they wish to. This simply cannot be offered in a hospital setting where service provision has to cover so many other types of admission, is under great pressure and there are so many other competing priorities.
Our service is not elective, nor is it deferrable. The people we care for don’t have a choice about their need for care nor do they have time to wait for it. In stark terms someone who is dying might now face their death somewhere in a hospital rather than in a hospice. It will cost the CCG considerably more than its grant to us to care for that same patient in PRH. By saving 25 per cent of the grant they pay to us, they will have to bear 100 per cent of the impact on their budget and resources elsewhere. And the best care the hospital could possibly provide among all its other priorities will not be anything like the dedicated support we can give patients and their families. That is a fact.
Last year, we cared for 2,740 people across the region; four out of five in their homes. Of this total, 217 people were cared for in our Telford hospice. The demand for hospice services is growing, not reducing, which was why we added a ninth bed to our capacity at Telford, funded entirely by donations from supporters.
The CCG mistakenly believes that our reserves – pre-donated funds – are ‘cash in the bank’ and can be used to make up the funding gap it has created. Unfortunately the very nature of charitable fundraising means that the income generated is volatile. We hold money in reserve because we are legally obliged to, as a contingency against a decline in charitable giving; it is not a subsidy fund for the NHS.
Since its beginning, the hospice has had a culture of strong financial management so we have healthy reserves, entirely from our donors and no-one has donated money to us to subsidise cuts in public funding.
The total value of our reserves includes our fixed assets – our buildings and equipment – funds that are already committed for service development and a general fund for contingencies.
Our contingency fund is precisely that: protection against any downturn in charitable giving. It is sufficient to cover our running costs for a year. Why? In the extreme, if we had to manage the closure of the charity, we need enough reserves to allow for the safe, managed closure of our services so patients are kept safe. Unlike the NHS, which has a guaranteed budget each year – voluntary income is not guaranteed.
Our only possible source of cash to plug the CCG funding gap would be from the funds we have already allocated to developing our future services. Our planned developments will help us to achieve the local and national strategy for community care, to the benefit of patients. To redirect these funds would jeopardise these developments – and therefore these benefits to the vast majority of our patients.
We have just committed to a £5 million expansion and improvement programme and have allocated more than £3 million of pre-donated funds to enable it to start. This draw-down will have to be replaced with future fundraising. This investment is solely from charitable funds, none is from the NHS. Charitable foundations have committed almost £1 million to this because we have underwritten the investment with our £3 million contribution. We will be asking the community to support this investment with a direct appeal for support.
This plan for the future is not a ‘nice to have’, it is a strategic response to an identifiable community need and is completely in line with local and national NHS strategies to expand care in the community.
This investment will give people better access to our specialist services, reaching them earlier in their illness, and give them more support if they are living at home. If we don’t develop these services, the patients we could have been helping will remain in an over-stretched and inappropriate NHS system.
As difficult a decision as it has been for the hospice to make in closing two beds, we believe we are protecting our overall service to Telford and Wrekin residents in the longer term. We have repeatedly asked the CCG for clarity as to whether this year’s funding cut is a one-off, permanent or the precursor of future cuts.
We are determined to maintain a working relationship with Telford and Wrekin CCG and have invited its members and senior management team to visit the hospice and see first-hand the valuable contribution we can make to the quality of end of life care when we work together in a spirit of partnership and cooperation. Working together should ensure the lowest cost to the CCG whilst giving the highest quality of care to those at the end of their life.