This month saw the publication of the Palliative Care Funding Review. The report grapples with the complex problem of working out how to fund palliative care in a way that gives the right incentives to release money from inappropriate secondary care to invest in alternatives.
The solution coming out of the review proposes a national tariff for selected episodes of palliative care. Note the scope is only for the palliative care element and so must be on top of other funding.
The tariff will be based on a classification that should reflect a person’s need for care. The proposed scheme differentiates between different phases and severity of illness, information about functional impairment and also includes some variables relating to the type of provider.
The report also has some wider resource implications including access to 24/7 community care, coordinators for end of life care, and non means-tested social care for people on the end of life register. The latter is especially timely given the report from the Dilnot Commission on 4 July (see above).
A new NHS tariff for palliative care will mean that the cost of palliative care within the NHS is clear to everyone, and money ‘follows the patient’. This should improve access to palliative care considerably.
All clinical care needs are included within the tariff, as they are for every other aspect of NHS care. However bereavement care, spiritual care, complementary therapies, support for carers and families, information and advice and respite care for adults are not included in the tariff, although some are covered by other sources of funding either within the NHS or from social services.
With access to respite care already unreliable, there must be some concern that hospices will find it even harder to provide it if funding for end of life care is more readily available than funding for respite.
The report also recommends that pilot projects be undertaken to assess the effectiveness of the proposals and particularly to look at whether accommodation costs can be excluded (ie, the cost of food and accommodation for those in a residential care setting).
End of life care register
A key recommendation of the review is that every Clinical Commissioning Group (CCG – formerly known as GP consortia) must hold an end of life care register. Furthermore, for everyone placed on that register, social care costs should be met by the state, excluding accommodation costs if the person is in residential care, in addition to the main palliative care tariff (irrespective of whether charges would normally be payable, even under the new scheme proposed by the Dilnot report).
The all party parliamentary group report recommended that end of life care registers should be standard practice, so this is a particularly helpful recommendation.
The report recommends defining the tariff by a new system of classification that considers the phase of someone’s illness and their care needs. Each ‘class’ will have a different sum of money associated with it.
Currently, there is no national funding mechanism for palliative care. It remains to be seen whether the government will move to a more equitable funding system and implement the new funding model.