I thank the Minister. The next item is a statement by the Minister for Health and Social Services on the reform of hospice funding. I call the Minister, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. I'm making this statement today to update the Chamber on the significant progress the Welsh Government has made to deliver on our important programme for government commitment to review voluntary hospice funding in Wales. Hospices play a critical role in providing essential care to more than 20,000 people in Wales affected by terminal illness each year, and help to prevent avoidable admission to hospital. Over 85 per cent of that care is provided in the community. This care has never been more needed than over the last two years when, throughout the pandemic, hospices have been there to support patients, families and carers through the most of difficult of times, in the most difficult of circumstances. 

Everyone in this Chamber will have been affected by COVID-19 in one way or another. Many will have lost loved ones, and will know someone who's been comforted by the exceptional range of services and support that hospices across Wales provide. Without these essential services, the NHS in Wales would almost certainly have been more severely impacted.

Pre-pandemic, approximately two thirds of hospice income—representing more than £25 million—was derived through fundraising activities and the generosity of the great Welsh public. However, the need to implement lockdowns and a range of other restrictions on society throughout the pandemic saw a sudden drop in that income. Fundraising events were cancelled, charity shops closed and campaigns were paused. But hospices were resourceful and they did adapt their practices in response to the pandemic. They accessed business rates relief, made use of the job retention scheme, and introduced innovations to improve care for vulnerable people—for example, adapting transport vehicles and use of technology for patient contact.

Minister, can you hold on a second? I can't see you on screen; I'm not sure if anyone else can see you on screen. They're all shaking their heads. Ah, that's better. Thank you.

Okay. Can you see me now?

Yes, thank you. Continue.

Thank you. Despite hospices putting emergency fundraising activities in place and reducing non-essential provision, there was still a very high and growing risk that hospice and end-of-life care services could slip into insolvency. That is why the Welsh Government stepped in and allocated almost £14 million of emergency funding to support Welsh hospices throughout the pandemic. This funding was provided specifically to reimburse hospices for their loss of income through their charitable activities, to protect their core services and to strengthen bereavement support.

Turning specifically to our programme for government commitment to review voluntary hospice funding, the Welsh Government has made significant steps to review the specialist palliative care funding formula, implemented back in 2010-11 following the palliative care planning review undertaken by Vivienne Sugar. Following the Sugar review, an annual budget of £6.3 million was put in place to help take forward the recommendations of her report—£3 million of which was allocated to voluntary hospices. In 2014, that funding was repatriated to health board budgets and ring-fenced until 2017.

While individual hospices have secured additional funding as part of service level agreements with health boards, there has been no recognised uplift of actual core costs since the original allocation back in 2010-11. Recognising this, in July 2021, I asked the end-of-life care implementation board to undertake a voluntary hospices funding review as part of a wider end-of-life care services review, which would include all statutory and voluntary sector provision. The preferred approach would have been to undertake the wider end-of-life care service review first, followed by the review of voluntary hospice funding. However, the urgent need to make recommendations for future hospice funding in time for the 2022-23 draft budget led to a prioritisation of the hospice funding review.

The original funding formula centred on an evidence-based model of care, simply quantifying care delivery around numbers of beds and the largely clinical teams of consultants in palliative medicine and clinical nurse specialists. Hospice at home was excluded from the formula, and has since become a vital part of care closer to home, allowing patients to exercise their choice to die at home. The formula also did not take account of the vital role of children's hospices in supporting children with life-limiting conditions and their families through the availability of respite care. A number of significant considerations were also acknowledged at the outset of the review, including that children’s hospices are inherently different from adult hospices, and a comprehensive assessment for people with palliative and end-of-life care needs had not been undertaken.

The review was led by a small team from NHS Wales Health Collaborative, and included analysis of information templates submitted by hospices and interviews. Regular meetings were held with Hospice UK and all hospices to keep them informed of progress with the work. In addition to this, the extent to which statutory funding contributes to voluntary sector services in other UK nations was also considered.

I received the final review in November 2021. The review recommended funding children’s hospices at a 21 per cent contribution of all agreed care costs. Also, the review recommended increasing adult hospices' funding to reflect the estimated inflationary impact on the original funding formula approach. This would include bed and community service costs, and funding the financial impact of implementing additional beds established since 2010-11. I am pleased to say that the Welsh Government has accepted the recommendations of the review, and will be making an additional £2.2 million available to Welsh hospices on a recurring basis from 2022-23 onwards. Eight-hundred-and-eight-eight thousand pounds out of this funding will go to our two children’s hospices, Tŷ Hafan and Tŷ Gobaith.

Phase 2, which is the wider review of all end-of-life-care, statutory and voluntary sector funding, will consider the whole spectrum of care. And it will do so using locally agreed models of care, applying the principles of value-based healthcare, and it will also be guided by the four aims within 'A Healthier Wales'. This phase will be overseen by the soon to be established national programme board for end-of-life care, as has been set out in the national clinical framework. The board will look at the variances in hospices' models of delivery highlighted in phase 1 of the review, as well as the relationships between health boards and hospices.

In summary, today’s oral statement provides a snapshot of the excellent progress made in reviewing voluntary hospice funding to date. This additional funding provides hospices across Wales with a significant increase to their core funding allocations, and offers a level of certainty on which they can plan and deliver future service provision. However, whilst I am encouraged by this progress on hospice funding, I do not underestimate the ongoing challenge for all end-of-life care services ahead. As such, Welsh Government remains committed to strengthening its focus on end-of-life care. We will continue to work closely with the national programme board to drive actions across Government and with stakeholders to improve end-of-life care services for all. Thank you very much.

Conservative spokesperson, Mark Isherwood. 

I thank you for your statement. I'm pleased to note that the Welsh Government eventually allocated almost £14 million of emergency funding to support Welsh hospices throughout the pandemic, after I, as chair of the cross-party group on hospices and palliative care, had to repeatedly raise the gap between the money the Welsh Government received from the UK Government in consequence of its funding for hospices throughout the pandemic in England and the amount the Welsh Government initially allocated to support hospices in Wales. 

Twelve years after I hosted the 2006 Assembly event, highlighting the essential role played by hospices in providing palliative care services in Wales, and calling on the Welsh Government to address the growing funding crisis they were facing, attended by every hospice in Wales, I chaired the cross-party group on hospices and palliative care's inquiry into inequalities in access to hospice and palliative care in Wales, which found that there's significant unmet need and undermet need, that statutory hospice funding has flatlined for a decade and therefore fallen in real terms each year, that statutory funding of children's hospices in Wales was significantly lower than in England and Scotland, and that statutory funding for adult hospices in Wales as a percentage of expenditure was lower than in any other UK nation.

Leading the Welsh Conservative opposition debate on hospices and palliative care services in Wales here in 2019, I noted that, while approximately 23,000 people in Wales have a palliative care need at any one time, including over 1,000 children, around 1 in 4, approximately 6,000 people, don't get access to the end-of-life care they need. I called on the Welsh Government to take action to help radically improve access to hospice and palliative care for everyone across Wales. 

In responses to written questions last year, this health Minister confirmed that, of its £8.4 million end-of-life funding, only some £800,000 was allocated specifically to support specialist palliative care services across Wales, and less than £200,000 of this went directly to children's hospices with none for adult hospices. Yet, for example, we heard at last Thursday's cross-party group on funerals and bereavement, which I chaired, that the joint project between Cardiff and Bristol universities to explore care and bereavement experiences during COVID-19 found that these were far more positive when support was provided by hospices. 

Given all of the above, I join our hospices in welcoming this long-awaited announcement, and must flag up the enormous work they've put into achieving this, including the Tŷ Hafan and Tŷ Gobaith children's hospices lifeline fund campaign, noting that they've received less than 10 per cent of their funding from statutory sources in Wales, the lowest level of statutory funding across the UK nations, and calling for the Welsh Government to provide the lifeline that hundreds of children and their families across Wales so desperately need.

Given her statement today that the Minister has accepted the recommendations of the end-of-life care board voluntary hospices funding review, and that she'll be making an additional £2.2 million available to Welsh hospices annually, including £888,000 to Tŷ Hafan and Tŷ Gobaith, will she confirm whether this now closes the hospice funding contribution gap with the other UK nations, both for children's and adult hospices? If not, why not, and what funding gap remains? How will the additional funding be delivered? How will the Minister monitor end-of-life care funding delivered via health boards to establish how much of this reaches hospices and whether this is delivering the best outcomes for patients and their families?

Given the Minister's statement that the funding will be available on a recurring basis from 2022-23, can she commit to this funding being recurrent for at least the lifetime of the sixth Senedd? Can she provide further details on what costs she envisages this funding will cover? Will she confirm whether this funding will be made available to our hospices via a single annual payment, allowing them the resources to invest in ensuring they can make the biggest difference to the people and families that use their services? Can she provide some clarity over how the hospices will report against such funding and confirm whether this will be based on reach and need and not be overly onerous? And finally, how will she, her officials and other public service partners continue to work with our adult and children's hospices, without whose sustainability and input it would be impossible to create a compassionate Cymru, a compassionate Wales?

Thanks very much, Mark. Can I thank you for your personal commitment to this very important area? I can't imagine the pressure and the difficulties that so many families have had to face during this extremely difficult time. It's hard enough to lose a loved one at any point, but to try and deal with this in the middle of a pandemic must have ben extremely difficult, in particular, I think, when it comes to children. So, thank you for your contribution and thank you for your focus on this. Thank you for recognising that we have given £14 million to the sector to make up for some of the loss that they saw during the pandemic, and for recognising that additional £2.2 million, which I can confirm will be recurrent. 

I am glad to see that you recognise that we've corrected some of the underfunding that was happening, and that's why we made sure that we undertook this review and that we placed a different priority on it. There's a broader review, but we went first for the immediate need to fill the funding gap. It was those experts who came up with the suggestions in terms of where that should land. I'm pleased to say that we've landed more or less in the same place as England when it comes to children's hospice funding, although I think it's really important, when we talk about voluntary hospices, that we're not comparing apples and apples here with England. Because, for example, in Wales, some of the hospices benefit from clinical support, such as palliative medicine consultants, and that's not necessarily the case in England. It is a slightly different way of dealing with the situation. So, thank you for that.

Of course we will be monitoring how this funding is spent, and of course we will make sure that the health boards are really ensuring that they're looking at what the need looks like within this space. I'm very pleased to see that one of the things that's been recognised here is the fact that, actually, ideally, people want to die at home in the comfort of their home and surrounded by people who they love. There's been a significant shift, I think, in terms of the focus of these hospices in terms of making sure that they can give that care within the community. So, I'm pleased that that's been recognised in this changed formula that has been undertaken.

Plaid Cymru spokesperson, Rhun ap Iorwerth.

Thank you very much, Dirprwy Lywydd. The first thing I want to do is to pay tribute and say 'thank you' to the hospice sector in Wales; to thank them for their vital service. Anybody who has had the privilege of visiting a hospice or has experienced the hospice at home service knows about the tireless care that they provide. I've worked with the sector as best as I can as Member for Anglesey, as Plaid Cymru spokesperson and as a Member of the cross-party group to try to bring forward a settlement that would provide the kind of assurance that the sector deserves. I'm pleased that we've had this announcement today. I asked the Minister about this in the health committee the week before last. We were promised a statement, so I'm pleased that she has kept her word on that. And it is a step in the right direction, but there is some way to go yet.

The financial context, as the Minister said, is that there has been no increase in the core budget, truth be told, for a decade by now. Now, I see this as a correction, if you will. I acknowledge what we heard from the Minister—that there will be a next phase in this review from the Government. But to give an idea of the figures and what they mean, £2.2 million in addition will go to the whole sector in Wales every year; it costs around £5 million a year to St. David's hospice alone, with only 10 per cent of the funding for that coming from the health board or Government. Before this announcement, it was 10 per cent of children's hospice funding that came from the public purse. There will now be, if I understand it correctly, the same level as in England, so 21 per cent of funding, but do bear in mind that Northern Ireland pays 25 per cent and Scotland pays half the costs. So, yes, the additional funding is to be welcomed, but I do look forward to seeing a further statement. 

It is unreasonable, I think, for us to continue to expect the same level of care and service that we are used to seeing and that's so important to families across Wales unless we're willing to make a fair contribution to that care. And I'd like to ask the Minister for an assurance that phase 2 of the review will look at the possibility of increasing that core funding to the voluntary sector further. And one additional question. There's more than just sums of money in the question here; we need to ensure too that access to hospice services is equal for everyone, no matter who they are, no matter where they are in Wales. There are major inequalities at present. Is this also something that the Minister is going to be looking at to ensure that this excellent service is genuinely an excellent service that everyone can access?

Thank you very much, Rhun. You are right to say that there will be a second phase for the review, and I very much hope that that will take less than a year to complete. What will happen is that a small group will be brought together under the leadership of end-of-life care clinical lead, Dr Idris Baker, and that group will be developing and formulating what the remit for the second phase of the review will be. That will be overseen by a new end-of-life care programme, so that will be a sub-group of that programme. And that review will look at funding in the sector and will look at the differences in terms of the different models for hospices that have been found during the first phase of the review.

I'm too am concerned, Rhun, to some extent, about ensuring that people can have access to this help wherever they are, and certainly, this was something that I raised with the children's hospices when I spoke to them in terms of how they cover rural areas, for example, if they're far away from the centres where they're located. They have made it clear that they have already made provision in that regard, but they do know that they have some way to go on that too. So, I hope that we will see that progress, and, of course, that is something that I hope that they will look at in the next phase of the review.

Thank you for your statement this afternoon, Minister. The hospice movement is a truly amazing addition to healthcare in the UK, as they fill the gap left by statutory services. One of the sad realities of life, unfortunately, and one of the sole guarantees in life, is that we all do eventually pass away, and hospices are there to help ensure that those with a terminal illness can have choices about their end of life. My constituents in the Vale of Clwyd are lucky to have the fantastic St Kentigern, based in St Asaph, to provide excellent palliative care. Minister, St Kentigern receives just over a sixth of its funding from statutory sources. Do you think that that's sustainable or fair, given the valuable service it provides to my constituents in the entire north-east Wales region? Even when funding is provided, St Kentigern gets a lower share than similar providers in the south. So, what are you doing to address this disparity? And finally, do you agree that, while no-one should die in an acute hospital bed, not everyone wants to die at home? And therefore, what plans do the Welsh Government have to fund increasing bed capacity at places like St Kentigern to give everyone a choice about how they die with a terminal illness?

Thanks very much, Gareth. As you're aware, about 33,000 people die in Wales every year and about 200 of them are children, and I just can't imagine the agony that parents in particular have to go through. That equates to about 90 people per day, but what we do know is that we're going to see an increasing number of people dying because of the demographic profile of the country. So, by 2039, we'll see a 10 to 15 per cent increase in that number—about 36,000 or so per year dying. And so, clearly, this is an area that will need more attention and we need more of a strategic plan for what the future will look like. 

I'm interested to hear about St Kentigern and their situation. One of the things that we've asked the second review to do is to look at, I guess, the differences that are being looked at—the variances in terms of the different models. So, it will be interesting for them to look at what St Kentigern is doing differently to some of the other places. So, that's something that that review will undertake.

And just in terms of bed capacity: well, we have seen an increase in the bed capacity, and one of the things that the reviewed formula has taken into account is the fact that there is an increase in bed capacity, and it's one of the reasons and part of the justification for giving additional funding.

Thank you to the Minister for this afternoon's statement. May I begin by saying that it's not just an excellent day for the Urdd for celebrating its centenary today, and the fact that we are celebrating Santes Dwynwen's Day, but relevant to this statement, I also wish a very happy birthday to Tŷ Hafan, which is celebrating its twenty-third birthday today? And the statement is an excellent way of celebrating the contribution made by the two children's hospices in Wales.

The two children's hospices in Wales have been the poor relations in the UK when it comes to state support. Before this announcement, our hospices received less than 10 per cent of their budget from state sources. By way of comparison, children's hospices in Scotland get 50 per cent of their budget from state sources. We're not talking about parity today with other nations, but it is a step in the right direction.

I regard the statement today as the minimum that is acceptable, and it provides a good starting point from which to increase the budget in future. It's easy to get wrapped up in figures and spreadsheets when talking about budget settlements, but what does this announcement actually mean today? The extra cash will be used to do things like provide additional—

Peredur, you need to ask your question now.

Sorry. When you contextualise this announcement today in terms of the financial security that we need for children's hospices, I'm sure there'll be well-spread agreement in our Parliament today, and it's not only long overdue, but it's very, very much welcome indeed. Diolch.

Thank you very much, Peredur, and I too would like to thank Tŷ Hafan for all of the work it does, and to wish them a very happy birthday for all the work that they've done over the years. They've transformed people's lives at a time when people are going through the hardest possible ordeal in their lives, and we can't thank them enough for everything they have done for children and their families over those 23 years. Thank you also—

And finally—

Sorry, Minister.

Thank you, Peredur. But just to say, of course we understand that there is a second phase to this, and, obviously, the financial issues associated with this will continue to be explored during that second phase.

Finally, Sam Rowlands.

Thank you, Deputy Presiding Officer, and thank you, Minister, for bringing forward today's statement. Since becoming a Member of the Senedd, one of the first things I did was meet with and visit Tŷ Gobaith in my region, North Wales, who, alongside Tŷ Hafan, do carry out exceptional work, and it's all been acknowledged here today, in supporting young patients and their loved ones. I've been really taken aback by the work that they offer and provide.

One of the huge concerns that they raised with me was this lack of funding from Government, and, therefore, I'm really pleased that cross-party support in relation to this lack of funding has led to Government today announcing a reform of hospice funding. I, like others here today, welcome this long-awaited funding, which is a good start, to acknowledge the importance of this work and make a real difference to the support that hospices can provide to people. But looking ahead, Minister, and at the national programme board for end-of-life care that you're setting up, how will we be assured of their speedy progress, and how will you balance the voice of hospices on this board with competing voices for such important funding?

Thanks very much, Sam. I'm afraid I haven't had a chance to visit Tŷ Gobaith yet, and I very much look forward to doing that, and the same thing with Tŷ Hafan. I'm afraid a pandemic is not the best time to visit hospices, but I very much look forward to having the opportunity to do that and to thank the staff for their incredible work over so many years.

You're absolutely right that the national end-of-life care programme will take into account the need to make sure that we are putting adequate funding in, and they will be looking at the variances in terms of the voluntary sector hospice models to make sure that we are getting a fair assessment, that it's all equal across Wales, making sure that they are giving the service to the whole population. 

I thank the Minister.