Hospice Services: Support — [Caroline Nokes in the Chair]

– in Westminster Hall at 9:30 am on 14 June 2023.

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Photo of Paul Holmes Paul Holmes Conservative, Eastleigh 9:30, 14 June 2023

I beg to move,

That this House
has considered support for hospice services.

It is a pleasure to serve under your chairmanship, Ms Nokes. You are intrinsically linked to the Mountbatten hospice, which I will speak about this morning, in your role as the Member of Parliament for Romsey and Southampton North.

I thank the all-party parliamentary group on hospice and end of life care and its chair and co-chair, my hon. Friend Peter Gibson, who is here today, and Baroness Finlay, for their work in promoting and championing the hospice sector. They have a lot of experience in the sector and I am grateful to them for lending me their support in this important debate.

The hospice sector in this country does incredible work for thousands of families and individuals every day. It is a fact of life that we all experience a bereavement at some point, and some of my colleagues know that we recently had the very sad task of saying goodbye to my office manager, Sue Hall. Sue was not just an employee of mine; she was my friend, confidante, an incredible wife and mum, and a friend to all. She was a magnificent woman—a local hero who helped people every day. She never baulked at a challenge or missed an opportunity to show people how much she cared. I am sure many, if not all, of those here have had that special support in their lives from someone they rely on. For me, that person was Sue. I never thought I would have to make do without her by my side.

Sue left us peacefully, surrounded by her family and friends on 30 March. She was comfortable and well looked after, and for that I will ever be grateful to Mountbatten hospice in my constituency, which cared for her at the end of her life. It made her final days and moments a special time for her family and friends. We can all hope at the end of our time on this earth to have an opportunity to say, “Thank you, I love you, and goodbye.” That is a truly special and incredible moment for everyone—one that the hospice Sue stayed in provides for people every day.

Sue’s journey had a profound impact on me as I spent time with her in the hospice learning about the work that it does and the struggles it faces. In a moment of weakness, her son-in-law, Miles Rogers—a good friend of mine—and I agreed to do a charity skydive for Mountbatten hospice on 24 June. The fundraising page is available on my Facebook page if anyone wants to contribute.

Mountbatten Hampshire is a hospice in my constituency that provides 24/7 in-patient and community domiciliary and palliative end of life care services to people across Southampton city and large parts of Hampshire. It also provides rehabilitation and enablement services, as well as psychological and bereavement support to parents and their families. Sue’s family and I will forever be grateful to it for its kindness during Sue’s last days. Having had the pleasure of meeting the hospice’s chief executive officer, Nigel Hartley, and the fantastic staff who work there, I know that their passion and commitment to providing the best possible care for all their patients is their top priority, and they give that care with skill, tact and grace every day.

Photo of Alan Mak Alan Mak Conservative, Havant

I thank my hon. Friend for securing this debate. Rowans Hospice does great work in the Havant constituency, and as a result it engenders a lot of loyalty, including from fundraising and support groups. Will he join me in thanking such groups for their contribution alongside the full-time staff at hospices?

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

I pay tribute to Rowans Hospice and to all the hospices that we will no doubt hear about this morning, given the number of people attending this debate.

As I say, I had the pleasure of meeting the CEO of Mountbatten hospice. Its work does not come without cost, but, as a charity, its services are provided free of charge to all who need them, thanks to the generosity of its amazing community and incredible volunteers, who give their time to support the best possible care for local people during the last years and months of their lives. Mountbatten currently supports around 1,000 families every day, and demand for its services is predicted to rise by 40% in the next 18 months. It costs £11.5 million a year to keep the services running, and the hospice relies on charitable support to fund its 24/7, 365 days a year services to people who need them.

Photo of Ellie Reeves Ellie Reeves Shadow Minister (Justice)

St Christopher’s Hospice in my constituency is widely regarded as the first modern hospice, and it is still pioneering today, but it has to fundraise £15 million a year. The cost of living crisis means that its costs are going up and its donations are at risk of going down. Does the hon. Member agree that the Government must review the current funding model?

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

The hon. Lady tempts me to come to content that I will cover later in my speech, but for now she can take it that I wholeheartedly agree, as do many Members here, I suspect.

No one will contest that our health and care staff deserve to be well paid for the incredible work they do, and in an ideal world we would see our life savers and carers never have to worry about their finances and pay, but it would be deeply irresponsible to facilitate pay rises without giving due consideration to the dramatic impact that rising wage costs have on these essential services. To give some specific context, Mountbatten Hampshire took over management of the hospice from the NHS in 2019. It has a contract with the NHS for roughly 35% of its costs, of which about £3.8 million comes from the local NHS commissioners in the form of an outcome-based contract. The hospice follows the NHS pay award each year to remain competitive and to retain and hire staff for its services, which means that the hospice has seen a 4.8% rise in costs this year and will see a further 5% next year, with no corresponding change in its NHS contract, leaving an increasing and worrying financial gap that the charity will find very hard to reconcile without public funding.

Several hon. Members:


Photo of Meg Hillier Meg Hillier Chair, Public Accounts Committee, Chair, Public Accounts Committee

It is interesting to hear about the Mountbatten, which I spent many years at when it opened, when I was a child. The hospice in my constituency, St. Joseph’s Hospice, is really cutting-edge, but the retrospective payment for nurses will cost it £470,000, and it cannot apply that yet because it has no certainty from commissioners about its funding. To keep it up will be another half a million a year, and it cannot afford that without certainty of funding. I am sure the hon. Member agrees that we need to press the Minister for some clarity on this.

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

I agree with the right hon. Lady; we do. In my experience, the uplift that has been given to local NHS commissioning groups is simply not making it through to those end of life services. I hope we will see some recognition of that from the Minister, and I am sure she will enforce this, to ensure that the funding to local commissioning groups gets through to these services.

Several hon. Members:


Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

I do not want to be harsh, but I have been warned by the Chair that I should get through my speech. I will make some progress and then give way shortly.

Written evidence submitted to Parliament by Hospice UK records that hospices across the UK employ 12,000 nurses, with 8% of the nursing workforce drawn from bank or agency, which make up a 9,400 full-time equivalent nursing establishment, but they are struggling to recruit registered nurses. A clinical survey in 2021 found that there was an 11% vacancy rate in community-based hospices and a 7% vacancy rate in hospice-based nursing roles in adult hospices, with 16% vacancy rates for hospice-based nursing associate and community-based healthcare assistant roles. The written evidence states:

“Since this data was collected, between March and May 2021, the sense on the ground is that these figures have increased and workforce shortages in UK hospices and across other providers that deliver palliative and end of life care have worsened.”

This is clearly the tip of the iceberg, and further pressures are to follow. Hospices are desperate for more support from the Government. The Mountbatten will end the year with a £1.4 million deficit, with no foreseeable change in the financial forecast with the current funding arrangement. The impact will be felt not only in the care sector but throughout the whole NHS.

Photo of Flick Drummond Flick Drummond Conservative, Meon Valley

My hon. Friend paid a fantastic tribute to his office manager, Sue. Rowans Hospice in my constituency is thinking about increasing its number of beds from 19 to 22, but that will cost an extra £130,000 a year, and the trust is nervous about making that commitment. What he is saying is very important. Does he agree that the Government need to give more money to this valuable service?

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

I suspect that I will be in constant agreement with interventions this morning. My hon. Friend and constituency neighbour makes an astute point, as usual, and she is right to pay tribute to the hospice in her constituency.

Communities such as mine in Eastleigh will suffer as hospices such as Mountbatten have no choice but to reduce their services and the extraordinary high-quality care they offer, and this comes at a time when demand is only growing. As if that were not enough, staffing costs are but one consideration that care providers are having to take into account. As we all know, the soaring price of energy has hit businesses, families and individuals all over the country, and none more so than those in the charity care sector.

Photo of Wendy Morton Wendy Morton Conservative, Aldridge-Brownhills

Acorns Children’s Hospice in the Walsall borough supports families and children in my constituency. Does my hon. Friend agree that, in these challenging times when energy prices are on the rise, we want any additional help to include the hospice sector?

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

I thank my right hon. Friend for her intervention. She tempts me to talk about issues that I will come to later in my speech—it is only a couple of pages away, I assure you, Ms Nokes. She is right that hospices have not been included in the energy support given to other charities, even though their services are energy intensive due to the equipment they use. Her point is well made and will be recognised in her constituency.

The energy bill for Mountbatten has risen by an eye-watering £250,000—a fivefold increase—and there has been no additional financial support. One might think that that is surely as high as prices can go, but a London-based hospice has forecast that its energy costs will increase by almost £300,000 a year due to inflation pressures. A north London hospice told Civil Society Media that it faces an energy bill of £433,000 in 2023-24, based on predicted energy costs.

Adult hospices are not the only ones affected by this issue. As my hon. Friend Steve Brine said in his letters to the Department of Health and Social Care, there is also uncertainty about the children’s hospice grant—a vital source of funding that represented an average of 15% of children’s hospices’ income in 2021-22.

Photo of Stephen Hammond Stephen Hammond Conservative, Wimbledon

My hon. Friend is absolutely right about the pressures on the sector, which also affect St Raphael’s in my constituency. The Government have been generous with the children’s hospice grant, but it runs out next year, and the lack of certainty is the problem. We would really like the Minister to stand up and say that she will renew the grant after 2023-24, which would provide a huge amount of certainty for the sector.

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

My hon. Friend, who is my past employer, makes a good point—although not as good as when I wrote his speeches. He is absolutely correct that there is uncertainty about that grant, and about how it is handed out by local commissioning groups. It is not getting through to children’s hospices, and I hope the Minister will have something to say about tweaking the way that grant is allocated to local areas.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

Sixty-six per cent. of adult hospice income and 80% of children’s hospice income is raised through fundraising—bake sales, charity shops and marathons—and Marie Curie depends on that more than others. Does the hon. Gentleman agree that we should put on the record our thanks to the volunteers who make the effort and get the money in?

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

The hon. Gentleman is absolutely correct. I only have to see Mountbatten local networks of fundraising and charity supporters, whether in charity shops or in fundraising roles. I am honoured that I may become part of that community—if I land on the ground safety, alongside Miles—but it will not end there. I will carry on fundraising for a fantastic cause.

When Mountbatten hospice wrote to me in January to outline those extraordinary energy costs, I was happy to write on its behalf to the Secretary of State. Unfortunately, the energy bill relief scheme and the later energy bills discount scheme did not ease the pressures, as the hospice was not eligible. Mountbatten still faces unsustainable pressure, as do hospices across the United Kingdom.

Of course, there are some people who ask whether a charity should not take the majority of its funding from its local community—from donations and contributions, rather than from Government funding. That is a fair question, but unfortunately it does not provide a solution, especially considering that community donations already support 70% of Mountbatten’s funding, which it has calculated to be the limit of what it can ask from people.

Photo of Andy McDonald Andy McDonald Labour, Middlesbrough

The hon. Gentleman is making an excellent speech. He is right about donations, but my local hospice, Teesside Hospice, is really struggling. I congratulate Peter Gibson on his work in that respect. Is Paul Holmes not describing a perfect storm? There is a statutory obligation on the NHS to fund hospices for medical care, but the NHS is entirely strapped. Can I divert him away from the solution of asking members of staff to tighten their belts even further? That is not an option. When we cannot recruit and retain, that is not the solution. We need a fundamental reset of the economic settlement.

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh

I hope the hon. Gentleman has not taken from my speech that I am suggesting that staff tighten their belts. In fact, I am advocating that hospices be allowed to follow the NHS pay settlement model, and be funded properly to so do. I would say to the hon. Gentleman that the Government have put their hand in their pocket through the £1.5 billion uplift, although that is simply not getting through from the Department of Health and Social Care and local commissioning boards to the hospices. That is where the Government need to step in to a greater extent. Therefore, I ask the Government to take the issue seriously and to continue to treat the charity care sector with the priority it deserves.

Hospices do incredible work, and they represent spectacular value owing to the services they provide. We cannot allow that vital link in the care chain to be broken, or even weakened, particularly at this time. Evidence submitted to the all-party parliamentary group on hospice and end of life care’s report detailed how the covid-19 pandemic made fundraising even more challenging for hospices. Hospices experienced a massive decrease in income while facing unprecedented demand for their services. One hospice’s overnight sitting service had to end due to lack of funding to sustain it, which highlights how dependent those services are on charitable donations.

It is important to highlight the fact that the sustainability of the hospice sector continues to be tested due to the cost of living crisis. Some sort of long-term funding settlement for hospices would be in the interests of all concerned because 160,000 more people each year are expected to require palliative care by the end of 2040. Having sufficient staff and volunteer resourcing in the specialist palliative care field is essential. An ideal outcome would be the Government and the NHS working with the hospice sector to provide an ongoing financial settlement, with regular contractual reviews to ensure that the support that hospices receive is at least the minimum they require to keep services running. That should be directed to cover both staffing and energy cost rises.

Doing that would be in the best interests not only of hospices, because hospices play a vital role in reducing pressure on NHS services by providing bed space and crucial care capacity. The NHS can scarce afford to lose such space and capacity, particularly in the light of the current waiting lists, but lose them it may if action is not taken.

Several hon. Members:


Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

Order. Members will see that a lot of colleagues want to get in. I will do my best to call as many Members to speak as possible, and that will require a three-minute time limit from the start. I call Kate Hollern.

Photo of Kate Hollern Kate Hollern Labour, Blackburn 9:47, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes, and I congratulate Paul Holmes on securing this important and timely debate.

I begin by paying tribute to East Lancashire Hospice, and the staff and volunteers who deliver exceptional services to people in difficult family circumstances. You will excuse me if I get a bit emotional, Ms Nokes, because my family benefited greatly from East Lancs Hospice, and I could not have come through a very difficult time without its support.

Sadly, many hospices are facing an existential crisis. Unlike big business, as energy and food prices rise, hospices cannot pass the cost on to their customers. In fact, the opposite is true, because as the cost of living increases, donations invariably decrease as individuals on whose generosity hospices rely feel the pinch. As a result, hospices have less money available for paying staff, who themselves are struggling to make ends meet.

It is vital that the Government address that unsustainable situation because the care provided by hospice services cannot be replicated elsewhere within the NHS. Indeed, hospices take a burden off the NHS. Let us be honest: a reduction in hospice services would result in increased hospital admissions, higher costs and bed shortages, all of which would further stretch our already overwhelmed health system.

According to Hospice UK, hospices are collectively budgeting for a deficit of £186 million. Therefore, Hospice UK is calling for the Government to take action to help hospices with rising costs, and asking for £30 million of Government funding for hospices to offset the cost of increased energy bills in the year ahead, as well as £102 million for hospices in England to help them to keep pace with NHS pay rises.

In April, I visited East Lancs Hospice. I met the chief executive and staff, and I had the pleasure of observing the remarkable care provided by this wonderful team every day. I was in awe of the diligence with which staff supported patients and their families, but I was also reminded me of the support and care given to John, my partner, in the last days of his life.

Back to business. The hospice does not receive full funding from the NHS; apart from its core grant, it must fundraise in order to make ends meet. Like most hospices, it is very creative in that fundraising. The turnover of the East Lancashire Hospice is £4 million, but the core grant is only £1.6 million. That means that they must find £2.4 million. I beg the Minister to address the funding for hospices urgently.

Photo of Peter Gibson Peter Gibson Conservative, Darlington 9:50, 14 June 2023

I congratulate my hon. Friend Paul Holmes on securing this important debate, and I extend my condolences to him on the loss of his office manager. I draw the attention of the Chamber to my entry in the Register of Members’ Financial Interests, particularly as a trustee of North Yorkshire Hospice Care, and to my co-chairmanship of the APPG on hospice and end of life care. I put on record my thanks to everybody in our hospices—the nurses, the doctors, the trustees, the volunteers and the fundraisers—for all that they do.

As my hon. Friend mentioned, the APPG recently published a report entitled “The Lasting Impact of COVID-19 on Death, Dying and Bereavement”. I know that the Minister has received a copy of that report, because I personally handed it to her. One of the key points in it was about sustainability of funding for end of life care and bereavement services, and about the need for funding to them to provide their care confidently, commissioning for the years ahead, not just the year ahead.

I recently convened a meeting of all the MPs and hospices in the Tees valley, and there is a very sad picture. In Darlington, St Teresa’s Hospice is posting a £541,000 deficit this year. Teesside Hospice is posting a deficit of £400,000 this year, and Alice House Hospice in Hartlepool has had to close a unit. It does not have to be this way. Ask anyone where they want to die; they will tell you that they want to die at home, surrounded by their loved ones. Our hospices provide support to enable that to happen. Given a choice between a hospital and a hospice, people will choose a hospice.

We know that deaths in hospital are costly, blocking beds and often giving people a less than good death. I want to see everyone have access to a good death, and I want the NHS to save money and unblock beds. That can be achieved with proper commissioning and support for palliative care, as required by the Health and Care Act 2022, not just in Darlington, Teesside or North Yorkshire, but right across the country. We would not, in this day and age, fund maternity care by running bake sales, skydiving or wing-walking, but it seems perfectly acceptable to many that that is how we should fund palliative care. It is not right and it is not fair, and the time for dealing with it is now.

UK hospices are budgeting for a deficit of £186 million this year. Our integrated care boards must step up to the plate, commissioning and paying for the hospice care that their community needs and, at the same time, safeguarding these institutions that are so integral to our communities, saving the NHS money and reducing bed blocking. It really has the potential to be a win-win situation. I implore the Minister to do everything in her power to get this sorted, once and for all.

Photo of Samantha Dixon Samantha Dixon Labour, City of Chester 9:53, 14 June 2023

It is a pleasure to speak under your chairmanship, Ms Nokes. I congratulate Paul Holmes on securing this important debate.

As we have heard, hospices provide compassionate care and support for more than 300,000 individuals a year who are facing life-limiting illnesses. They offer a place of comfort, dignity and peace not just for their patients, but for families and loved ones. May I take this opportunity to pay tribute to the incredible staff at hospices around the country, in particular the Hospice of the Good Shepherd in Backford in my constituency, where members of my own family have received care in the past? We should also thank the wider palliative care workforce, who work extremely hard to provide good care for so many.

Unfortunately, as we have heard, the reality for so many hospices is becoming increasingly bleak. Collectively, they are budgeting for a deficit of millions due to rising costs, with high energy bills and rising staff costs hitting hospices at a time when donations have dropped as a result of the cost of living crisis. I applaud the trustees at the Hospice of the Good Shepherd, who have taken the decision to match NHS workforce payments—an important step to establish the workforce and continue as a going concern. However, they are facing energy consumption that is going through the roof. They cannot reduce it, because they need to keep machines running and keep the in-patient unit warm or cool for those who need care.

As we know, the majority of hospices rely on charitable funding for a significant part of their finances. When I visited the Hospice of the Good Shepherd, the staff told me about the brilliant ways people raise funds. They include the corporate challenge, where local businesses grow £50 into £20,000, the Chester Sparkle Walk on 16 June, and local people holding individual events—my friends Steve and Zena held a garden party on Saturday and raised £800.

Those imaginative initiatives are essential for hospices to keep a good connection with their communities, but with costs increasing, Government must do more to lend support to hospices and their staff so that they can continue to provide their essential work.

Photo of Robin Millar Robin Millar Conservative, Aberconwy 9:56, 14 June 2023

It is a pleasure to serve under your chairmanship. Ms Nokes. I thank and congratulate Paul Holmes: judging by the attendance at this debate, he has struck a chord.

I would like to pay tribute briefly to two hospices in my constituency, St David’s and Tŷ Gobaith, which is Welsh for “Hope House”, and particularly to the clinical teams there. The UK has a reputation for having some of the best palliative care in the world, but it is not appreciated as much as it might be. I thank healthcare workers, the volunteers, who have such a critical role to play, and those who donate: donations provide up to 70% of Tŷ Gobaith’s income.

It is true indeed that hospices play a key role: 90 children a year are looked after by Tŷ Gobaith, which has the effect of reducing pressure on the NHS and delivering end of life care within homes across north Wales, as my hon. Friend Peter Gibson mentioned. The hospice faces record numbers of referrals, as increasing numbers of babies and children in Wales are living with complex life-limiting conditions. It forecasts a deficit of £1.3 million this year and will not be cost-neutral in 2026.

As the chief executive of St David’s has said, part of the problem is that awareness of the role and value of the hospice does not come until the point at which it is needed. My point is not to talk about how we have a perhaps fading Christian message in our society of a God who walks with us through troubles—through that valley of the shadow of death. It is not about a fading tradition in which the body of the deceased was once laid out at home, or about the trend in science where we are now able to extend the life of the body beyond sentience. It is more that it is the hospice that is in that space, very often helping us and walking through it with us. That role and the excellence of palliative care are crucial and must not be neglected. Beyond the care itself, it is about research into and understanding of that support.

On the point about finance, it is clear that across Wales £4.4 million is needed from the Welsh Government. The pressures on finance from that most pernicious of taxes, inflation, are incredible, but staffing is the biggest cost: 71% of hospice costs are related to staffing. In Wales in particular, there is pressure through the NHS pay deal. Hospices must compete for the staff that they have in their care homes. If I had time, I would talk about the challenges of energy supply costs: St David’s has had an extra 50% on its heating and energy bill as a result of price rises.

Hospices have earned our respect. There is no doubt that their staff and teams have also won our deep gratitude. Now they must have our support.

Photo of Yasmin Qureshi Yasmin Qureshi Shadow Minister (Equalities Office) 9:59, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes. I congratulate Paul Holmes on securing today’s important debate. It is personal to me, as I know it is to many parliamentary colleagues here. My mother died recently, and then my brother died about 11 months ago: the very least we can do for those who have been given a terminal diagnosis is to ensure that they die with dignity, surrounded by loved ones. Hospices are there to help and to alleviate physical, emotional and psychological suffering. Their work ensures that a dying person’s final days are made as peaceful as possible.

Bolton Hospice, which serves my constituency, has a reputation for providing outstanding care to its patients, but it is expensive to run and gets minimal Government support. A constituent recently wrote to me to praise its work, telling me that her husband had been given just months to live:

“The ‘hospice at home’ team supported me and the girls to make unforgettable memories from the comfort of our living room…later he was admitted to the inpatient unit at Bolton Hospice where he passed away with his loved ones at his bedside.”

Even beyond his death, the hospice continued to support her and her young daughters through those very difficult times.

Bolton Hospice needs to raise over £4 million each year to be able to provide its specialist services. It is an independent charity; it relies solely on the generosity of donations and fundraising from the people of Bolton. The cost of living crisis has tipped its financial difficulties from a challenging position to crisis point. In the current climate, it is £457,000 worse off than in 2008. Hospice care, as we have heard, is an intensive user of energy, because of the need to maintain temperatures as well as extensive electrical equipment, from oxygen pumps to ventilators. Rising food prices have also meant that the cost of feeding patients has increased by 10%, while the cost of transporting patients has gone up by 44%.

Like other hospices, Bolton Hospice has worked hard to improve its fundraising, but it is running at an operational deficit of £1.2 million. Unless the Government intervene with an uplift of funding for 2024, it will have to reduce beds by 40% and reduce its care or end other vital services. The Minister must acknowledge that if hospices have to reduce or close down, that will place pressure on the NHS and our hospitals. At this time, because of the rising cost of living, the local community is not able to give as much money. I ask the Minister to make an exception in the case of hospices, and grant them the money.

Photo of Chris Green Chris Green Conservative, Bolton West 10:02, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes, and to follow my constituency neighbour Yasmin Qureshi, who champions the cause of Bolton Hospice so effectively. I congratulate my hon. Friend Paul Holmes on securing this timely debate; the fact that it is so well attended demonstrates how important the hospice movement is, right across the land.

The service that Bolton Hospice, Wigan and Leigh Hospice and Derian House Children’s Hospice provide to my constituents is an immensely important part of the community. The charitable and fundraising aspect represents their importance to so many people in the community. When we are going through very difficult economic times, whether they are caused by war in Europe, by covid or by lockdown restrictions, that makes it very difficult to fund hospices, so they have relied for many years on simple things such as sponsored walks and other events and activities. They value that relationship with the community. I have never had a sense from the hospice movement that it wants to be dependent on the national health service. They need that healthy relationship, but they also need certainty of funding from the national health service.

My principal question to the Minister, because so many of the key arguments have been made so compellingly, is what she can do with the integrated care systems and integrated care boards, as well as with the national health service, to maintain and shore up their relationship with their local hospices. That point is not necessarily recognised, because the hospice movement is independent of and separate from the national health service. When the NHS is going through a difficult squeeze, it is perhaps those other services, which are so important to the local community and which have such fantastic staff and so many superb volunteers doing amazing work, that are not necessarily recognised by the local system in the way they should be. The Minister must encourage and support integrated care systems and integrated care boards to deliver.

Several hon. Members:


Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

Order. I will reduce the time limit to two minutes after the next speaker.

Photo of Cat Smith Cat Smith Labour, Lancaster and Fleetwood 10:04, 14 June 2023

I congratulate Paul Holmes on securing this debate and on volunteering to join the community of those of us who do daft things to fundraise for our local hospices.

Lancashire and South Cumbria hospices have been informed that our ICB has offered them a 0% uplift on their 2022-23 funding. Following on from last year’s 1.7% uplift, that results in significant pressure, with the cost of living crisis and the need to retain doctors and nurses and be competitive with the NHS.

People often do not realise that our hospices rely on the good will of local communities and on fundraising. On average, two thirds of adult hospice income and four fifths of children’s hospice income is raised through fundraising. St John’s Hospice in Lancaster costs more than £5.1 million a year to run, and only about a third of that is provided by Government funding. That is why I decided two months ago that I would run the 26.2-mile London marathon to try to plug that gap, but I only managed to raise £1,500.

Hospice funding has never been a sustainable model. The crisis, rising energy costs and inflation are creating a perfect storm. The cost of living crisis is putting pressure on charitable donations. Hospices cannot simply reduce their energy use, and they need to remain competitive with NHS pay to recruit and retain staff.

Trinity Hospice in Blackpool’s hospice-at-home service directly supported 70% of all those who died at home on the Fylde coast last year. The Minister will also be aware of Brian House Children’s Hospice, which is part of the Trinity service. For many years, it has served families on the Fylde coast who have the joy, but also the challenges, of raising and loving a child with a life-limiting diagnosis.

I want to press the Minister on the issue of children’s hospices. I have visited the hospice on many occasions and have seen the amazing work to support so many of my constituents living in the most unimaginable circumstances, yet Brian House has seen a huge challenge to its funding, with its grant cut by £50,000. It is already one of the children’s hospices with the least Government and health authority funding in the country: only 14% of its expected £1.6 million annual operating costs. A further loss of £185,000 next year is unimaginable.

I thank the Minister for meeting my constituency neighbour, Paul Maynard, and me. Unfortunately, the hon. Gentleman cannot be here today, but he shares my concerns about the funding for Brian’s House Children’s Hospice. Can the Minister reassure him and me that this issue is on her radar and that she is doing all she can to ensure that no children’s hospice loses out on funding because of changes to formulas?

Photo of Kevin Foster Kevin Foster Conservative, Torbay 10:07, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes. I congratulate my hon. Friend Paul Holmes on securing this debate.

Like many Members in this debate, I have seen at first hand what it means to be supported by hospice services. Back in January 2014, my mother Linda was entering the final stages of her battle with bowel cancer when she was cared for by St Luke’s Hospice Plymouth. The staff there helped create some very special memories, which made her passing easier for all of us, especially my mum. Similarly, the support for my family from the local hospice and palliative care teams in Tameside two years ago as my stepdaughter Anne approached the end was significant to us all.

Colleagues have expressed and described the challenges facing the sector, but I also want to add a note of optimism to the debate. Rowcroft Hospice in Torquay marked its 40th anniversary last year not just by looking back over those 40 years, but by firmly looking to the future, unveiling a multimillion-pound investment and development programme that includes a new 60-bed specialist nursing home centred around a village green. A village hall, restaurant and allotments would also be part of the development, as well as a children’s nursery and estate workshop. The plans are very welcome, as they will be a boost not only for Rowcroft but for Torbay’s entire health and social care sector, with the hospice facility at its centre.

I am conscious that time is limited, but I have a couple of specific points on which I want to hear the Minister’s thoughts. First, even though it is clear that the hospice movement does not wish to become a fully publicly funded healthcare service, what further options may be provided for support with some of the costs they face? Secondly, what support will be provided to hospices that are looking to expand their services and develop new integrated care offerings, as Rowcroft Hospice seeks to do?

Hospices are a unique place where life is added to days when days can no longer be added to life. They provide a service not just to in-patients, but to a whole community. I hope we can support them to continue doing so.

Photo of Mary Foy Mary Foy Labour, City of Durham 10:09, 14 June 2023

I thank Paul Holmes for securing this important debate. I extend my condolences to him for the loss of his manager Sue.

I start by giving my heartfelt thanks to all those who work in hospices. Ensuring that people can pass away in comfort and dignity is an extremely honourable profession, and it means a great deal to people, as we have heard. The cost of living crisis is affecting hospices up and down the country, and we need to take it seriously. Even before the cost of living crisis began, working in a hospice was challenging. The Government should not be making it harder.

The Minister should be concerned by what hospices such as the brilliant St Cuthbert’s Hospice in my constituency are saying. Inflation, for one, is a real concern. What St Cuthbert’s is receiving from the integrated care board does not even come close to either wage inflation or general inflation. It is seeing a massive rise in its energy costs, by tens of thousands of pounds. As we have heard, a care home cannot reduce its energy consumption.

The marketplace for specialist staff is currently extremely competitive. The absence of a proper workforce plan from the Government is not helping. It should be noted that despite the challenges it is facing, St Cuthbert’s Hospice continues to run at 100% satisfaction. I know the Minister will mention the £100 million announced in the spring Budget, but that falls short of what is really needed. Hospices are collectively budgeting for a deficit of more than £180 million this year.

Where is the support for energy bills? Hospices need to be able to offset their costs. After all, it does not reflect well on a society when the Government do not prioritise end of life care. Patients require the utmost dignity, and the Government should be ensuring that their dignity is prioritised.

Photo of James Wild James Wild Conservative, North West Norfolk 10:11, 14 June 2023

I congratulate my hon. Friend Paul Holmes on securing this important debate. It is timely for me, as on Friday I visited the Norfolk Hospice Tapping House in my constituency to talk to the staff and volunteers who provide the care, comfort and compassion for people living with life-limiting illnesses.

Tapping House is rightly a valued part of the west Norfolk community, supporting more than 1,000 families each year. At the heart of that hospice, and all hospices, are the incredible staff who provide high-quality care and go above and beyond to make people’s final days as comfortable and memorable as possible—even, I heard, providing virtual reality headsets so that patients can imagine being on a tropical island and enjoying a cocktail from their bed. The brilliant team at Tapping House is supported by hundreds of volunteers, and it is testament to the great care provided there that many of the volunteers and fundraisers are family members of people who spent their last days in the hospice. We have heard about the escalating costs in Tapping House, as energy costs have risen by 36% in the past year alone.

That brings me to funding. Only 30% of Tapping House’s services are funded from the NHS, with the rest coming from donations. Despite the challenging economic backdrop, Tapping House just held one of its most successful events, Tulips for Tapping, at which people could go into tulip fields near Sandringham and experience their great beauty. That event raised more than £140,000. However, the NHS funding received for in-patient units has not increased for the past two years, and community-based services have not seen an increase for several years.

I would be grateful if the Minister could say how much of the £1.5 billion for additional costs has actually flowed through to hospices. Along with other MPs, I have previously called for additional support for hospices, and the Government responded positively. The sector needs urgent support now; I hope the Government will carefully consider the requests that have been made and provide that additional support.

Photo of Tim Farron Tim Farron Liberal Democrat Spokesperson (Environment, Food and Rural Affairs), Liberal Democrat Lords Spokesperson (Communities and Local Government) 10:13, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes. I pay tribute to Paul Holmes for securing this important debate.

St Mary’s Hospice at Ulverston, St John’s Hospice at Lancaster and the Eden Valley Hospice at Carlisle provide tender, professional and specialist care for people with life-limiting conditions and their loved ones—something we are so grateful for. They prove that life has dignity from beginning to end. Hospitals, however marvellous they are, do not have the resources to replicate the care that is provided by hospices.

The costs of running a hospice have gone through the roof in recent times. Val Stangoe, the chief executive of St Mary’s, one of our three local hospices, said to me:

“The recent settlement by the NHS Lancashire South Cumbria ICB of 0.0%”— as pointed out by Cat Smith

“has left our hospices in a state of financial deficit, with potential loss of hospice beds and services.”

She went on:

“Your local hospices”— our hospices—

“are now operating on a deficit budget, have received the lowest settlements in England. The proposed 0.0% uplift equates to almost 10% in cuts, significantly impacting delivery of services. This stands in contrast to other regions, where hospices have received an average uplift of 2.7%”— which is not enough. She continued:

“The disproportionate treatment faced by hospices in Lancashire South Cumbria is unfair and must be addressed.”

My fundamental ask of the Minister is this: will she directly involve herself in that situation to stop our hospices in Cumbria suffering? I have been asking the Government for months to come up with a scheme to help hospices that are struggling with their energy costs, which have gone up three times in recent months. There are lots of promises and no action.

There is a cost to meeting the NHS pay settlement. There is a cost to ensuring that hospices are paid properly so that they can pay their staff, keep them, and recruit them in the first place, and so that they can pay their energy bills. But the cost of not doing that is far greater, not only in terms of the health damage and people’s pain and suffering, but for the hospitals that have to pick up the pieces when hospices are not able to meet people’s needs.

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

Because one speaker has dropped out, I am going to increase the time limit back to three minutes.

Photo of Robin Walker Robin Walker The Parliamentary Under-Secretary of State for Scotland, Chair, Education Committee, Chair, Education Committee 10:15, 14 June 2023

I congratulate my hon. Friend Paul Holmes on securing this debate, and everyone who has spoken. We have heard some fantastic speeches.

Hospices provide a vital public service, but it is important to recognise that they are not, and do not want to be, part of the publicly funded NHS. Their flexibility as independent organisations helps them to meet the many and varied needs of people at the end of their life and with life-limiting conditions. They do a fantastic job of fundraising to support their activities so that they can deliver impact way beyond the value of the small public contributions they receive.

I am fortunate to have two brilliant hospices in my patch—St Richard’s Hospice and Acorns Children’s Hospice. I remember the first time I visited St Richard’s, and there was a sense of trepidation. It is a place where people go to die; would it not be a sad and depressing visit? Not a bit. I was amazed at how uplifting and positive it was. A few months later, I sadly got to know the hospice much better. Just a month after I was elected, my father was admitted to St Richard’s Hospice, and it provided amazing care and incredible support to my family. I echo Yasmin Qureshi, who talked about people dying with dignity with their loved ones around them. That is what the work of adult hospices should be, and is, all about.

St Richard’s tells me that only about £700,000 of its £12 million income comes from the NHS and the public purse. It has been offered an uplift of 1.8% by our local ICB, which would be worth about £40,000. A 1% pay rise for its staff would cost about double that, and matching the NHS 5% increase would cost about 10 times as much. I will not ask Ministers to take over funding for hospices, or the NHS to take a much larger share of hospice funding, but it is fair to ask them to provide help when inflation and the Government’s own pay increases are driving up costs for hospices. The ask from Hospice UK is for £30 million of Government funding to offset the increase in energy bills and £102 million for hospices in England to help them to keep pace with NHS pay rises in the next year. That is not unreasonable.

Children’s hospices also do an amazing job. They are also uplifting and inspiring places, as we have heard from many Members. I am fortunate to have Acorns in my patch, which has already been mentioned by my right hon. Friend Wendy Morton. It has a new CEO and it is about to celebrate its 20th anniversary. I want that to be a successful moment, and certainty about the children’s hospice grant would be incredibly helpful in that respect. The grant has sustained children’s hospices—it has kept them going year after year—but its short-term nature has become a problem for them.

We recently saw some welcome news from the Government about sports funding in schools—they have finally provided a multi-year settlement after many years of not being able to do so—and I hope they consider doing the same for children’s hospices. A multi-year settlement would make a massive difference, and giving some certainty that the grant will be renewed is essential.

Photo of Stephanie Peacock Stephanie Peacock Shadow Minister (Digital, Culture, Media and Sport) 10:18, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes. I pay tribute to Paul Holmes for securing this important debate and for his incredibly powerful speech; I pass on my condolences. I also pay tribute to Barnsley Hospice and Bluebell Wood Children’s Hospice in South Yorkshire, which I want to focus on.

Six-year-old Daniel from Darfield in Barnsley has been receiving care at Bluebell Wood for mitochondrial disease and cerebral palsy. He struggles to sit, eat and stand, and his family simply do not know how long they have left, but they treasure every day despite facing many challenges. Daniel has received excellent care, and his family are grateful to Bluebell Wood for all that it does, but they want greater security for hospices and they want to speak directly to the Government to ask for it, because they do not know whether Daniel will be able to receive the end of life care that he might need at Bluebell Wood. I have raised this issue at Prime Minister’s questions and I was grateful for my discussion with the Minister when I met her a few weeks ago.

Last year, Bluebell Wood hospice was forced to close because of staffing pressures. It is now open again, but only to 90% of its capacity. When I visited a few weeks ago, the staff spoke about not only how they are of course there to provide end of life care, but how they do so much more. They provide respite care and support for parents, siblings and families. They try to provide fun and happiness, to make memories at what is an incredibly difficult and traumatic time. I saw that work at first hand. It was incredibly moving also to see at first hand the hospice’s end of life suite. The staff took me into what they call the cold room, which is where families will spend their final time together at the very end of the life and after passing. Often, it is where the larger family can say their goodbyes.

The staff told me that there is nothing they can do to prolong a child’s life at the worst moment in a family’s life, but what they can do is do everything they can to support families, which is often so important to the grieving process. That is the most powerful case for the provision of greater support and security for hospices—for all the different things we have spoken about today, including the continuation of the energy support grant, particularly for children’s hospices, and of course the provision of a longer-term and more secure model.

I conclude by thanking the amazing staff, medics and volunteers who continue to do all the work that they do at Bluebell Wood, at Barnsley Hospice and at hospices across the country, so that Daniel and all the children and young people in a similar situation receive the care they deserve when they need it.

Photo of Rachael Maskell Rachael Maskell Labour/Co-operative, York Central 10:21, 14 June 2023

It is a pleasure to serve with you in the Chair, Ms Nokes, and I thank Paul Holmes for securing this timely and important debate.

For children in York, hospice care is provided by Martin House, and for adults by St Leonard’s. I pay tribute to all the staff at both hospices for their services and their love, care, professionalism, sacrifice and dedication for their patients and the families they serve. Where would we be without them? I will never forget the doctor, who had experience right across the NHS, who told me that before she came to St Leonard’s she had never seen care like it. That is what people across this country experience as they pass from this world.

Hospices are special places, as we have heard at lot in this debate, but they are also important places whose funding we cannot just leave to the rattling of tins. That is why it is so important that we focus on their funding, which is the call from today’s debate that the Minister must hear loud and clear. It is not good enough just to say that ICBs have the money and it is their decision, because ultimately hospices need funding from the Government. Now that the Government have put it on the statute book, thanks to the Lords, they need to make sure that they put the money behind this service.

Let me talk about St Leonard’s, which this year faces a £1 million deficit. It has not received the increase in funding to cope with the pressures of inflation. It received just £340,000 from the better care fund, which is the same amount as in 2016. There has been no increase, despite the fact that there has been an increase in the number of patients, moving from 200 back then, with the hospice-at-home service, to 700 patients a year now. St Leonard’s provides excellent care in the home, allowing people to choose where they die and the support they receive when they die.

The hospice faces fuel costs that are up by 180% for that hospice-at-home service. Of course, the in-patient service has seen energy costs rising, alongside the rising cost of food and so many other things. Indeed, staffing costs have also increased and are up by 31% over the last three years. We cannot just keep rattling tins when the cost of living crisis is impacting on everyone; we need to find a secure, assured and long-term funding solution for the services we are talking about.

Less than 30% of St Leonard’s funding comes from statutory sources. That situation cries out to this Government: “Surely, ensuring that people have a good death is worth finding the money for.” That is why I call on the Minister to think about what this means not just for NHS budgets but for families, carers and all the people who depend on hospice services. We need to move urgently to find that security, just as people find that security at the end of life.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 10:24, 14 June 2023

This is one of those occasions when being called last means I gain a minute, so I am pleased to have the opportunity to do just that—thank you, Ms Nokes. I thank Paul Holmes for setting the scene so well, and for giving us the chance to participate in a debate that moves us all. Some Members have told very personal stories.

I put on the record my thanks to all the charities, groups and staff who give hospice care, and give families, and us in this House, so much across this great United Kingdom. Our NHS is under immense strain, and we completely understand that there is a finite budget, but questions have to be asked about the use of funds when we look at those at the end of their lives living in conditions that are not acceptable. Rising costs from energy, food prices and staff costs, which are required to meet expected NHS pay rises, mean that hospices across the United Kingdom of Great Britain and Northern Ireland are collectively budgeting for a massive deficit of £186 million this year. Unless we are going to understaff, under-feed, under-medicate or under-heat our dying patients, more money is needed—that is the bottom line.

It is always a pleasure to see the Minister in her place. She grasps the situation very well. She is a lady well known for her compassion and understanding, and I look forward to her response. I agree with Hospice UK, which says that hospices need financial support to continue to offer their essential services. Government funding of £30 million for UK hospices to offset the increased cost of energy bills in the year ahead needs to go beyond the energy bills discount scheme. Additional funding for hospices from the Department of Health in Northern Ireland is also needed; I do not know whether the Minister has had a chance to consider that. The fact is that funding for hospice care is unsustainable. By the end of the year, 86% of hospices will be impacted by increasing energy prices. They need to keep medical machines running and their in-patient units warm for those in their care. Some 71% of hospice expenditure is on staff, which is a massive issue. As I referred to in an intervention, charities and volunteers run 66% of adult hospices and 80% of children’s hospices.

Over the next few years, I and others, as we often do, will help those hospices. Marie Curie, based in Knock Road in Belfast, is a hospice that I have visited to see people who have now passed away. I understand what such hospices do. The facts are clear: savings can always be made with improvements, but on nowhere near the scale that is needed. I therefore believe, with respect, that the Government and the Minister must man the breach. We regularly prioritise human rights in other nations, and the most basic right to a good death must be prioritised in the United Kingdom. That is what we want. It is a very simple request, and I hope the Minister can answer in a positive fashion.

Photo of Patrick Grady Patrick Grady Scottish National Party, Glasgow North 10:27, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes. I, too, congratulate Paul Holmes on securing the debate, and echo the tributes and condolences that have been paid to his chief of staff, and all those who knew her.

Many, if not most, people will know, or know of, someone who has passed away in the care of a hospice. The hon. Members for Blackburn (Kate Hollern), for City of Chester (Samantha Dixon), for Bolton South East (Yasmin Qureshi), for Torbay (Kevin Foster) and for Worcester (Mr Walker) all spoke of their personal experiences. I have spoken previously of Liz Quinn, a long-standing activist in Glasgow Kelvin SNP, who spent her final days in the Marie Curie Hospice in Glasgow shortly before the 2017 election. In a debate in March I spoke about my good friend Melanie, who at that point was receiving care from the wonderful and dedicated staff at the Highland Hospice in Inverness. That care continued right up until the end, about a month or so later.

In many ways, that care provision has not stopped, because the hospice is still there to support Melanie’s husband, their son, and other family and friends. The compassion and support shown by the hospice movement, both before and after bereavement, is another of the aspects that make it such a special and valuable service. For that, we thank all those who work and volunteer for our hospices. The wraparound care—from the respite, which is beneficial to both the patient and their family, to ongoing support for their emotional wellbeing, practical advice for families dealing with finances, and signposting to other more specialised services, especially helping younger people and children to come to terms with trauma and loss—is all part of the service.

As we have heard, that incredible work is mostly done without reliance on public funding. Hospice UK estimates that up to two thirds of adult hospice income, and four fifths of children’s hospice income, derives from fundraising. Much like the hon. Member for Eastleigh, I hope to contribute in a small way by running the Loch Lomond 10K on Saturday for the Highland Hospice in memory of Melanie—perhaps we can swap JustGiving pages. We can aim to the heights of Cat Smith by running a marathon eventually.

As Jim Shannon said, we ought to express our thanks to all the people who have raised funds in so many ways; whether that is through runs, bungee jumps, skydives or marathons, it is admirable and inspiring. But increasingly it is not enough. The cumulative impact of energy, food, staffing and other price rises have left the hospice sector across the UK budgeting for a deficit of around £186 million this year. It is becoming a literally existential crisis for many individual hospices. In particular, we should recognise the work of the all-party parliamentary group on hospice and end of life care. I pay tribute to Peter Gibson for the report that was produced early this year.

Perhaps in some areas of the public sector, maybe even in health or wider services, there are possibilities to cut costs, but that is much more difficult for hospices. Medical machinery must be able to run 24/7 and 365 days a year. Temperature control—usually that means heating, although in the current season it may mean a little bit of cooling—is vital because maintaining comfortable temperatures for patients is a key aspect of palliative care, as is the provision of wholesome nutritious and tasty food.

The Government may have a target of reducing energy and food inflation, but that does not mean prices reducing; lower inflation just means prices rising a little slower. All that is driving wage inflation. Of course hospices want to be able to keep up with NHS pay rises. The better pay and conditions are for staff, the better level of service they in turn will be able to provide for those in their care.

We must acknowledge that there are staff shortages across the health and care sector as a result of the Government’s decision to force through a hard Brexit. We will never know how many trained and talented health and medical workers arrive here on small boats because the Government refuse to ask them—they would prefer to put them up in hotels or deport them to Rwanda than let them put their skills to use in hospices or hospitals.

The risk of all those challenges is a reduction in a service that everyone who has spoken in this debate agrees is of immense value on so many levels, but reduced provision is not going to mean that there is reduced demand. In fact, Sue Ryder has calculated that demand for palliative care in England is likely to rise by 55% in the next 10 years. If the hospice sector cannot provide the care, the costs will still have to be met from somewhere, either by the NHS directly, by other social care providers, by local authorities or ultimately by the families of the people who need the care themselves. They will have to take time out of the workforce to become full-time carers or pay emotional, psychological or even physical costs to their own wellbeing as they try to cope without professional support. That in turn simply increases costs for social security or the NHS. Therefore, in a way, providing adequate support for palliative care now also has longer-term preventive effects in the future.

The sector has made its funding requirements clear to the UK and Scottish Governments. Those include at least £30 million to offset energy costs above and beyond what is provided through the energy bills discount scheme. Sue Ryder sees the need for a step change in the funding approach, saying a commitment to fund 70% of total palliative care costs is the minimum required to ensure the sustainability of the sector in the medium term. In his intervention, Stephen Hammond made an important point about budgeting certainty.

The Government must take this seriously. Access to care and compassion at the end of life should not have to be fought for or seen as some kind of luxury. If Westminster Hall debates are to have any kind of impact, it should be to give notice to the Government of the challenges that lie ahead and an indication that our constituents are paying attention. Sixteen Back Benchers in a Westminster Hall debate—it is a pretty good show these days. That is to say nothing of the eight different interventions. That suggests the seriousness with which the Government must take this issue.

Many people in Glasgow North are thankful for the support that the hospice sector has provided to their loved ones. I hope the Minister, when she responds, will agree that a cost of living crisis should not be allowed to turn into a cost of dying crisis.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health and Social Care) 10:34, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes. This has been a really important and good debate; we do not always say that about debates in this place. I thank Paul Holmes for securing it. He spoke with great passion and personal insight, and I am sure Sue’s family and friends will thank him for what he said. I also thank all hon. Members who spoke about their personal experiences. It is not always easy to do that here, but they have shown great courage.

Many Members thanked the amazing hospices in their constituencies. I hope they will forgive me for also paying tribute to LOROS Hospice in Leicester West, which I have visited many times. I am blown away by the care and compassion there, and the complete humanity shown to others. I am very grateful for that.

The argument I want to make today is that we need a much bigger, more serious debate about what makes for a good death, in the words of Jim Shannon. Policy really needs to change across the board. When the welfare state and the NHS were created, average life expectancy was 63. Now it is over 80, and one in four babies born today is going to live to 100. Back then, most people died of infectious diseases or accidents. Now, it is long-term chronic conditions. That means we are now experiencing death in a very different way. Often, death is not sudden; it may be long and difficult, both physically and emotionally.

Hospices—including hospice at home, because that is where many people want to die—need to be seen as an essential part of our health and care system, not an optional extra, a luxury or an add-on, as part of that much bigger debate about what makes for a good death. “A good death” is not perhaps a great campaigning slogan for any political party to focus on, but it is the truth of what we face, and politics needs to keep up with the changes in society. We need to start looking at that. The vital role of hospices and the need to properly plan a funding system, our workforce, training and how we link services and support is the context within which I see today’s debate. Quite frankly, people do not want to die in hospital. They want to die in the community and at home, with integral support for family and friends. That is our vision; that is what we need to deliver.

Photo of Abena Oppong-Asare Abena Oppong-Asare Shadow Exchequer Secretary (Treasury)

I thank the shadow Minister for giving way. I completely agree with the points she has raised. I thank Paul Holmes for bringing the debate forward and for sharing his personal story, as have others in this room. It is not easy to share those stories, but it is important that we do.

I have seen first hand how hospices play a vital role in communities. They go over and beyond, and are truly heroic. I am patron of Greenwich and Bexley Community Hospice in my constituency; I have seen how they provide compassionate end of life care. Does my hon. Friend agree that it is vital that the Government recognise the issues hospices face, particularly during the pandemic and with the cost of living crisis?

Photo of Caroline Nokes Caroline Nokes Chair, Women and Equalities Committee, Chair, Women and Equalities Committee

Order. I remind the Member that interventions should be short.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health and Social Care)

I absolutely agree with my hon. Friend and will come on to many of the points she raises.

I want to touch on about five issues, as part of shifting us to a different position on how we ensure people have a good death in the 21st century. The first issue, which I hope the Minister will comment on, and which all right hon. and hon. Members have spoken about, is the real need to review how hospices in England are funded, so that this absolutely critical sector has certainty and security in the months and years ahead. That was a key recommendation of the all-party parliamentary group for hospice and end of life care.

Many Members have spoken about the huge financial pressures on hospices: food prices, energy costs, the costs of NHS pay settlements. As Sue Ryder says, most hospices have seen a 10% increase in their costs, but only a 1% increase and in some cases no increase at all in NHS funding from integrated care boards, creating a perfect storm. ICBs have a statutory requirement to meet palliative care and end of life needs of their populations, but where is the funding? I hope the Minister will say whether the Government will institute the review because, without that, we will not have security for the future.

My second point, which has not been discussed in this debate but which I care passionately about—I would like to hear the Minister say something about this—is inequalities in access to hospice, end of life and palliative care. We know from the Parliamentary Office of Science and Technology that the pandemic exacerbated inequalities in accessing good palliative and end of life care for minority ethnic groups, and there are also socio-economic inequalities in access to hospice care. We know from Sue Ryder that there are also inequalities in access to bereavement support. We want to see everybody have fair access. Will the Minister say something about that?

The third issue relates to help to die at home, something I have campaigned on for many years as a Member of Parliament. There are still at least 10,000 people a year dying in hospital when they want the choice of dying at home. They are not getting the fast track NHS continuing healthcare support that they are supposed to get within 48 hours so that they can die at home. Our brilliant hospices have all sorts of support that they want to give, so I ask the Minister: why is that still a problem and what are we doing about it?

My next issue, which has been raised by many Members, concerns children’s hospices. Rainbows, the sole children’s hospice in the east midlands, wrote to me to express its concern about the children’s hospice grant potentially being wound up. As recently as 22 May, the Government replied to a written question:

“Funding arrangements for children’s hospices beyond 2023/24 have not yet been agreed.”

We cannot have children’s hospices not knowing what is happening to their grants. We have to be able plan ahead better.

Fourthly is something that my hospice, LOROS, has raised with me, but also lots of care homes. Bear with me on this. Many care homes are now essentially providing a lot of end of life care because the level of need that people have when they go into a care home is so great that that is what they need. But the staff might not be properly trained, and LOROS has said that it could work with care homes to make sure the staff are trained. That is one specific ask, so perhaps the Minister could meet me and LOROS to look at what hospices could do to better support our care homes.

Last but by no means least is workforce shortages. Sue Ryder stated:

“The Government must plan for the workforce as a whole system across health and social care” and charitable providers. That is really important. We have to stop seeing all those different bits of the system as separate. We Labour Members have set out our plans for the biggest expansion in the NHS workforce’s history and for fair pay agreements and for social care staff. We urgently need to see the Government’s workforce plan, and I would like to see that covering all the issues.

In conclusion, we have heard today about the manifold pressures on hospices. I do not think I have ever been in a debate where so many Members have spoken so powerfully and positively about a part of the health and care system and what it does. It shows the strength of feeling and support, but I ask everyone here to think about how we as a Parliament can put achieving a good death as a big thing that we can make progress on and continue this campaign in future. I look forward to hearing the Minister’s comments.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care) 10:44, 14 June 2023

It is a pleasure to serve under your chairmanship, Ms Nokes. I thank my hon. Friend Paul Holmes for securing this debate on hospices, and I thank all hon. Members who have contributed. Both the number of colleagues in the room and the passion of so many contributions show the strength of feeling and level of support for hospices in all our communities.

We have heard from so many colleagues this morning: my hon. Friends the Members for Darlington (Peter Gibson), for Aberconwy (Robin Millar), for Bolton West (Chris Green), for Torbay (Kevin Foster), for North West Norfolk (James Wild) and for Worcester (Mr Walker), and the hon. Members for Blackburn (Kate Hollern), for City of Chester (Samantha Dixon), for Bolton South East (Yasmin Qureshi), for Westmorland and Lonsdale (Tim Farron), for York Central (Rachael Maskell), for Barnsley East (Stephanie Peacock), for Lancaster and Fleetwood (Cat Smith) and for Strangford (Jim Shannon). In addition, many other hon. Members have contributed by intervening. In the course of today’s debate, many fantastic local hospices have rightly been praised for what they do for our communities.

My hon. Friend the Member for Eastleigh spoke about the Mountbatten hospice in his constituency and how it cared so wonderfully for his friend and colleague Sue Hall. Many hon. Members spoke about their personal experiences, which often involved family members, and the amazing ways that hospices have helped family members and themselves through difficult times. I, too, remember the amazing care that my granny received in her local hospice in Dorset when I was in my twenties. I still hold in my head the experience of visiting her there—the tranquillity of the hospice and the amazing care that she was clearly receiving, which made the last weeks of her life as bearable as possible. I remember the kindness and peace that I felt there in that hospice. I, too, have that personal experience and appreciation of what hospices do.

A theme of this debate has, rightly, been the importance of dying well—dying with dignity and dying with the right care in the place where a person wants to die, which is very often at home. Dying well depends on good end of life care, for which we in this country rightly have a good reputation. Most end of life care is provided through NHS services, but hospices are an important part of end of life and palliative care in our communities. As we know, hospices provide care in their facilities, but increasingly and very importantly they provide care to people in their own homes towards the end of their lives, and also support families through those difficult times and through bereavement.

Photo of Stephanie Peacock Stephanie Peacock Shadow Minister (Digital, Culture, Media and Sport)

The end of life care that I spoke about in my contribution, which is so important, remains closed at Bluebell Wood Children’s Hospice; it is the one part of the hospice that has been unable to reopen. Will the Minister commit to doing everything that she can to support the hospice to reopen, so that it can continue to provide end of life care, and not just all the other services it provides to families that need them so much?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

As the hon. Member mentioned earlier, we have indeed met and spoken about the hospice to which she refers. I have also met with several other hon. Members. I am grateful to them for coming to me to talk about the specific difficult situations faced by some of the hospices serving their communities.

That brings me to exactly what I was coming to talk about: the financial pressures on hospices, which have been a strong theme of the debate. I know very well, not just from this debate but from conversations with hospices, about the financial challenges that hospices are facing. In fact, financial challenges are being faced by many organisations that provide care in our communities, whether NHS organisations or care homes, as Liz Kendall mentioned. In particular, there are the extra pressures of energy costs—such organisations often use substantial amounts of energy—and the higher costs of staff pay. We know that many hospices pay their staff in alignment with the NHS agenda for change pay scales.

An additional difficult context for hospices at the moment is fundraising. That was clearly hard during the pandemic, but since then many households have been affected by the higher cost of living and therefore have found it harder to contribute to fundraising efforts in their communities, including those organised by hospices. I know how hard that context is for our hospices.

On energy costs, many hospices have been able to benefit from the Government’s energy bill relief scheme, which ran to 31 March. Eligible organisations, including hospices, will continue to get baseline discount support for gas and electricity bills under the energy bills discount scheme, which is running from 1 April 2023 to 31 March 2024. In addition, last year NHS England released £1.5 billion of extra funding to integrated care boards in recognition of the extra costs arising from inflation in the services they commission. ICBs have been responsible for distributing that funding according to local need, including to palliative and end of life care providers in our communities, whether they are NHS organisations or hospices.

Photo of Tim Farron Tim Farron Liberal Democrat Spokesperson (Environment, Food and Rural Affairs), Liberal Democrat Lords Spokesperson (Communities and Local Government)

Of course, ICBs are not elected, but the Minister is. She heard what Cat Smith and I had to say about the 0% increase that the Lancashire and South Cumbria ICB has granted—or not granted—our hospices. Will she directly get involved in that to fix it so we do not have to have the 10% cuts that St Mary’s Hospice thinks we will have to deliver?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I will not commit to getting involved in a specific conversation between a hospice and an ICB. That would not be the right thing for me to do as a Minister. The hon. Gentleman and I have had several conversations over the years that I have been a Minister, so he will not be surprised to hear that I have been seeking transparency about the extent to which the funding has or has not gone to hospices. I have been seeking data on whether the rates being paid to hospices have or have not gone up so that we have transparency about the extent to which the funding that has gone to integrated care boards to support with inflation is getting through to the services that need support.

Photo of Peter Gibson Peter Gibson Conservative, Darlington

Although I acknowledge and appreciate everything the Government did to support hospices during covid, it is simply not the case that every ICB across the country is passing the right amount of money to the hospices from which it commissions services. Will the Minister commit to publishing information about which ICBs are stepping up to the plate and fulfilling their statutory obligations, and which are not?

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I commit to continuing to dig into getting visibility on the extent to which extra funding is going through to hospices. Of course, there is a balance to be struck when giving integrated care boards the freedom to do what we want them to do, which is to understand fully the needs for care in their populations, and make good decisions about how they fund care for their populations. None of us believes that a Minister in Westminster has the answers about what should happen and exactly how funding should be distributed in every single one of our communities. I will continue to get that visibility, because it is important that we know the extent to which our hospices are getting support for the extra financial pressures that we have been discussing.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I will make a bit of progress, because I am conscious that the clock is ticking.

Integrated care boards are responsible for ensuring the provision of the end of life and palliative care that is needed in our communities across England. In addition to the funding, I am working with NHS England to ensure greater visibility relating to what that means in practice and what is being commissioned.

The shadow Minister’s point about inequality of access was very important. We know that there is inequality of access to palliative and end of life care. Some communities are much better served than others, in part due to the fantastic legacy of our hospices: where there is a really good hospice, there is often much better access to end of life and palliative care around it. We want to improve equality and reduce some of the disparities in access to end of life care. As part of that, people should be able to do what most people want—to die at home with the right support in place.

I want to talk about the funding for children’s hospices, which several hon. Members brought up. Recognising the importance of palliative and end of life care for children and young people, NHS England provided £25 million specifically for that, via the children’s hospice grant during this financial year. I have, of course, heard the calls for that grant to be continued, and for greater continuity and visibility of funding further out. I cannot say more on that today, but I can assure hon. Members that I have been speaking to NHS England about that funding beyond this year. I do expect further new to be communicated about that shortly, appreciating the level of concern among hon. Members and children’s hospices in their communities.

Photo of Rachael Maskell Rachael Maskell Labour/Co-operative, York Central

I am grateful to the Minister for giving way. The Health and Care Act 2022 put a responsibility to fund palliative care on the statute books. Will the Minister set out what has changed, to enable that funding to come forward? We know there are people in our communities who are not receiving that care, although they need to now under the law. The funding needs to be in place for them to receive the care that they need at the end of life.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

That alludes to exactly the point I made a moment ago. As flagged in that 2022 Act, ICBs have responsibility for commissioning that care, using the budgets they receive through NHS England. I am working to ensure the visibility of the commissioning, to be assured that that is taking place, so that we can be assured about the availability of end of life and palliative care for our communities.

I want to make a final point as I close; I am looking at the clock ticking. Against the backdrop of financial concerns, which I of course recognise and which we are discussing, is the strength of hospices in their communities, and the importance, as mentioned by hon. Friends, that they are not solely financially dependent on the state and the NHS for funding. They receive some NHS funding, but it is important that hospices are successful in fundraising and gaining support from our communities. That is one of the strengths of their model, and I want to continue to support that.

I pay tribute to all the volunteers and those involved in fundraising, including many hon. Members this morning who mentioned the fundraising efforts that they are personally making for hospices in their communities. I wish very good luck to my hon. Friend the Member for Eastleigh for his forthcoming skydive. All credit to him for having the courage to jump out of an aeroplane. I sincerely hope that he is successful.

Photo of Helen Whately Helen Whately Minister of State (Department of Health and Social Care)

I wish him very good luck; it is fabulous that he is doing that for his own hospice. I also commend the efforts of many other hon. Members. I conclude by thanking all hon. Members for coming today and for their contributions to this important debate.

Photo of Paul Holmes Paul Holmes Conservative, Eastleigh 10:58, 14 June 2023

Thank you, Ms Nokes. I will briefly wind up by saying thanks to all hon. Members for the heartfelt contributions that they have made. It has been incredibly humbling sitting here. If my career does end on 24 June with my skydive, and this is the one thing I have managed to do, it will be entirely worth it. I thank the Minister for responding. I also thank Sue’s family—her husband Jerry and her girls Rosie and Phoebe—who have been immensely strong over the past year or so.

I hope the Minister has recognised that there are serious concerns about the funding of hospices. In the environment she set out of the ICBs being given the money, she should take credit for the uplift they have been given. I hope that after this morning’s debate she will take a stronger line in holding those ICBs to account because, frankly, that money is not getting through when it should.

Question put and agreed to.


That this House
has considered support for hospice services.