Hospice Funding

Motion made, and Question proposed, That this House do now adjourn.—(Keir Mather.)

19:00:00

May I start by wishing you a very happy Easter, Madam Deputy Speaker, and by thanking the Clerks, the Doorkeepers and the House staff who have drawn the short straw and have to be here for the Adjournment debate at the end of the day? I am pleased to have secured this debate on hospice funding, a topic that I know is of concern to Members from across this House. Even on the last day of term, the subject still gives pause to so many. A hospice provides a beacon of hope to so many people in their darkest times. It provides the comfort and knowledge needed at a very difficult time, and without hospice support, many would be lost. That is why, across the country, we see volunteers giving up their time and their finances to support local hospices—because, primarily, many of them are charities, although they receive some funding from the NHS. Members from across this House, from every party, believe that hospices matter.

First, I commend the hon. Lady for bringing this debate forward. She is absolutely right to highlight the work of hospices, but also all those groups that raise money for hospices, so that they can do their work. For instance, the Elim church, which has a cancer group that holds a dinner or breakfast every month, recently gave £5,000 from a coffee morning, as well as its monthly offering. Again we see charitable organisations, particularly when they are supported by churches, making the difference in this nation. Does she agree that while they are admirable, we cannot expect coffee mornings and fun runs to raise the funding that the Government have an obligation to provide? Rather than seeking to end life, the Government must seek to ensure that people’s last days in palliative care are dignified and pain-free. That will only come with fully funded end-of-life palliative care.

I thank the hon. Member for that intervention, and I pay tribute to all the volunteers who organise the fun runs, and to volunteers in my constituency, such as Sharon Williams, who does the Thames hospice walk in Denham village every year. These are the people who support our local hospices, and we should all pay tribute to them. Hospices matter because each year they support 310,000 people and 92,000 family members. Hospices matter because they are vital holistic care services for people and their loved ones at the end of life. Hospices matter because they provide crucial end-of-life and overall healthcare, relieving the pressure on the NHS. They provide both community specialist and acute care. However, I suspect that the Minister and the Government already know this, and I am sure that they agree that hospices matter, so let me turn to why this debate matters. The hospice sector is under enormous pressure, and it faces an unprecedented challenge. The sector is caught in the triple squeeze of increased demand, increased cost and uncertain funding. Only the Government have the power to change that squeeze. Only the Government can eliminate the increased cost or create more certain funding. In this House, recent months have been consumed by a debate about assisted dying, while the real scandal of the lack of support for end-of-life care through hospices goes below the radar. It is estimated that the demand for palliative care in the UK will increase by 25% in the next 25 years, but as hospices face this increased demand, the Government have decided to saddle them with increased cost, and have failed to provide a long-term settlement. Let me speak about the excellent Thames hospice that supports many families in my constituency and the constituencies of my neighbours. I would not be here today were it not for Baroness May of Maidenhead. As a long-term champion of Thames hospice, she asked me to have a word with the hospice, as it was so concerned about its funding, which I did, and that led to this debate. Again, Members of Parliament from both Houses continue to champion this important cause. I recently met Dr Rachel de Caux, the chief executive officer of Thames Hospice. Like many other hospices, Thames hospice represents the very best of our communities: people who believe in providing quality of life at end of life, for everyone; passionate people who care, like the Thames hospice Denham support group, and the volunteers who make donations and support those who go into the hospice. Through their excellent work, they enable 80% of the people they support to receive dignified end-of-life care at home, and the rest to get specialised in-patient service. I visited the service recently, and when I visited the call centre, I was moved to see volunteers and staff working around the clock to help those who had just received a terminal diagnosis, or families who could not cope. They were going to people’s homes and working all hours of the day and night to ensure that people had the pain support and palliative care that they needed, at home or in the centre. Thames hospice, like many hospices, faces a critical moment. Less than one third of its income comes from the NHS. Like many hospices, it raises the rest through its charity shops, fundraising efforts and the generosity of private donors. The Chancellor’s Budget was like a hammer blow to its finances, and it faces a deficit of up to £1 million, largely as a result of the Government’s choices. The national insurance tax raid, from which this Government recently voted not to spare hospices, will add £300,000 to its costs for the next financial year, while changes to the national minimum wage will add another £200,000, both through the direct impact and the need to maintain pay differentials. Meeting the NHS pay settlement, which the hospice needs to do to keep clinical staff—but which, again, it needs to do without Government support—will add a further £100,000. Finally, Thames hospice’s suppliers face the same cost pressures, and are passing those on to the hospice through higher prices. I know the Minister will talk about the £1 million settlement of additional funding for hospices that was announced in December, but let us set out the detail of that money: it was for capital expenditure, and is welcomed, I am sure, by hospices, but it was not money for meeting operational cost pressures. It was also split across 170 hospices, so it became a drop in the ocean for individual hospices and their needs.

Will the hon. Lady join me in commending Compton Care hospice in my constituency? The hospice, which I visited recently, does great work raising funds, and it really welcomed the £100 million support provided by this Government. However, the hospice emphasised to me that if it was not there to provide social care, therapy and respite care for patients and their families, the NHS would need an extra 100 beds. Hospices provide invaluable services to our communities, which makes it so important for us to continue to support them as much as we can.

The hon. Gentleman makes an excellent point about the pressure that hospices take off the NHS. The wonderful work of the hospice the hon. Gentleman mentions is the reason the NHS can function in the way it does. The cost savings on palliative care—both in hospital and out-of-hospital care settings—are invaluable. The hospices in our constituencies are a model that already works, and they are trusted by the community. I think we should be funding that model, instead of allowing hospices to die on the vine because of a lack of funding and changes to the funding model. I thank the hon. Gentleman for that point.

I congratulate my hon. Friend on securing this debate. We should not just complain about this terrible new tax that is being applied to hospices, but point out to the Minister that the return on taxpayers’ investment in what hospices spend on the dying is very great indeed. If a little bit of the big increase in funding that the NHS received was transferred to hospices, it would pay great dividends; it would save the need for much more costly care in the hospitals. The return is 300%, according to St Helena hospice, just outside my constituency, on whose behalf I am speaking this evening. I hope the Minister will address that point when he winds up.

My hon. Friend makes an excellent point. That 300% cost benefit would be replicated across the country, in every hospice setting. A small amount of money given to hospices through the NHS funding model would be invaluable. We talk about palliative care and assisted dying, but why are we not having a debate about increasing hospice funding, and making that service part of the NHS? If hospice settings were part of the NHS, they would be exempt from the rise in national insurance contributions. That increase is devastating hospices right now. Many rely on volunteers or low-paid workers in charity shops. The money raised helps pay for the running of hospices. Although that is a wonderful model, hospices are not exempt from the NICs increase, as other NHS bodies are. Even changing the status of hospices to make them part of the NHS would go a very long way to making their financial model viable.

The hon. Member is making a powerful speech. I have steered the palliative care commission for the past six months, and the one thing that has become crystal clear in our minds is that the fundamental funding model is completely broken; it is not fit for purpose. Furthermore, we need more integration in the system. Hospices are involved in part of people’s care; they do not provide the entirety of their care. Does she believe that the findings of the commission need to steer the future funding of the hospice sector?

That is an excellent point. We should be led by the evidence, and also by what the commission finds. I wish to highlight the hon. Lady’s long-term work championing out-of-hospital care provision—not just palliative care, but all adult social care. I can recall many a debate on this matter in which there were just one or two of us in the Chamber, and she was always one of them. She is a long-term champion of the vulnerable, of palliative care, and of those who desperately need better services. May I thank her for all that work? Madam Deputy Speaker, it is not often that you will see me reach across the House, but let us give credit where credit is due. There are Members from all parts of the House who have championed these causes over and over again, and it is only right and fair that I recognise them today. There is a very real prospect of the hospice sector collapsing under the weight of the national insurance changes, and that would be unimaginable. These are institutions that are trusted in our communities and that we need to protect. They need additional funding from the NHS. The Government must act. I urge them to please reconsider the national insurance changes. Exempting hospices from the NICs increase, or helping to fund their operating costs, would make a material difference to their ability to survive. Our hospices matter, and I hope the Minister will hear that message loud and clear, and show us that the Government understand how vital they are.

19:13:00

I thank the hon. Member for Beaconsfield (Joy Morrissey) for securing this important debate. I wish to take this opportunity to thank all those who work or volunteer in the hospice and palliative care sector for the care and support that they provide to patients, families and loved ones when they need it most. This Government want a society in which every person receives high-quality, compassionate care from diagnosis through to end of life. We are determined to shift more care out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting. Palliative and end-of-life care services, including hospices, will have a vital role to play in that shift. In England, integrated care boards are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local population. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. Although the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at the end of life, as well as to their loved ones. Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding that each charitable hospice receives varies, both within and between ICB areas. This variation is dependent on demand in that area and on the totality and type of palliative and end-of-life care provision from both NHS and non-NHS services, including charitable hospices within each ICB footprint. This Government understand the financial pressures that hospices have been facing, which is why we have announced the biggest investment to hospices in England in a generation. We are ensuring that hospices in England can continue to deliver the highest quality end-of-life care possible for patients, and for their families and loved ones. We are supporting the hospice sector with a £100 million capital funding boost for adult and children’s hospices, to ensure that they have the best possible physical environment for the care they give. We are pleased to confirm that the Government have released the first £25 million tranche of the £100 million capital funding, with Hospice UK kindly allocating and distributing the money to hospices throughout England. An additional £75 million will be allocated in the coming weeks for use in the 2025-26 financial year. The £100 million capital funding will help hospices to provide the best end-of-life care to patients and their families in a supportive and dignified physical environment. Funding will help support hospices and will enable much-needed improvements, including refurbishments, the overhauling of IT systems and improvement of facilities for patients and visitors. We are also providing £26 million in revenue funding to support children and young people’s hospices. This is a continuation of the funding that, until recently, was known as the children and young people’s hospice grant. ICBs will once again administer the funding to their respective children and young people’s hospices on behalf of NHS England. This is in line with NHS devolution policies, and it promotes a more consistent national approach by supporting commissioners in prioritising the palliative and end-of-life care needs of their local population. I am pleased to confirm that NHS England has now communicated the details of the 2025-26 funding allocation and dissemination to individual hospices. I do accept that there is unwarranted variation and inequality in access to, and quality of, palliative and end-of-life care in England, but we are working to reduce these variations. NHS England has published statutory guidance and service specifications to support commissioners in prioritising palliative and end-of-life care. It has also developed a palliative and end-of-life care dashboard, which brings together all relevant local data in one place. The dashboard helps commissioners to understand the palliative and end-of-life care needs of their local population, enabling ICBs to put plans in place to address and track the improvement of health inequalities and to ensure that funding is distributed fairly, based on prevalence. NHS England has also published the ambitions framework, which sets out our vision to improve end-of-life care through partnership and collaborative action between organisations at a local level throughout England. Additionally, NHS England has developed an assurance system with specific steps and deadlines to ensure the timely dissemination of the £26 million revenue funding to children and young people’s hospices, because we know that there were some quite significant problems last year with the transmission from NHS England through the ICBs to hospices. These steps include regular oversight sessions with ICBs, regions and hospices and giving ICBs a hard deadline within the first quarter of the financial year by which they are expected to disseminate the funding to hospices, including escalating to NHS England if any ICB is unable to meet the deadline. If the deadline is missed, NHS England has put steps in place to ensure that all hospices receive the funding within the timescales outlined. We, alongside key partners and NHS England, will continue to engage proactively with our stakeholders, including the voluntary sector and independent hospices on an ongoing basis to understand the issues they face. In fact, I recently visited Katharine House hospice in Stafford and heard from staff how important our record investment has been to them. More widely, in February I met key palliative and end of life care and hospice stakeholders in a roundtable format to discuss long-term sector sustainability in the context of our 10-year health plan. I recognise the concerns that hon. Members have raised about funding and employer national insurance contributions. In July last year we inherited public finances in their worst state since the second world war, and we took the necessary decisions to fix the foundations in the public finances at the autumn Budget, enabling the spending review settlement of a £22.6 billion increase or uplift in resource spending for the Department of Health and Social Care from 2023-24 out-turn to 2025-26. I gently point out to the Conservative party that while I believe it has welcomed that unprecedented settlement, to my knowledge it has been silent on its preferred means of generating that revenue. I gently say that Opposition Members cannot have it both ways. They cannot welcome the £22.6 billion on the one hand but, on the other hand, condemn the way in which the money is to be raised without coming up with their own plan and proposals for how they would raise those funds.

We have to recognise that the hospice sector is in quite a difficult place financially. However, if there is good advance care planning, money currently spent in secondary care could be invested in the hospice sector and in more community provision. Surely that must be a first step that would not only get better clinical outcomes but be better for the whole of the palliative care pathway.

My hon. Friend speaks with tremendous and deep knowledge of the sector. I welcome the work that she is doing on the commission on palliative and end-of-life care, and we very much look forward to seeing the outcomes and results of that. My hon. Friend is right that if we are to make the three big shifts at the heart of our 10-year plan—the shifts from hospital to community, from sickness to prevention, and from analogue to digital—the delivery of that will require a left shift in terms of both funding and reform. It is absolutely right that we take a hard-headed look at funding across our NHS and ensure that funding is going to where it is needed. She will know that the share that hospitals get of overall NHS funding has gone up dramatically since the early 2000s, to the detriment of primary care, community care and palliative care—all the things that happen outside hospital. That is something that we must address and shift upstream, because we will never solve the considerable challenges that our NHS is facing until we make that left shift. I note that the funding announcement was warmly welcomed by the sector. Toby Porter, chief executive of Hospice UK, said: “Today’s announcement will be hugely welcomed by hospices, and those who rely on their services. Hospices not only provide vital care for patients and families, but also relieve pressure on the NHS. This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need, when and where they need it.” I hope that the measures I have outlined in my response to the hon. Lady will go some way to reassuring all Members of this Government’s unwavering commitment to the sustainability of the hospice and wider palliative and end-of-life care sector.

I thank the Minister for outlining what the Government are doing. Will he consider looking at the exemption to the national insurance increase for workers and at allocating more funding directly to hospices so that they can conduct the palliative care that is needed in the out-of-hospital care provision? Although the Government may want to give it to palliative care, there is no directive that does so at this time, aside from capital expenditure. Therefore, could more money be allocated to hospices for operational costs?

The definition of where employer national insurance will be levied is based on the Office for National Statistics’ definition of where it should be, and it is the same definition used by previous Governments. I do not think that point is up for debate.

To clarify, the NHS and the staff within it are exempt from the changes. How is that part of the national statistical average, when everyone in healthcare who is under the NHS umbrella is exempt from the changes? All I am asking is for hospice care, which is out-of-hospital care provision and which technically falls within adult social care, to be incorporated into the exemptions already given to the NHS.

The exemption was given to 100% full-time workers within the NHS; in essence, hospitals. As regards GPs, dentists and care providers, ENICs are being levied on those other parts of the health and care sector. Every aspect of my portfolio is therefore seeing ENICs being levied.

A suggestion to the Minister would be to integrate the staff working in hospices into the NHS payroll. It would be that simple to exempt them from those national insurance increases.

The decisions on ENICs and where they are being levied have been made. I think it was made very clear that the line was drawn where it was drawn. Any attempt to try to reverse engineer where that line should be drawn would not really be aligned with the policy decisions that were made at the Budget.

Was it the Government’s intention to put an additional tax on hospices? Is that exactly what the Government intended to do, or is that an unforeseen consequence?

I would not dare to speak from this Dispatch Box on behalf of the Chancellor, but I am absolutely clear that when she did the autumn Budget, she knew that she had to dig us out of a very deep hole indeed, and that required levying taxes that she had to levy. The line had to be drawn somewhere and that is where the line was drawn. On the other questions asked by the hon. Member for Beaconsfield, the funding has gone through Hospice UK, so it is not direct funding in that sense. Hospice UK has kindly co-ordinated the process because it is extremely well informed about which hospices across the country have opportunities to upgrade their infrastructure, whether that be IT infrastructure, refurbishment or whatever it might be. It has reviewed those proposals, worked at tremendous pace and, as a result, we have managed to deliver the entire £25 million of the first tranche. We are now working closely with Hospice UK on the £75 million and I am confident that that money will be out of the door and into hospices in very quick time this year, based on the outstanding performance on the first £25 million tranche. I therefore hope the hon. Lady will be reassured on that point. In closing, I hope that we at least have a consensus on the vital importance of hospices. The Government are committed to working at pace to ensure that we secure a sustainability and solidity for the sector going forward. I thank the hon. Member for Beaconsfield once again for securing this important debate. I also thank and wish everybody in this Chamber all the very best for the recess, and I look forward to seeing them all on the other side. Question put and agreed to.

19:29:00