Hospice and Palliative Care

19:00:00

I beg to move, That this House has considered hospice and palliative care. First, I thank the Backbench Business Committee for granting time to support this important debate, and I thank colleagues from across the House for supporting my application and joining me today to discuss a subject that, to use an old cliché—but in no more apposite a context—is truly a matter of life and death. When this House debated the Terminally Ill Adults (End of Life) Bill last November, the crisis in hospice funding and concerns over the provision of palliative care were a constant refrain in the subtext of many of the speeches from supporters and opponents of the Bill. As someone who entered the Chamber that morning undecided as to how I would vote, I became increasingly convinced throughout the five hours of powerful argument and testimony that no matter what the House decided, the time had come to address hospice funding for the provision of palliative care head on, for death is as much a part of life as living. While as parliamentarians we readily focus on what makes a good life, we rarely consider what makes a good death. It is possible to have a good death, as I saw with my mother, who passed away in comfort at the beautiful Arthur Rank hospice in Cambridge, and with my father, who died in the exceptional palliative care facility at Bellevue hospital in New York. As a family, we remember those times as sad, but cathartic, with moments of laughter as well as tears, as when my father—somewhat confused towards the end of life, but with a glint still in his eye—asked, as I sat next to him stroking his forehead, whether I was a lady friend. Sadly, however, too many in our society do not experience a good death, and we need to start asking why. The hon. Member for Spen Valley (Kim Leadbeater) bravely took on that challenge with her private Member’s Bill, and I hope that this debate will afford us an opportunity to build on those foundations.

Does the hon. Member agree that the renewed focus on the hospice and palliative care sector is extremely welcome and overdue? Does he agree that the extra £100 million of investment shows how seriously this Government are taking the issue, showing that people approaching the end of life are fully supported in whatever choices they make?

I agree with the hon. Lady, and I will be coming to those points. Today is not about rehashing the arguments made that Friday, but to allow Members time to discuss and reflect on this separate, but inextricably linked subject. It is not the last word on hospice and palliative care, but an important step in forging a consensus that I hope will unite us, no matter where we ultimately stand on assisted dying. I began by referencing the crisis in hospice funding. Before I proceed further, I echo what the hon. Member for Spen Valley said and thank the Health Secretary for the £100 million in capital and digital moneys he announced last month. It will make a profound difference to the sector’s current financial position. I have been asked by individual hospices and Hospice UK to convey their genuine gratitude. In a similar vein, the Government’s recently announced commitment to extend the children’s hospice grant by a further year is deeply appreciated and equally vital to maintaining levels of service in this heartrending, but profoundly important part of the hospice movement. However, these are only short-term fixes and fail to provide the long-term funding and certainty critical to securing the future of the hospice movement. Currently, only one third of hospice funding is provided by the Government, with the rest coming from charitable sources. That leaves hospices vulnerable to increased cost pressures, as can be seen in a recent Hospice UK survey, which found that at least 20% of hospices had cut services in the past year or were planning to do so. Becca Trower, the clinical director of the wonderful St Raphael’s hospice, which provides excellent care to residents in my Wimbledon constituency, was unambiguous when she told me: “We have a funding crisis and we need to protect our hospice.” Last year, that meant that St Raphael’s was forced to strip £1 million from its £6.5 million budget by ending its hospice at home service that provided vital care, advice and support to patients and carers in their own homes. It was a virtual ward, in fact, but not one that fitted within the NHS definition of such, which would have attracted the separate integrated care board funding available for such initiatives. In just one month, the cuts to the service directly impacted 26 patients, many of whom spent their last days taking up valuable hospital beds, dying in the one place they did not want to die and putting further pressure on the NHS. When the Government are aiming to move medicine into the community, it makes no sense for hospices to be forced into a position that achieves the opposite. That contradiction is mirrored in the current funding settlement, where the Government have given with one hand and taken with the other by increasing employers’ national insurance contributions. The refusal to exempt charities will exacerbate the challenges confronting hospices. The amazing Shooting Star children’s hospice, for example, provides wonderful support for families in my constituency. It estimates that the change will add another £200,000 to next year’s cost base. Hospices need certainty. Doubts over funding undermine morale and sap energy, making the recruitment and retention of staff another huge issue for the sector. To address these problems, the Government need to introduce a consistent, reliable funding mechanism that reflects the rising costs of care. Hospices consequently need to be included within the NHS’s much-anticipated 10-year health plan. In parallel, staffing needs must be addressed in the next NHS long-term workforce plan. It should not be forgotten that hospices provide a variety of services in addition to palliative care, including emotional, psychological and spiritual support, as well as physio and occupational therapy, practical support, complementary therapies, respite care and bereavement services. Much of that is beyond the clinical, and not something that the NHS can be expected, nor can afford, to provide. That is why no one I spoke to in the hospice movement thought that hospices should be subsumed within the NHS. They provide a complementary service that extends well beyond the clinical, and to which a charitable funding model is more effective and appropriate.

I commend the hon. Gentleman on setting the scene so well. One of the concerns that I and others in the Chamber have is the impact on the workers in hospices. It is not just about the financial implications, which are all part of the overall issue, but burnout. Staff are working long hours. They are volunteers in many cases, and they do that because it is what they are committed to. Does he share my concern that burnout in hospice care will have an impact on the NHS in the long term?

I agree with the hon. Member. We need more palliative care specialists and we need more training, and there is a real danger of burnout. It is not just hospices that provide palliative care. When talking to specialists within and beyond the hospice sector, I have been struck by their commitment to giving patients a good death and their frustration that so many do not receive one. A palliative care doctor recently told The Guardian: “I sometimes see patients…who come into hospital in unspeakable agony and want their lives to end. It is not because their pain cannot be prevented, but because they are not getting the care they need.” A local oncologist told me: “Demand for services is simply outstripping supply. The majority of patients are not getting their end of life care wishes met. The specialist palliative care teams are very good but there are not enough of them and they do not have adequate resources.” Huge regional inequalities exist in the provision and quality of services due to the vagaries of the current funding model. The Health and Care Act 2022 included for the first time a statutory duty for ICBs to provide palliative care. However, it did not include a minimum standard of core provision, leaving it to what each ICB considers appropriate. Freedom of information requests submitted by Hospice UK in 2023 found that adult hospice funding consequently ranged from just 23p to £10.33 per head of population across different ICBs. For children’s hospices, the variations were even starker. Research from the amazing charity Together for Short Lives found that spending per child with a life-limiting condition varied from an average of £531 in Norfolk and Waveney to just £28 in South Yorkshire.

On the point about the postcode lottery—an oft-used cliché by politicians—I have heard from Hospice UK that, on one occasion, a single gift from a legacy covered the running costs for a hospice in the UK for five years. Does my hon. Friend agree that that is one of the starkest and most extreme illustrations of how the current system is so unbalanced and, from one street to the next, leaves people with such disparities of access to such an important element of healthcare?

I agree, and I will come to some solutions that might address this issue. We must increase the core responsibilities of ICBs in this area. Inevitably, much palliative care is provided not by specialists but by generalists, such as GPs, trainee doctors and community nurses for whom care of the dying is not their primary focus. Many lack the training, time and resources needed to provide what is possible, not through their fault but due to a system that does not regard palliative care as a core function. That is all too evident at the outset of their careers, with one medical student telling me: “I only received 2 mandatory days training on palliative care in my entire degree. This is simply not enough and we need to increase training across the board to ensure patients are given equal access to high-quality care.” Since the Shipman case there is unacceptable legal uncertainty, particularly among non-palliative care specialists, about the extent to which analgesics can be given in a sufficient quantity to alleviate pain, even where that might hasten death. The system requires a complete overhaul. We need more palliative care specialists and better training for non-specialists, including robust advice on the legality of giving sufficient pain relief to alleviate suffering, buttressed if necessary and appropriate by more explicit guidance in the Director of Public Prosecutions’ code for Crown prosecutors and the Lord Chief Justice’s criminal practice directions. ICBs should be required to provide a minimum level of palliative care as a core function. This would have a transformative effect on how palliative care is funded both within and beyond the hospice sector, rather than leaving it to the generosity of particular ICBs such as South West London and Surrey Heartlands, both of which do all they can to fund local hospices, but within the constraints of a funding model that limits their ability to do so. In concluding, I want to return to where I began. The debate is a matter of life and death. Ensuring a good death is important not just for the individual at the end of their life, but for those they leave behind. Knowing that someone passed away peacefully can bring real comfort to those mourning their loss. I would like to end with the words of Fleur, whose son received end of life care at the wonderful Shooting Star hospice. She said: “Hospices are not just places where life comes to a close…they are places where those left behind learn how to keep on living. When my son Toby died, our hospice didn’t just care for him—it cared for all of us, to give us a future not defined by trauma, but by love, resilience, and hope. Months later, when my daughter had to step back into a hospital—the place where we had first been told we would lose Toby—she froze, overwhelmed by fear and grief. When she returned to the hospice, the very place where Toby had taken his last breath, she ran inside, kicked off her shoes, and threw herself into the arms of a nurse.” That is what it is possible to achieve. I hope the Government are listening.

19:14:00

It is an absolute honour to follow the hon. Member for Wimbledon (Mr Kohler), who made a wonderfully poignant speech. I thank him for securing this debate. As the Member of Parliament for Huddersfield, I have had the privilege of witnessing at first hand the exceptional work of hospices such as Forget Me Not children’s hospice and Kirkwood. These organisations are lifelines for individuals and families facing life-limiting conditions. I welcome the recent announcement of the expansion of hospice funding, which is a crucial step in addressing the financial challenges that these vital organisations face. Hospices such as Forget Me Not and Kirkwood do not just offer medical care but provide emotional, psychological and practical support to patients and their families. They ensure dignity and compassion at every step of their journey, addressing the full spectrum of needs for those they care for. Steve, a local dad whose son, 10-year-old Ethan, receives support from the Forget Me Not hospice, spoke of its life-changing work for Ethan and the whole family. Steve said: “When he’s here he’s comfortable, it’s a lovely environment. It’s not clinical and he’s treated like a normal person.” They are not just care providers but community builders, offering spaces of comfort and support during life’s most difficult times. Huddersfield University is leading on joint work with local hospices about research and clinical practice in end-of life-care. It includes working with Kirkwood hospice to create a postgraduate certificate in end of life care, the first of its kind in the UK to link with a hospice. While I am sitting next to my hon. Friend the Member for Spen Valley (Kim Leadbeater), I must pay tribute to how she conducted the debate on her Terminally Ill Adults (End of Life) Bill. There is no doubt that she has moved the debate on funding for hospice care, and I thank her very much. The expansion of hospice funding is a significant and welcome development, but we must acknowledge that many hospices, including those in my constituency, still face immense financial pressures. Forget Me Not children’s hospice recently launched an urgent appeal to address a £1 million funding gap. The expansion of funding must be part of a larger, ongoing strategy to ensure that long-term commissioned funding for hospices is part of the 10-year NHS plan.

St Leonard’s hospice in my constituency lovingly cared for my uncle with extraordinary compassion last year in his final weeks. I hear my hon. Friend’s calls for hospices in her constituency but does she agree that, because of their empathy and the important work that they do, we must all campaign for the funding that our hospices desperately need?

I absolutely do. I pass on my condolences to my hon. Friend and his family, and pay tribute to the local hospice and the work that it has done to support his family. I want to raise NHS England’s £26 million funding for children’s hospices—formerly the children’s hospice grant. Traditionally, that funding was distributed centrally by NHS England but last year, as has been mentioned, it was disseminated by integrated care boards. That has caused delays to many children’s hospices’ access to their funding, including Forget Me Not. It is critical that the funding is ringfenced for children’s hospices, and I hope that the Minister will review whether it can again be centrally distributed, to avoid further delays. The new funding for hospices is an important milestone. I welcome the Government’s approach and thank the Minister for his work. I know that the hospice sector very much welcomes the additional funding, but can it also mark the beginning of further Government support for these essential services? Hospices are an integral part of our healthcare system, and we must ensure they have the resources and support that they need to continue their vital work, including the specialist doctors and nurses that are needed in many hospices. Through Government action, community support and the tireless effort of hospice staff and volunteers, we can ensure that hospices not only survive but thrive, continuing to provide the compassion and dignity that every individual deserves.

19:19:00

First, I congratulate the hon. Member for Wimbledon (Mr Kohler) on securing this debate. As a member of the Backbench Business Committee, I can tell him he made a very convincing argument for this debate. Like others, I suspect, one of my aims this evening is to praise my local hospices, Lindsey Lodge in Scunthorpe and Saint Andrew’s in Grimsby, which both provide care to my constituents. I have particular affection for St Andrew’s, as my father passed away in its care, and my mother actually died on the day she was supposed to move in. That was more than 30 years ago; I have seen how they have developed in the years since, and they continue to provide absolutely superb care. Of course, demand is increasing: demographics have changed, and people are living longer. Hospices do actually ease the burden on the NHS. St Andrew’s has 133 permanent staff, but more than 400 volunteers. As it happens, I visited St Andrew’s last Friday—the meeting was scheduled some weeks ago, but it was convenient timing for this debate. I do have a specific question for the Minister relating to St Andrew’s, which I will come to later. Voluntary donations in areas such as north-east Lincolnshire are crucial, as they are elsewhere. However, with relatively low incomes and very low property values, when people leave a legacy of a share in their property, perhaps, that does not realise the same sort of return as it would in many other parts of the country. I could provide a whole list of what St Andrew’s hospice delivers; instead, I will give one or two significant statistics. It delivers more than 3,000 adult in-patient bed nights and 694 children’s hospice at home sessions; it has physiotherapy, creative therapy and social work contacts; it provides spiritual care for its patients and their families. The cost of operating all parts of the charity in 2024-25 is more than £18,000 a day; only four years ago, it was £14,000 a day—a significant rise, as Members will appreciate. Some 80% of that cost has to be earned or raised by the hospice, which, in times of economic challenge, is increasingly difficult. Its statutory income for ’24-’25 is expected to be only 21.5% of its total income. Currently, for every £1 of statutory income, St Andrew’s has to raise £4.60, posing a considerable financial challenge for the hospice, the volunteers and the fundraisers. As we know, healthcare inflation runs ahead of general inflation, and hospices have to try to keep pace with statutory salary increases related to the national minimum wage. As with the social enterprises that provide social care in north-east Lincolnshire, hospice staff do not automatically get the increases that go to NHS workers, and the gap is inevitably widening. I raised this matter with the Secretary of State at health questions last week, and I think it will be a growing problem with further NHS wage increases later this year, as the gap between NHS workers and those providing care in hospices and social enterprises widens; it will be about 10% by the time the next increase comes. Needless to say, that is causing difficulties for those employees. I have a specific question for the Minister, which I will write to him about in the next day or two—I do not expect him to have all the details of St Andrew’s in his pack. St Andrew’s gets only 21% of its income through statutory contributions, which I understand is about 12% below the national average; this has come about because of a whole series of historical adjustments. My plea to the Minister is that St Andrew’s is brought up to the national average as soon as possible.

19:24:00

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this important debate. As a nurse for 25 years and as co-chair of the all-party parliamentary group on hospice and end of life care, hospice and palliative care has always been at the heart of my work, both in this Chamber and in my community. I start by acknowledging the fantastic decision by the Government to boost investment in hospices by £100 million—the largest funding uplift in a generation. That is a clear sign that the Government are listening to the hospice sector and responding with actions, not just words. However, this uplift must be the beginning and not the end. This new money will not last forever. We must now take concrete steps to ensure that the awful conditions in the hospice sector that we inherited are never repeated. It is worth noting that while the independent commission on palliative and end of life care recently created by my hon. Friend the Member for York Central (Rachael Maskell) is welcome, it will mainly be about delivery and not funding. We simply cannot wait for a palliative care taskforce to complete its report; that could take months, which this sector cannot spare. In my role, I hear time and again about postcode lotteries and the chronic lack of funding that plagues this vital sector. Through no fault of its own, John Taylor hospice, which does fantastic work in my constituency, is facing a crisis in funding; it has had to announce redundancies and a reduction in in-patient beds due to the funding shortfall. That story is being repeated all over the country—I am sure many Members in this Chamber have a similar situation that they could share. Hospice care still relies heavily on charity, bake sales and donations to fund much of the work that supports families during their most vulnerable moments. That must change. This postcode lottery not only is unfair, but undermines the principles of universal healthcare. We cannot allow end of life care to depend on where someone lives and how much money they have. Hospices across the UK provide care and support to 300,000 people every year. They are an absolutely essential part of our healthcare system, although they are in the charity sector. Every single day, hospices face rising costs of energy, food and medicine; every single day, they deliver exceptional care, even as pressures mount; and every single day, they battle deficits that threaten their ability to continue. Despite all those challenges, our hospices save the NHS millions each year by alleviating pressures on hospitals and providing community-based care. However, their ability to continue this vital work is at risk, and they need long-term sustainable support. We need to face the future head on and fix their funding model permanently. While I absolutely understand that hospices are under pressure, the integrated care boards that fund them are similarly under a great deal of pressure due to year-on-year budget reductions from NHS England. Asking ICBs to find extra money without it being allocated centrally as revenue is impossible. Death is a part of life, as the hon. Member for Wimbledon said, and as we all know. Nobody would say we should neglect healthcare, so why are we neglecting the hospice sector by not securing a sustainable funding formula? To truly address the gaps in our system, we need a sustainable funding model that ensures hospices can meet growing demands without being forced to cut services. The people of this country deserve a future where every family, no matter their circumstances, can access the highest quality of end of life care without worry, one where hospice care is not a postcode lottery but a promise. Let us turn this moment into an opportunity. We must act urgently to implement and improve a sustainable funding package for hospices and palliative care. With constructive action, we can build a system that uplifts the most vulnerable among us, strengthens the NHS and shows the best of what we can achieve as a nation. Let us ensure that the legacy of this debate is not one of uncertainty, but one of determination and passion, and that when we see the 10-year plan, hospice and palliative care will be fully funded going forward.

19:31:00

I pay tribute to my hon. Friend the Member for Wimbledon (Mr Kohler) for securing this debate and I thank the Backbench Business Committee for granting it. As he stated, the debate has taken on an added salience since the hon. Member for Spen Valley (Kim Leadbeater) brought forward her Terminally Ill Adults (End of Life) Bill on assisted dying. I hope we can all agree that regardless of what happens to the passage of the Bill, there is an urgent need to address hospice and palliative care. I want to touch briefly on two points: on children’s hospice funding and support; and, more broadly, on inequalities in access to palliative care, which relate to the concerns many of us have about that Bill. On children’s hospices, I am very proud to have Shooting Star children’s hospice in my constituency in Hampton, to which my hon. Friend the Member for Wimbledon referred. As he stated, as well as serving children and young people and their families in my constituency, it actually serves a very wide area of south-west London, west London and all of Surrey. It provides care and support to children with life-limiting conditions, respite care, family support and, importantly, a bereavement service. From talking to the mother of a teenager who died very unexpectedly from an asthma attack in my constituency, I know that her young teenage friends have been very well supported by Shooting Star as they have been grieving their friend who so unexpectedly and tragically lost her life. I want to take this opportunity to pay tribute to Shooting Star for its incredible work. Like other hospices, Shooting Star relies on the goodwill and generosity of so many in our community and beyond, skydiving, running, donating clothes and toys to its shops. As my hon. Friend pointed out, it now faces a £200,000 bill as a result of the employers’ national insurance rise. While I welcome the Health Secretary’s announcement prior to Christmas to renew the children’s hospice grant, I reiterate its question which was echoed by my hon. Friend: is this a long-term commitment and not just for the next financial year, and will it be ringfenced? It has told me time and again that it cannot plan for the future if it is living hand to mouth, year to year in terms of recruiting staff and putting services in place. Hospice funding is so variable. As we have heard, Together for Short Lives reports that NHS funding in 2022-23 for children varied by as much as £483 per child. Hospice UK made a freedom of information request which found, shockingly, that 40% of ICBs have absolutely no idea how much they are spending on children’s palliative care. We need to hold our ICBs much more accountable for children’s and adult palliative care. Together for Short Lives also highlights a £295 million spending gap in NHS spending on children’s palliative care, when compared against National Institute for Health and Care Excellence standards. That brings me to my second substantive point, on the variability of palliative care with particular regard to how it compares to national standards. Marie Curie estimates that one in four people who could benefit from specialist palliative end of life care do not receive it. People are more likely to get good palliative care, frankly, if they are richer, more educated, white and younger. The inequalities across our society in access to palliative care are growing and demand is growing, too. I had a number of conversations with the hon. Member for Spen Valley. These inequalities are one of many reasons why I really struggled and could not support her Bill on Second Reading. They really, really concern me. Back in 2011—getting on for 14 years ago—NICE recommended that there should be a designated palliative care advice line out of hours implemented in every area of the country, but only one in three areas offers that service. That shows us just how poor we are at putting in place what we have already been told needs to be provided so that people can die a good death. If that happened in any other area of care, particularly in cancer, there would, rightly, be outrage that we were not implementing NICE recommendations. The 2024 Marie Curie “Better End of Life” report said that large numbers of people were struggling to access services. There was late recognition of their needs and poor communication. It found that the impact on carers of poor end of life care was profound. The physical and emotional toll that it took on carers left one carer saying: “The overall experience is that no one really cares.” When we are at our most vulnerable at end of life and our loved ones are also struggling, we deserve so much better. We need far greater investment in palliative care and hospice care. I urge the Minister to take genuine action to address both the geographic disparities and the deep inequalities that exist in accessing palliative care. We have a moral imperative, particularly if the assisted dying Bill makes progress. We cannot be in a position where assisted death is available universally on the NHS to those identified in the Bill, but access to good palliative care is not. That is what grated with me most and why I could not walk through the Aye Lobby that day. I urge the Minister and the Bill Committee to ensure that duties are written into law so that there is genuine choice at the end of life. Whether the Bill passes or not, we need to see much greater action on good palliative care.

19:38:00

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this important debate and for his passionate contribution. It is shocking that, on average, only one third of hospice funding is provided by government, with the rest coming from charitable donations. Rising costs, inconsistent income and a shortage of state funding have left the hospice sector in a precarious position. Indeed, many have had to cut back on the services they can offer and are struggling to meet growing need. A recent meeting of the all-party parliamentary group on hospice and end of life care made for a sobering experience for all the MPs present, because every representative from the hospice sector outlined their fear around the future. I am blessed to have both Claire House and Zoe’s Place children’s hospices in my constituency of Liverpool West Derby, but we witnessed first-hand last year the seriousness of the situation for hospices with the threatened closure of Zoe’s Place, which rocked us all to the core in my great city. It was unthinkable that something so precious should be lost, but, due to the lack of funds, it was going to happen. However, the community of Liverpool and beyond rose to the challenge by raising an incredible £5 million in 30 days to ensure that this amazing place could remain open. While I have the chance, I want to thank every single individual and organisation who worked relentlessly to make this happen: without them all, the city of Liverpool would have lost Zoe’s Place. There are so many that I could name, but let me thank the Steve Morgan Foundation, the 64 Trust and TJ Morris for underpinning this remarkable community effort. They should not have had to do this. I am pleased, then, that in December the Government recognised the crisis faced by hospices and committed £126 million to the sector, with £100 million of one-off funding and a one-year extension of the children’s hospice grant, but this is still only a sticking plaster. Hospices need consistent, reliable funding that accurately reflects the cost of care and their value in society to be able to meet the growing demand for palliative and end of life care, to ensure that people have the best possible experience at the end of their lives, and to prevent future funding crises. Hospice sector leaders have estimated that the need for palliative care in the UK will increase by 25% over the next 25 years, and it is clear that long-term reform of the hospice funding model is necessary to ensure that this demand can be met. That is why I back the calls from Hospice UK for the Government to commit themselves to a long-term reform of hospice funding in their 10-year plan for the NHS. I have a couple of questions for the Minister, who has been superb in supporting me over Zoe’s Place. Will the Government ensure that the confirmed £26 million NHS England funding for children’s hospices for 2025-26 is ringfenced, distributed centrally, and increased in line with inflation in subsequent years, and does the Minister recognise the strong preference among children’s hospices for that £26 million to be distributed as a centrally managed and ringfenced grant rather than being distributed via integrated care boards? Without ongoing Government support and a fresh funding model, what nearly happened to Zoe’s Place in Liverpool will happen elsewhere. Hospices will undoubtedly close down. The problems are systemic, and it will take Government action to fix that. The city of Liverpool rose to the challenge to save Zoe’s Place; now this place has to rise to the challenge as well, and give all hospices the funding that they need to survive. This cannot wait, because all who rely on these incredible services do not have time on their side.

19:42:00

Let me first pay tribute to the hon. Member for Wimbledon (Mr Kohler) for securing this important debate, and for his heartfelt contribution. I imagine that there is no one in this House, or even across these islands, whose life has not been touched by hospice care, and I want to pay a personal tribute to my niece, Dr Róisín Etchells, who works in this field. Recently the House had what was by all accounts a respectful, informed and emotional debate on the concept of assisted dying, thanks to the efforts of the hon. Member for Spen Valley (Kim Leadbeater). Perversely, this Government have introduced additional employer national insurance contribution charges on the independent hospice sector, which can only be described as an attack, an assault on the very concept of assisted dying as we currently deliver it—for that is what hospice care is and does, and what others who deliver palliative care in the independent sector within the community do. In Scotland one of the leading providers of such care, both in residential settings and in the community—within people’s homes—is Marie Curie. It operates at least two residential services and community care in almost every local authority area in Scotland. Here I declare an interest as a proud supporter of Marie Curie, and as someone who has helped to raise significant funds for it. It does wonderful work, providing skilled care and brightening the lives of patients as they face the prospect of their last weeks, days and hours. Ask any family who have benefited from this support; I defy anyone to find a critic. Of course I understand that the Government must balance their books and that public sector pay rises must be funded, but the failure to offer mitigations in key areas of these self-same public sector services is misguided, ill-informed, clumsy and counterproductive. “Where will we find the money for these services?”, Ministers will cry, but they know that there are alternatives. In their populist haste to win the trust of the electorate, they rashly promised not to increase income tax. They should look at Scotland, where those with the broadest shoulders pay a little more, where in every tax bracket more people are coming to pay their taxes in Scotland every year, where 60% of taxpayers pay less than their counterparts in the rest of this disunited kingdom, and where the Government responsible for this alleged mismanagement have enjoyed public support for close to 20 years and continue to do so. We in the Scottish National party estimate that if the UK Government had matched the Scottish tax bands, they could have raised £16 billion. In the recently announced Scottish Budget, it was encouraging to see that the Scottish Government committed themselves to increasing hospice funding by £4 million, and to providing additional funding for hospice staff to match NHS pay awards. To me, that is the difference between the Scottish and UK Governments. While the UK Government hike national insurance on employers and vote against amendments to exempt hospices from that hike, the Scottish Government increase hospice funding, and put more money in the pockets of hospice healthcare workers. Like other Scottish MPs, probably, I received a heartfelt plea from Children’s Hospices Across Scotland. If the Minister had read it, he would know how desperate the situation is. I implore the Government to think again, to engage with the Scottish Government to ascertain the cost of mitigations for hospice and palliative care service providers and others, and to provide the same mitigating support that has been given to the NHS and other public services in Scotland.

19:46:00

Let me begin by paying tribute, as others have done, to some local hospices. Both St Luke’s and East Cheshire do a spectacular job, and are very well loved local institutions. I want to say a particular thank you to the staff, of course, but also to the volunteers, and the donors who are literally keeping the lights on. I greatly welcome the £100 million of capital that the Government are providing for hospices, and I ask the Minister to meet me, along with my hon. Friends the Members for Crewe and Nantwich (Connor Naismith), for Mid Cheshire (Andrew Cooper), and for Macclesfield (Tim Roca), to discuss a potential local project. On revenue funding, it would be remiss of me not to mention that St Luke’s and East Cheshire hospices receive 15% and 16% respectively of their funding from the NHS. May I ask the Minister to review that, and commit himself to a funding floor that is transparent, fair and consistent across the country? The quality of the experience that my constituents and their families have at the end of life should not depend on the generosity of individuals.

19:47:00

I thank the hon. Member for Wimbledon (Mr Kohler) for speaking so eloquently in this important debate, and for securing it. I also thank the Backbench Business Committee. Hospices are fantastic places, and all of us in this country are lucky to have them. People go to hospices not to die, but to live the last few days or weeks of their life. While I am pleased that the assisted dying Bill has led to a renewed interest in hospice and palliative care, I am sad that so much of the focus has been on death and the dying process, rather than on the broader support and care offered by hospices and palliative care providers—sometimes over many years—to people who have illnesses that may be life-limiting, and who require certain types of medical intervention to manage their symptoms. That is a very important part of the work that hospices and palliative care teams do, but as I say, much of the focus is often on the death process, rather than the treatment given to those with chronic conditions. Speaking as a former consultant psychiatrist, it would be remiss of me not to mention the psychological support and mental health interventions by palliative care teams and hospices. They are experts in pain relief. Palliative care teams brought a lot of relief to me when, as a junior doctor, I tried to manage very difficult situations in patient care. They are experts in analgesic components. It is important to recognise the palliative care teams working in not only hospices but hospital settings and the community to alleviate people’s symptoms. I pay tribute to the fantastic local hospices and care teams in the Runnymede and Weybridge constituency, at Woking & Sam Beare hospice, which I have visited and is a fantastic place, and at Princess Alice hospice, based in Esher. We also benefit from Shooting Stars, in the constituency of the hon. Member for Twickenham (Munira Wilson). I hope to visit that one day. I thank all the teams who work in those hospices for delivering care and support, but also for keeping the hospices running, and for their vital fundraising. Many people support hospices in lots of different ways, including through direct donations and organising fundraising events, and I am pleased to have been to fundraising events for Woking & Sam Beare hospice. In fact, a week or two ago, I went to the Chertsey panto, which has been running for 12 years. It supports the Woking & Sam Beare hospice. The performances, if one can call them that, have raised £60,000. The panto has to be seen to be believed; one will never forget the Chertsey panto after one has gone to it. The team who organise and run it are absolutely fantastic. It is a fantastic institution and raises a lot of good money for the hospice. We also have charity shops. There is a great one in Weybridge that has been raising money for quite some time. I pay tribute to everybody for what they do, no matter how big or small, to support our hospices and our palliative care sector.

Will the hon. Member join me in promoting a fundraiser being held by St Wilfrid’s hospice in Eastbourne, called “I’m a CEO…Get Me Out of Here!”? It is trying to get lots of local chief executive officers and MPs to join the hospice staff in the Sussex jungle, to raise cash for the great work that the hospice does.

The hon. Member will have to explain further what is required from those who commit to fundraising in the Sussex jungle. He is right to pay tribute to those doing great work in support of our hospice sector. Its funding model is part public and part private, which gives hospices a great benefit. As they sit outside the NHS, they have greater flexibility in how they approach care provision. Woking & Sam Beare hospice is 31% funded by public sector money. It has 2,000 staff and, as I said, delivers fantastic care and support. Much of this debate has been about the future of funding for our hospice sector. Although I am grateful to the Government for the money and support that they have put forward for hospices, sadly they have given with one hand and taken away with the other. The rise in employers’ national insurance contributions is very damaging, and hospices also need to manage increases to staffing budgets as a result of the Agenda for Change. Marie Curie has said that the national insurance component will cost it roughly £2.9 million per year. Could the Minister say what impact assessment has been done on the national insurance contribution rises for hospices, and on the Agenda for Change? How many hospices in the UK are running a deficit, and how does he expect that to change over the next year and going forward, as a consequence of the decisions made in the Budget? If there is an opportunity to reverse those decisions, does he supporting doing so?

19:54:00

I thank the hon. Member for Wimbledon (Mr Kohler) for securing today’s debate. I am incredibly proud of many things in Beckenham and Penge, but particularly St Christopher’s hospice. It was founded in 1967 by Dame Cicely Saunders, the founder of the global hospice movement. The movement came about because Dame Cicely, a nurse who was researching pain control, believed that more could be done to help people at the end of their life. That included dealing with physical symptoms and tackling the stigma around painkillers, but also the idea that people should be able to achieve emotional closure through individualised care and support. The assisted dying debate has been mentioned today by Members from across the House. I had over 2,000 constituents contact me about that debate, and there was roughly a 50:50 split between those who supported and opposed the Bill, but every single one of them was united by compassion, and they relayed their experiences of seeing people at the end of their life. I pay tribute this evening to a woman I was incredibly fortunate to work for in this place, Dame Tessa Jowell. Tessa was a very good friend, a mentor and an amazing boss. Six years ago next week, she made her final speech in Parliament. Tessa was diagnosed with a terminal brain tumour. I was with her from her diagnosis through to writing the press release on the night she died. She finished her speech in the other place by saying: “In the end, what gives a life meaning is not only how it is lived, but how it draws to a close.”—[Official Report, House of Lords, 25 January 2018; Vol. 788, c. 1170.] I sincerely believe that. St Christopher’s hospice gives meaning to life as it draws to a close. It does so by taking a holistic approach; it cares for a patient’s physical, spiritual and psychological wellbeing. I have seen at first hand the intimate bonds and relationships established between staff, volunteers, patients and families. The hospice is one of the largest providers of palliative care education in the world. For all those reasons, we in Beckenham and Penge all support St Christopher’s hospice, which is a huge part of our community. I was fundraising for the hospice long before I became an MP, and I continue to do so. People help in lots of different ways, and I want to give a special mention to Penge Fest, which is south-east London’s answer to Oktoberfest. Local businesses such as Brewery, the Three Hounds and Designer Drapes, organisations including Friends of Cator Park and Penge business improvement district, and many more came together with local residents for a day of fun and fundraising that included an oompah band. The event brought Penge high street to a standstill last summer. We will continue to fundraise for St Christopher’s hospice, but we should not have to do so to pay for the basics. Supporting our hospices benefits everyone, from the NHS to patients, and that is why I welcome the Government’s announcement, just before Christmas, of an extra £100 million in hospice funding, as well as the extension of the children’s hospice grants. That will ease the strain on hospices and benefit patients, as well as the wider health and care systems. However, hospices still face pressures, including increased demand for services, the rising cost of provision and discrepancies in funding across the country, which many Members have mentioned this evening. That is why, as the Minister recognises, hospices must be a key part of the Government’s plan to shift care into the community, including through the provision of at-home care services. That can ease the acute pressures on the NHS. I invite the Minister to visit St Christopher’s to see its fantastic work for himself, and to discuss the role of hospices in the Government’s commitment to ensuring that every person has access to high-quality end of life care. I thank the hon. Member for Wimbledon again for securing today’s debate, and the Government for the vital work that they are undertaking on this important issue.

19:59:00

I thank my hon. Friend the Member for Wimbledon (Mr Kohler) for securing this debate on this important subject. As many people said during the assisted dying discussions, it is clear that the one thing that everybody has in common is a desire to see better palliative care being made more available across the country. Nearly a third of palliative care in Scotland is delivered by charities, and it is the same across the UK. In Scotland, hospice charities provide end of life care to over 20,000 people a year, ensuring compassion and care at the end of life. This figure is expected to rise by 40% in the next 15 years. My constituency does not have a hospice within its boundaries, but we have many people who work and volunteer in the hospice sector. There is concern that the lack of understanding of the core role and wide scope of palliative care, which has for too long been funded outside the NHS despite being a fundamental aspect of care, has led to a shortfall in services, including palliative care for children. For too long, hospices have struggled with insufficient funding from consecutive Scottish and UK Governments, with less than half the funding for hospice care coming from Government sources. While the £100 million extra is absolutely welcome, there is still a huge shortfall. The national insurance increase is projected to cost Scottish hospices an extra £2.5 million a year, and it comes at a time when Marie Curie has highlighted that one in four people across the UK are unable to access the necessary support. This increased financial burden will undoubtedly lead to fewer beds, reduced services and a diminished quality of care for some of our most vulnerable citizens at the end of life. Inevitably, this will compound the effects of the staff shortages already being faced by the care industry, further straining hospice care providers. Where palliative care is available, there are still shortages, especially in psychological support and spiritual care, plus the possibility of serious recruitment problems with any assisted dying provision and in the social care structures that support people in their own homes. Fourteen hospice care providers have already issued an open letter calling for cross-party consensus on sustainable hospice funding. Their plea highlights the urgent need for additional support to ensure that these vital institutions are not forced to ration care or to close their doors. I therefore urge the Government again to consider exempting hospices from the recent national insurance hike. This would be a practical step to alleviate the financial strain on hospices and hospice charities. By doing so, we would not remove crucial funding from palliative care which, as we have heard, is often raised by charitable donations. We must support palliative care services and ensure that all who need hospice care can access it, allowing them dignity and compassion in their end of life care.

20:03:00

Thank you, Madam Deputy Speaker, for calling me to speak in this important debate, and I thank the hon. Member for Wimbledon (Mr Kohler) for securing it. I am grateful that the Government have recognised the immense importance of our hospices’ vital work with the recent announcement of a £100 million funding package. My constituency is served by the extraordinary work of St Catherine’s hospice. For 40 years, St Catherine’s has supported and lovingly cared for individuals with a terminal illness and their families, not only on site in Scarborough but in people’s homes in an area of North Yorkshire covering more than 1,600 square miles. St Catherine’s provides an incredible service and, like most hospices around the country, is a charitable, independent organisation largely funded through donations, fundraising and the income from its high street charity shops. I would like to place on record my sincere thanks to the wonderful staff, the army of selfless volunteers who give freely of their time, and the generosity of the local people who all ensure that hospice care is available to everyone in the constituency. St Catherine’s welcomed our recent funding announcement, but it is clear that one-off capital injections alone will not address the underlying structural funding deficit. At the heart of the issue is the lack of clarity, equity and accountability in how integrated care boards allocate funding. Currently, there is no standard formula for funding distribution, which is creating disparity across hospices. St Catherine’s receives approximately 30% of its funding from the NHS, which is insufficient to meet the growing needs of the community. Some hospices receive much more, and others slightly less. Greater transparency and a consistent framework are needed to ensure equitable funding across all providers, whether NHS or charity based. This inequity places immense pressure on charitable fundraising and limits what hospices can achieve. St Catherine’s alone must raise over £6 million annually. Surely the hospice sector needs funding models that align with service outcomes. A model similar to the mental health investment standard, mandating a minimum level of investment in palliative and end of life care, could perhaps provide the consistency and accountability that are so urgently needed. Long-term strategy is equally critical. It is my hope that a 10-year NHS plan will include detailed guidance for ICBs on commissioning hospice care, supported by a national funding strategy that reduces reliance on voluntary contributions for essential services. Dame Cicely Saunders, the founder of the modern hospice movement, said: “You matter because you are you. You matter to the last moment of your life”. Our hospices strive to make every moment matter for patients and their loved ones. We must recognise hospices as integral partners within the healthcare system. By doing so, we will ensure that hospices are adequately supported to deliver extraordinary care both now and in the future.

20:07:00

Hospices provide vital care for adults and children with life-limiting conditions, offering end of life care, pain management and bereavement support to families, but despite being this essential part of healthcare, the hospice sector has challenges due to inadequate Government funding and the taxes that they are putting on it, and to workforce shortages. That is all compounded by rising costs and economic uncertainty. Before I became a Member of Parliament, I have to confess that I had, perhaps fortunately, very little contact with the hospice sector, despite having worked in health and social care for the majority of my career and being a local government councillor for 17 years. During the election campaign, I was invited to the Shooting Star children’s hospice, which has been mentioned by numerous Members across the House. I visited Christopher’s, which is its in-house care facility in Guildford. I think it is actually in the constituency of my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt)—I am sure that the hon. Member for Guildford (Zöe Franklin) will correct me if I am wrong. There I saw the true meaning of selfless day-to-day acts of kindness and care, with people looking after some of the most vulnerable children and their families. They are the absolute exemplar of people providing dying well. I also have the Phyllis Tuckwell hospice in my constituency, which is currently going through a multimillion-pound rebuild funded by donations from people who have either used or care for our hospice in Farnham. When it is open—hopefully by the end of the year—it will provide 18 new palliative care beds alongside rehabilitation and services for the families as well, along with therapy sessions. Both are shining examples of what dying well should look like. As other hon. Members have mentioned, the one good thing to come out of the assisted dying debate has been a much greater focus in this House, and indeed across the country, on what it means to die well. I echo some of the comments we have heard: let us get palliative care and hospice care right first, before we start thinking about whether or not we should be allowing people to kill themselves. Despite the Government’s announcement just after Christmas, which I would be churlish not to welcome, the reality is that adult hospices and children’s hospices are almost totally reliant on charitable donations. The rest comes through the integrated care boards and, as the hon. Member for Scarborough and Whitby (Alison Hume) just mentioned, it is a complete postcode lottery. I am grateful to the hon. Member for Wimbledon (Mr Kohler) for securing the debate, and he mentioned the significant variation in per person funding depending on where they are in the country and at which hospice they are being treated. The children’s hospice sector is the starkest example, with some places funding just under £30 a head, whereas others fund over £500 a head. This inequity in care clearly leaves some families worse off. The Government really have not made it easy for the hospice sector. It is still not clear to me that the Health Secretary and the Department of Health had any clue that the national insurance contribution changes were coming down the line. If they were aware, had they allocated this funding beforehand? Was this in their plan, or have they been scrabbling to try to make up the difference since they heard this announcement? Despite asking questions, I have not heard an answer. We also have not heard whether the Government will cover the costs of the national insurance contribution rise. My personal view is that they must, because the hospice sector, alongside so much of the care sector, is vital not just to the people who use it, but to the wider health economy. Underfunding and taking money from hospice care will have a significant cost impact on other parts of the health service.

The hon. Member seems to welcome the additional £100 million for the hospice sector and, indeed, the additional investment in the NHS that have come out of the Budget, but he seems not to welcome the way in which that revenue is being raised. How would his party raise the revenue needed for the NHS and the hospice sector?

Well, the simple fact is that what the hon. Members and his Front-Bench team are doing is ensuring that the NHS is worse off, because raising the money will have a greater impact on the rest of the service. [Interruption.] The Minister for Care is shouting at me from the Front Bench, and I am sure that, in his response to the debate, he can outline whether he and his team knew about the national insurance contribution rises and whether they planned for them. The other part of this is the workforce, who have been touched on briefly. There is a real shortage of qualified healthcare professionals. Vacancy rates for hospice nurses have risen to nearly 19%, and the corollary is that staff morale is low. Again, the Government need to make sure that the long-term workforce plan that they and the NHS are rolling out includes how we will ensure that hospice staff are part of the long-term funding. Hospice UK has warned, seriously, that without urgent action, some, indeed many, hospices may be forced to close their doors in the next 12 months. I have some requests of the Government. First, as the hon. Member for Birmingham Erdington (Paulette Hamilton) said, we need them to commit to a long-term sustainable funding model for hospices. That is not to say that hospices should be brought into the central NHS—I personally believe that the innovation of the hospice sector is down to its independence from the NHS—but they need multi-year funding to understand where they stand. Secondly, as has been mentioned, we need to scrap the postcode lottery that comes from the integrated care boards. Some kind of ringfenced funding, particularly for children’s hospice grants, would prevent a lot of the delays and inequities in the service. As I said, we need to make sure that hospice staff are integrated into the NHS long-term workforce plan and are paid in parity with similar NHS roles.

Will the hon. Gentleman join me in paying tribute to the Phyllis Tuckwell hospice, which does great work in his constituency and mine? I have been speaking to the hospice over the last few days, and it requires £25,000 a day to maintain its services. The hospice has told me that it desperately needs multi-year funding settlements to offer a guarantee of future financial security, as well as a clearly articulated workforce plan to ensure continuity of high-quality staff.

I think I mentioned Phyllis Tuckwell at the beginning of my speech, so I entirely agree with the hon. Gentleman. It does fantastic work in Farnham and across Surrey and Hampshire. I am sure like all hospices around the country, it relies on donations but requires secure funding from the Government. I welcome the £100 million of capital investment. We need to remember that hospices and palliative care are not a “nice to have.” They are absolutely essential charitable services, and they must be fully integrated into the funding and planning frameworks of the Department of Health and the NHS. They provide compassionate, life-changing care to thousands of adults and children every year. However, this vital work is being undermined by short-sighted Government policies. If the Government are serious about improving end of life care and reducing hospital pressures, they must deliver fair funding, address workforce challenges and ensure that no family are left without the care they need, regardless of where they live. This is not just about numbers—the Minister might listen to this. It is about dignity, it is about compassion and it is about humanity at the most vulnerable time in people’s lives.

Order. Members will see that we have some pressure on time this evening, and I want to get everyone in. Before I call the next speaker, I suggest an informal four-minute time limit.

20:17:00

I congratulate the hon. Member for Wimbledon (Mr Kohler) on securing this important and timely debate. The provision of hospices and palliative care is an essential part of our nation’s health service, playing a unique and vital role in our communities and often providing services that the NHS simply cannot cater for. We are very fortunate in north London to be served by two amazing hospices. North London hospice and Noah’s Ark children’s hospice provide extraordinary end of life care, comfort and dignity for individuals and their families in Enfield, Barnet and Haringey. I have had the pleasure of visiting both, and I have seen at first hand the exceptional services they provide. North London hospice supports over 4,000 people each year. Its services range from in-patient care to community-based support that allows people to die at home, if that is their wish. It also provides counselling, support and wellbeing therapies. Its community engagement is excellent, and I had the pleasure of attending its compassionate neighbours event in December. Through the programme, community volunteers befriend and support individuals at the end of their life, providing friendship and help with chores on a regular basis. Similarly, Noah’s Ark children’s hospice, which I visited on Friday, provides a lifeline for children with life-limiting or life-threatening conditions. Its hospice at home service allows children to receive care in familiar surroundings, which is often invaluable for families. I doubt that the services and facilities it provides can be bettered. These organisations are models of good practice, but they are indicative of the challenges faced by hospices in England. Both face financial challenges to keep going, and the extraordinary work done by their fundraising teams should be highly commended. North London hospice has £16 million of running costs every year and could not provide its current services without donations and fundraising. It was an honour to raise funds for that hospice when I ran the London marathon in April last year, as did many other people to raise money. My time was five hours, 51 minutes. Noah’s Ark children’s hospice has to find a staggering £6.5 million a year to keep going and has even talked me into doing some fundraising, although I politely declined the skydiving option, as fun runs are more my choice of activity for fundraising. The additional £100 million of capital investment for hospices announced by the Secretary of State for Health and Social Care is very welcome, as is the £26 million for children and young people’s hospices. However, demand for palliative care is expected to rise by 25% over the next 25 years so the funding model for hospices needs to be resolved for the long term. Although the NHS provides some financial support, that typically accounts for only a fraction of their costs. Moreover, the process of accessing public funding through integrated care boards is fraught with challenges. Hospices must navigate a labyrinth of bureaucracy to secure funding that has often already been allocated to them. Delays, inconsistencies and a lack of transparency in decision making can leave hospices in financial limbo. We have all seen the extraordinary fundraising efforts undertaken by hospices, but while those activities are inspiring, they also highlight a stark reality: hospices are being asked to do too much with too little. The current funding model creates a sense of perpetual precarity, where even a slight downturn in donations could have devastating consequences for patients and families. The question we must ask ourselves is this: do we, as a society, truly value the care that hospices provide? If the answer is yes, we must reflect that value in our policies and funding structures. That means increasing NHS funding for hospices so they are not forced to depend so heavily on charity; streamlining the process of accessing funds through ICBs, with clear timelines and accountability; and recognising the unique challenges faced by children’s hospices by providing them with the additional support that they need. In conclusion, hospices such as the North London hospice and Noah’s Ark children’s hospice exemplify the best of what we can achieve as a society. They are places of compassion, expertise and hope, but they cannot continue to operate under the current financial and bureaucratic pressures. We owe it to them—and to the people they serve—to provide the support that they need to thrive. Let us ensure that hospices have the resources they need to continue their vital work—not just today, but for generations to come.

Order. I will now be imposing a hard stop at four minutes, and that may reduce even further. I call Sorcha Eastwood.

20:22:00

I thank the hon. Member for Wimbledon (Mr Kohler) for bringing this matter to the House. I also pay tribute to the hon. Member for Spen Valley (Kim Leadbeater) for how she has conducted the debate on assisted dying, which we have all talked about so much and which most hon. Members have mentioned today. Regardless of people’s opinion on the matter, during the debate on the Terminally Ill Adults (End of Life) Bill everyone agreed that we need to discuss palliative care. We need to ensure such care is delivered equitably, not just locally; as a lot of hon. Members have said, delivery is not only about hospices but about palliation. I do not have a hospice in my constituency of Lagan Valley, but some of my constituents have been moved to the Southern Area hospice and the Marie Curie hospice. As well as that, we have the wonderful Daisy Lodge—a facility used as a hospice but also as somewhere for people to go to get respite. This is about supporting people to live well. I think it was the hon. Member for Vauxhall and Camberwell Green (Florence Eshalomi) who said during the debate on the Terminally Ill Adults (End of Life) Bill that before we die, we have to live well. That should really be at the forefront of what we are talking about today whenever we are capturing the spirit of asking how we can help people to live the lives they should be living, in a way that is not impacted by inequality through a loss of services. One of the issues mentioned during that debate was cancer; I know a lot about that as my husband has cancer. I want to make it clear that most people want to be able to die at home. For some, that is very achievable and doable. However, haematological neoplasms often prohibit many people who suffer from blood cancer from being able to die at home. We heard from the hon. Member for Farnham and Bordon (Gregory Stafford) about issues to do with the workforce. With cancer, there is sometimes a real onus on haematologists because so much of the treatment is do with “the bloods”: how they are performing in terms of chemotherapy, radiotherapy and otherwise. In 2019, the Northern Ireland Affairs Committee raised the issue of workforce with the British Society for Haematology and the Royal College of Pathologists. I was concerned about that at the time, but I am not sure we are much further on with that now so I remain concerned to this day. I am also concerned about the impact of the national insurance contribution increase. I was the only Northern Irish MP to propose an amendment to the National Insurance Contributions (Secondary Class 1 Contributions) Bill to try to exclude Northern Ireland from the increase; unfortunately, that was unsuccessful. The increase creates an unfair further divide between people who provide community and voluntary services, and those who provide statutory state services. It is incumbent on all of us to keep talking about dying well. We have a good Irish tradition of wakes; we really get into the spirit of helping people through loss, bereavement and grief. We can continue to do that only if we have strong, well-funded hospices.

I was in the hon. Lady’s constituency yesterday, so I know well the points she makes and I thank her for letting me visit. She talks about dying well. Will she join me in paying tribute to the Douglas Macmillan hospice, in the constituency of my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner), which does so much to provide care and compassion to many people in Newcastle-under-Lyme and across north Staffordshire, as it seeks to ensure that people do indeed die well?

I thank the hon. Member for his contribution and of course I will join him in that. In closing, I want us to keep talking about living and dying well because we cannot shy away from that debate. We owe it to our constituents, not just mine in Lagan Valley but those across the UK, to ensure that we get this right.

20:26:00

In this Parliament, we have spoken at length about the importance of valuing dignity at the end of life. That principle must be applied to hospice and palliative care, which has faced uncertain funding and been too hard to access for too long. Like most of us, I have reason to be grateful for the work of palliative care professionals. Even though more than 15 years have passed, I still remember with a great sense of gratitude and relief the compassionate care that my grandmother, Janet Russell, received at the end of her life at the St Mary’s hospice, which is now the Birmingham hospice, in Selly Oak. In advance of the debate, I have been in contact with five palliative care professionals in my constituency, who stressed the consequences of the long-term pressures we have heard so much about, including the shortages of palliative care workers and the strain that puts on those who remain. One said: “I’m deeply passionate about what I do and I have seen many lives improved by palliative care but I’m exhausted and often think about giving up.” The strains on the system have led, to quote again from one of my constituents, to “a higher threshold for admitting patients and a lower threshold for discharging patients…we are being asked to stretch further, with less, for longer…you can’t give quality medical care when your hands are empty”. My constituents stressed that there can be public misunderstandings about the nature of palliative care, which reduces suffering, and on average extends life. Those misconceptions have been exacerbated by some of the media coverage of the assisted dying debate, which can make people less likely to seek such care. A number of hon. Members spoke about the importance of children’s hospice funding. The children’s hospice grant was effectively ended last year, although it is important to note that transitional arrangements were put in place. The new funding announced before Christmas has been welcomed by the sector; it is important to stress how welcome that funding is. I heard that recently at the Acorns children’s hospice, which in the last year has cared for 14 children from Northfield. I heard about the plans that Acorns has to put that funding to good use when I visited recently, alongside my constituency neighbour, my hon. Friend the Member for Birmingham Selly Oak (Al Carns). It is an exceptional facility, but the sector still needs long-term funding certainty, set out on a multi-year basis, if it is to deliver efficiencies and certainty for staff. I welcome the constructive approach that the Minister has taken on this issue since July. I ask him to give us an update today, or soon, on whether the Government will be in a position either to restore the children’s hospice grant on a long-term basis or provide similar certainty through another means. Whatever happens in this Parliament in respect of assisted dying, will the Government work with palliative care professionals to set out, as part of the NHS 10-year plan, a clear timeline for improving palliative care provision, which in too many areas is strained? I thank the Backbench Business Committee for making time for this important discussion, and the hon. Member for Wimbledon (Mr Kohler) for the constructive tone in which he led the debate.

Order. We have 60 minutes left, and 19 Members still wish to speak, so I will have to drop the time limit to three minutes.

20:30:00

I shall be as fast as I can, Madam Deputy Speaker. There is no doubt that there is massive support for the hospice movement in this place. While the new funding is welcome, Clare Gallie, the chief executive of the Lewis-Manning hospice in Poole said: “There is simply no point in having fully fitted and beautiful buildings if we cannot afford the staff to run them!” When someone has a terminal diagnosis, their world turns upside down. It may have come out of the blue, or it may be after years of intensive treatment, when they are already at breaking point and sick. Families have to come to terms with losing the person they love, and learn to cope with managing distressing symptoms, processing their own emotions, and managing money worries and potentially their own health issues. People will be coming in and out of the house at a time when they just want to be left alone. They will also be terrified of being left alone and something awful happening. They are more likely to call their GP on a Friday afternoon, worried that no one will be around at the weekend; more likely to witness a distressing symptom and ring for an ambulance, creating an emergency dash to the hospital and a lengthy stay on a trolley; and more likely to be subjected to blood tests and interventions that will not alter the path of their disease. I went on that journey when my mum, Lin Foster, died of ovarian cancer aged just 59, but we were lucky: we had the support of district nurses and palliative care teams through Forest Holme. For the last eight weeks of her life, when she did not leave her bed, those people came in and out of her house with no need to knock. They knew where the kettle was, and they knew when we needed our own time. They managed her every need, including supporting her as she planned her own funeral. She did not want to go to hospital. She wanted to end her days in the thatched cottage that had been her lifelong dream. That is what most people say they want, but only 37% of cancer patients are at home at the time of their death. Junior doctors tell us that palliative patients are spending months in general medical wards, frequently dying there. I was told: “It is not right, it is not humane because general wards lack the skills”. It also does not save the NHS money. I have written to the Minister about the Lewis-Manning anticipatory care model, which I also raised with the all-party parliamentary group on hospice and end of life care. That programme seeks involvement at the point of diagnosis. Lewis-Manning ran a pilot from April 2024 to this month that saved NHS Dorset £765,000 across Poole and Purbeck.

I am grateful to my hon. Friend, and to the hon. Member for Spen Valley (Kim Leadbeater) for her Terminally Ill Adults (End of Life) Bill, which has done so much to bring this debate into the national consciousness. Does my hon. Friend agree with the Liberal Democrat policy that the Government should exempt hospices from the NIC rise?

I completely agree, but what is really ridiculous is that, according to the Department of Health and Social Care, over 10 million hospital days followed an emergency admission in the last year of life, and 10% of people who died of cancer had three or more emergency admissions in the last three months of their life. The anticipatory care model can prevent some of those admissions and reduce the trauma. Further to my letter, sent in November, I urge the Minister to meet me and Clare Gallie to talk about a transformative approach. I was deeply concerned when Marie Curie emailed me to say that Dorset integrated care board will stop commissioning specialist end of life care from March. The rationale is that personal care commissioning will go via council frameworks, but they do not require expertise in the provision of end of life care. I urge the Minister to insist that the specialists are listened to in the framework and to ensure that Lewis-Manning and Marie Curie are heard. Those organisations are looking to make redundancies and close services at a time when hospital beds are at a premium—

Order.

20:35:00

Hartlepool is incredibly lucky to be served by an amazing institution—one that has touched the lives of so many in our town. Alice House hospice and the brilliant people who work there, like hospices across the country, provide essential support to those in their final stages of life, ensuring that they receive the dignity and care they deserve. The stark reality, though, is that Alice House alone requires £3.6 million each year to operate, with only 25% of that money coming from the Government. That means it has to raise £7,000 a day just to keep the doors open and to provide services. Any additional work beyond ordinary maintenance comes at an extra cost. As we have heard, that is a situation mirrored across the country. Dignity at end of life should not rely on charity. Rising costs and inconsistent financial support have left many hospitals struggling, forcing them to cut back their services. Indeed, Hospice UK reports that as many as 20% of hospices were cutting some level of provision, fuelling a bed crisis. Sadly, that was the case for Alice House when it closed its long-term care unit in 2023. I welcome the Labour Government’s recognition of this financial crisis and its backing through the £126 million announced in December. While that support is welcome, we cannot be complacent. We need to ensure that the 10-year NHS plan includes long-term commitments to reforming the hospice funding model. That is essential not just to prevent another funding crisis, but to ensure that hospices can provide the essential care on which our communities rely. The need for palliative care is projected to increase by 25% over the next 25 years. We must therefore act now to ensure that our hospices can meet demand. They are not just places of care, but vital support systems that relieve pressure on our NHS, providing specialised care and training to health professionals across the board. When hospices are forced to cut services, the need for care does not disappear. It shifts directly on to our already overburdened NHS. Life has a tendency to shape and focus one’s attention on the issues in this place. My father has Alzheimer’s. Although he is currently very well, I know that our family—me, him and my wonderful mother—are going to face a difficult future. We have a responsibility now to fix that future for everybody who will need that care in the future, and I hope that is what the Government will do.

20:38:00

It is a pleasure to speak in the debate and to follow the hon. Member for Hartlepool (Mr Brash). I thank him for his personal story. Personal stories tell the story of the debate we have in front of us. During the last debate on assisted dying, the dire straits of our palliative care system were rightly put under the spotlight, so I am pleased to see this debate to address the system and the lack of funding. I will refer to two charities in Northern Ireland that I have had contact with. One of them is Northern Ireland Hospice. It has highlighted that the Government fund approximately 30% of service costs, so the majority of its income relies on the good will and generosity of voluntary donations and other fundraising activities. That means 70% of the funding to provide its specialist palliative care for over 4,000 infants, children and adults with life-limiting conditions in Northern Ireland comes from the funding raised by volunteers. We owe a lot to Northern Ireland Hospice and its volunteers. The people of Northern Ireland are incredibly generous when it comes to charitable giving, but when we take into account the cost of living crisis and the fact that it naturally reduces what people can give—it is a fact of life—we can see the concerns of the hospice sector. Indeed, when Northern Ireland Hospice believed that its funding would be cut by health trusts last year, it announced that it would have to cut the number of beds available in children’s hospices from seven beds all week round to six beds Monday to Friday and only three at the weekend, which represents a massive change in what it is able to do. That is not the news that we want to hear. It does not mean that fewer children need hospice facilities, but that costs have risen, the ability of fundraisers has decreased, and the Government have not enabled health trusts to make up the difference. Although I have underlined the situation in children’s hospices, the issue is replicated in adult care in every corner of the UK. The hon. Member for South Antrim (Robin Swann) is here. He is a former Health Minister of Northern Ireland, and whenever Northern Ireland Hospice needed help, he was able to allocate funding to get it over that hard patch. I thank him on the record for all that he did to make that happen. Funding for palliative care is simply not sufficient. I referred to burnout when the hon. Member for Wimbledon (Mr Kohler) very kindly let me intervene earlier. Medical staff whose loyalty and passion for the job keeps them in post, doing overtime or working unpaid to provide cover, are exhausted and unable to carry on. Marie Curie says that one in four people will die without the right care and support. Far too many people are dying in avoidable pain, in poverty, and alone. By 2048, the need for end of life care will have risen by up to 25%, so the challenge for tomorrow is even greater than the challenge for today—over 730,000 people will need care every year. We know that that crisis is looming, and now is the time to make changes for our loved ones and our constituents. Like other Members, that is what I am asking the Minister to do.

20:41:00

I thank the hon. Member for Wimbledon (Mr Kohler) for securing the debate. I will challenge any politician, regardless of their rosette, when they say that the NHS is broken. It is not broken; it is just underfunded. It is starved of the resources that it needs to function at its very best. We on the Labour Benches are enormously proud of the NHS and its founding principles: the universal right to comprehensive healthcare that is free at the point of use. Money should never be the passport to the best treatment. People should get the best that modern science can offer. The NHS is our greatest creation, and it is socialism in action. As the NHS endures another hard winter, so must Labour’s founding principles. The private sector should not always be the solution. The private sector receiving an extra £2.5 billion a year in Government funding to cut waiting lists is not one of the principles—of either the NHS or the Labour party. There was an earlier back and forth between hon. Members on how to find money. That does not necessarily have to mean cuts; I suggest an annual wealth tax. In Scotland, our hospices remain under enormous strain. Annually, approximately 21,000 adults and children receive expert palliative care, end of life care and bereavement support. The heads of all 14 hospice charities in Scotland have said that their sector is in the grip of an insurmountable funding gap, and staff have spoken openly of the dire possibility of budget shortfalls reaching the point where there will be no other option but to introduce service reductions. Of course, staff will do everything in their power to avoid that, but it is the stark reality of palliative and end of life care in Scotland. The hospice sector needs the Scottish Government to provide further financial support to address the shortfall in statutory funding, which is not keeping up with increased costs. That, coupled with the Scottish Government’s delivery on their promise of a new national funding framework for hospice care, is desperately needed, so that hospices can prepare for the long term.

The Secretary of State repeatedly tells us that all roads lead to Westminster when it comes to funding. Does the hon. Member agree that the Scottish Government can do only what is possible with the resources made available by Westminster?

The Scottish Government need to do much better with the resources they have been given. On the topic of funding, hospices also rely on financial donations, and people the length and breadth of the UK raise so much for hospices. Naturally, many loyal supporters of the hospice sector have not been immune to the bankrupt political ideology of austerity, and the ensuing cost of living crisis has seen ordinary people become poorer, with out-of-control food bills, escalating food costs and sky-high mortgages and rents. Overall, the general erosion of living standards means that donations are an expense that many people can simply no longer afford. The rebuilding of wider society cannot happen without the rebuilding of and investment in the vital public services that people rely on. That includes a properly funded and resourced health and social care system that has the same principles and ethos as when Labour created it.

20:45:00

I will not focus on assisted dying/assisted suicide this evening, because as the hon. Member for Wimbledon (Mr Kohler) said in a good opening speech, we are all united in this place in our desire to see improvements in the palliative care system, but I feel compelled to make this simple point of fact. Studies and research show that in jurisdictions and countries around the world that have introduced an assisted dying/assisted suicide law, the investment in and the quality of palliative care has declined, relative to those that do not have an assisted dying/assisted suicide law. That is for reasons that are fairly comprehensible. That is a fact. I implore the House: let us fix our palliative care system before we consider opening up the law on assisted dying. The United Kingdom is, of course, the birthplace of the hospice movement, and we have some of the best palliative care services and specialists in the world, but as we have heard this evening, our system simply is not working. We have demand for palliative care and hospice services on a scale that was never anticipated in the post-war years in which the NHS was developed. The challenges of growing demand have been sadly exacerbated by decisions that the Government have made, as we have heard.

On Friday, I went to St Barnabas hospice in Lincoln, our local hospice, which does wonderful work, and talked to its chief executive officer, who is tearing his hair out. Because of the national insurance increase, he is losing £300,000 a year. He pays his nurses less than the local hospital; he has to. He is literally funding the NHS and cutting his own service in the hospice. I beg the Government to think again about the national insurance increase on hospices.

My right hon. Friend makes absolutely the right point. It echoes the experience of hospices across the country. Prospect House, which is on the edge of Swindon and is in my constituency of East Wiltshire, receives only 23% of its funding from the taxpayer. It faced a significant deficit this year, so it took immense pains and steps to bridge its funding shortfall. There was a huge response to a public fundraising appeal, and it raised over £170,000 from the local community, but that was before the Budget. The effect of the national insurance increase alone on Prospect House is £170,000, so the public’s generosity has been entirely wiped away by the Chancellor, and Prospect House is back exactly where it was. Julia’s House in Devizes is a children’s hospice, and the most wonderful, moving place that I have visited in my time as an MP. It has had a similar experience. It gets only 8% of its budget from the taxpayer. Its deficit has gone up from £900,000 before the Budget to £1.1 million now. We therefore desperately need a comprehensive review of palliative care. I pay tribute to the hon. Member for York Central (Rachael Maskell), and to Baroness Finlay in the other place. They are leading a review of palliative care, with a view to coming forward soon with recommendations for the Government on how to improve the system. Indeed, thanks to Lady Finlay’s amendment to the last Government’s Health and Care Act 2022, integrated care boards are required to commission palliative care. Unfortunately, no money was attached to that amendment, and as we have heard, the way in which some ICBs commission care is not good enough. I regret, for instance, that the ICB in our area will not commission Julia’s House, the children’s hospice that I mentioned, so we need a better commissioning model. I take issue with the point made by the hon. Member for Birmingham Erdington (Paulette Hamilton) that ICBs cannot find the money for these services in their budgets. They could if they did their job properly and commissioned services locally. They should be able to move budgets around. The fact is that if proper investment is made in palliative care, money is saved elsewhere in the NHS; that is the crucial point. Expensive bed stays in hospital would be reduced, as would demand on ambulances and other services. It should be possible to improve palliative care within the ICBs’ current envelope. We do not want a system of enforced uniformity, or a great new national bureaucracy. I am concerned to hear some hon. Members suggest that we nationalise the system; I do not think that is right. We need to ensure that ICBs can do the job that they need to do, and that hospices can innovate as they want.

20:49:00

The crisis in funding, and the postcode lottery and health inequalities faced by many families, particularly in accessing hospice and palliative care, weighed heavily on my decision to vote as I did in the debate on the assisted dying Bill. That is why I am sincerely grateful to the hon. Member for Wimbledon (Mr Kohler) for securing this very important debate. I was profoundly moved by the extraordinary work of our local hospice, Compton Care, when I recently visited its new hub in the Scotlands, Low Hill, just before Christmas. I was deeply moved by the work that its people do to support families who turn to them at their darkest time. I saw outstanding medical care provided by specialist medical teams and counsellors, but also the wraparound support that they provide—everything from creative therapies and grief counselling to bespoke support for bereaved children. There were also those quiet, crucial moments when the specialist staff knew just what to say, just when things were so difficult for families —moments that are unimaginable to navigate. That is why the Government’s extra £100 million for hospices across the country and their extra £26 million for children’s hospice services are essential. It is the biggest investment in a generation, a clear sign of this Government’s commitment to everyone having access to high-quality end of life care. It will result in hospices such as Compton Care reaching more people, especially in communities that have long felt the brunt of deepening health inequalities. It will provide much welcome support for families across Wolverhampton and Willenhall, and ensure that no one faces the end of life without the care, comfort and compassion that they deserve. I welcome the Government’s investment boost in hospice and palliative care, but I will continue to advocate for equity in care.

May I intervene?

I have nearly finished, thank you. I will never lose sight of constituents’ fundamental right to dignity and care, which matters right until the very end.

20:52:00

I start by thanking the compassionate, dedicated and caring hospice staff and volunteers who, year round, support patients and their families through some of the most difficult moments of their life. I welcome this debate, which highlights the need for greater, more consistent Government support for the work of delivering that vital care. Most pressingly, we must ensure that fiscal policies do not negatively impact our hospices, because hospices are pillars of our healthcare system. They support over 300,000 people annually and provide not just outstanding clinical care, but emotional and psychological support. I have seen at first hand the many ways in which hospices work to bring some sense of comfort and normality at a very distressing time, from providing group activities and special events to creating quiet spaces for reflection. Hospices are not just care providers; they are vital partners in the healthcare system, reducing pressure on NHS services by offering specialist in-patient care and community-based services. Hospices prevent unnecessary A&E visits and facilitate timely hospital discharges. When hospices are forced to cut services, the burden on the NHS only grows. That makes long-term support for hospices not just compassionate but practical. A constituent recently contacted me to tell me about her husband’s experience. Unfortunately, there was no room for her husband at my constituency’s local hospice, the Princess Alice hospice. My constituent strongly believes that her husband’s end of life experience would have been more peaceful and less painful had he been admitted there. Instead, he was left at home, in extreme pain for hours. The community nurses did eventually come to administer pain relief, shortly after which he passed away, but my constituent has expressed that the whole experience was deeply traumatic for her and her children, and urged me to call for more funding, so that other families can be spared such distress. Despite the crucial role of hospices, the hospice sector is at breaking point. As a fundraiser, I work closely with hospices, and I know just how precarious their financial situation is. Many people do not realise how little of hospice care is funded by the Government. On average, the Government fund only one third; for the remaining funding, hospices are reliant on charitable donations. This imbalance leaves hospices vulnerable to financial crises as, thanks to rising costs and inconsistent donations, they fail to bridge the gap. This funding model does not work. One in five UK hospices has had to cut services in the last year, or was planning to, due to insufficient funding, and this trend will continue unless action is taken. Although I welcome the Government’s £126 million package for hospices, we must see it for what it is—a stopgap, not a long-term solution. We need a plan to put hospices on a sustainable, fair and consistent financial footing. A long-term reform of hospice funding is needed as part of the NHS’s 10-year plan. Hospices such as Shooting Star and Princess Alice embody the values of compassion and community. They provide comfort where there is pain, hope where there is despair and dignity where there is loss. It is our responsibility to ensure that they continue this vital work.

20:55:00

I thank the hon. Member for Wimbledon (Mr Kohler) and the Backbench Business Committee for enabling this important debate. This morning, I visited Myton hospices’ Rugby Myton support hub, which, together with its two in-patient centres and teams providing many distinct services, gives valued care to my constituents in Rugby. I want to put on record my sincere gratitude to all the staff and volunteers. The team this morning briefed me on the services they provide at the hub, which I will briefly mention. They provide coffee mornings, counselling for patients and families, opportunities to enjoy arts and crafts and to hear music, physical exercise sessions, self-care advice, support for carers and much more. All are delivered with kindness, and all are supported by an amazing array of volunteers. This is all backed by incredible fundraisers, including the former mayor of Rugby, Councillor Maggie O’Rourke; Myton was her mayoral charity recently. Local communities often rise to the challenge of fundraising, and they recently helped Myton to secure £240,000 to recruit, train and pay five registered nurses, so that more people in Coventry and Warwickshire can access a hospice bed. I hope the Minister will consider three points that arose from my visit. First, volunteers and good will are of course wonderful, but they can only go so far, so any additional long-term funding from the local ICB or central Government would go a very long way, particularly given that the charitable nature of hospices means that there can be a multiplier effect. Secondly, to dispel myths, today I saw that hospices are not just about the last few weeks or days of life. They give a huge range of support to people with life-limiting conditions, so that they can live better until the very end of their life. Furthermore, they are there to support families, and hospices wish to engage with people much earlier in their illnesses. Thirdly, on communications, I hope the Minister will consider the point that despite the best efforts of organisations such as Myton hospice, many people do not understand what hospices are and what services they provide, or that they are free and are not private providers in the traditional sense. What more can the Government do to help hospices educate the public about their services, particularly now that there is more of a spotlight on palliative care, following the recent vote on the Bill introduced by my hon. Friend the Member for Spen Valley (Kim Leadbeater)?

20:58:00

Hospices in Devon were already struggling before the Government’s Budget last autumn, which introduced a hike in employers’ national insurance. To talk first about the national picture, we have heard that a third of funding for hospices tends to come from the state, through the NHS. However, in Devon, it is less than a fifth. For Hospiscare, a charity based in Exeter, the figure is 18%, while for Seaton Hospice at Home and Sidmouth Hospice at Home, the figure is 0%; they do not receive any funding at all from NHS Devon. Last year, I got together with Ben Bradshaw and Simon Jupp, the former MPs for Exeter and for East Devon. We put aside our political differences—Simon Jupp and I were contesting the seat of Honiton and Sidmouth at the time—wrote to the chair of NHS Devon, the brilliant Sarah Wollaston, and secured an extra £500,000 for hospice care in Devon. None the less, the charity Hospiscare still has a deficit of £2.5 million per year. Following the national insurance announcement last autumn, The Guardian reported in mid-November that Whitehall was considering options to relieve the financial pressure on hospices. It suggested that civil servants were weighing up the possibilities of offsetting the NI rise, funding hospice nursing staff directly, or setting up a “direct funding pot” for hospices. Following the announcement on 19 December and the Christmas gift of capital funding for hospices, it seems that the Government chose the direct funding pot for hospices. The problem with the additional capital funding is that a lot of hospices do not have physical buildings. They do not have infrastructure. They provide nursing services and hospice at home, so they cannot simply offset day-to-day spending with that capital spending. They are completely missing out, and that is the experience for Seaton hospice at home and Sidmouth hospice at home services in my east Devon constituency. In conclusion, these charities step in where the NHS does not. Providing care is central to the Government’s vision of shifting treatment from hospitals to communities, yet the current trajectory seems to be forcing patients back into overstretched, acute hospitals.

21:00:00

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this debate and for his excellent and moving opening speech. Hospices across the country care for hundreds of thousands of people living with conditions that limit their lives or mean they face their lives coming to an end. I wish to put on record my thanks to two hospices that provide crucial services for people in my area. Ellenor is a specialist palliative care provider for adults and children based in the constituency of my hon. Friend the Member for Gravesham (Dr Sullivan). Since 1985 it has been providing hospice care for those who need it most, and it recently opened a new wellbeing centre, which is a hugely welcome addition to its facilities. I also pay tribute to Demelza, which has children’s hospices in the constituencies of my hon. Friends the Members for Sittingbourne and Sheppey (Kevin McKenna) and for Eltham and Chislehurst (Clive Efford). Demelza supports families who are going through what I can only imagine are some of the most difficult circumstances I can possibly think of, where children are facing serious or life-limiting conditions. Given the importance of such services, I understand the high degree of concern from the sector before the Government’s announcement of further funding last month, with the NHS England children’s hospice grant not having been confirmed at that point for 2024-25. I therefore join hon. Members who have welcomed the 19 December announcement by the Secretary of State for Health and Social Care of £100 million in funding improvements for hospices, such as updated IT and improved facilities for patients and visitors. I also very much welcome the news that hospices for children and young people will receive £26 million in revenue funding for the next financial year. Hospice UK has welcomed that funding, saying that it will “bring clarity to critically important services for children with life-limiting illnesses.”

What does the hon. Member think about the many hospices that do not need the capital but are desperate for the income? I would be interested in his answer.

I thank the hon. Gentleman for his question. The capital funding will be of immense help to a wide variety of hospices in ensuring that they can upgrade their operation so that they are less reliant on revenue funding from the charity sector and from the NHS. We need a sustainable funding model, and I know the Minister will come back on that at the end of the debate. Finally, let us wish Hospice UK, individual hospices, and our NHS every success with their amazing care for all who need their services, and hope that they will be able to find a sustainable financial future as a result of the Government’s work.

21:04:00

I begin by thanking my hon. Friend the Member for Wimbledon (Mr Kohler) for bringing forward this incredibly important debate. Anyone who has been paying attention to my contributions in this place will not be surprised that I am once again expressing my deepest possible concerns about St Raphael’s hospice in my constituency. Its case is emblematic of the problems across this undervalued and dramatically important sector. One of my first visits after being elected as the MP in July was to St Raph’s hospice, where I saw the incredible care that it offers to residents in my constituency and beyond. I have met people from the hospice several times since then, including just this morning, and it is clear that while the Secretary of State’s £100 million announcement is welcome, it simply does not go far enough. The funding is restricted to capital expenditure fractions, such as refurbishments and digital services. While undoubtedly important to modernise and update the capability of our hospices, the funding does not address their immediate financial hardship, especially in the context of the Chancellor’s Budget. St Raph’s is set to face an estimated £140,000 increase in staff costs this coming year due to the rise in employer national insurance contributions. This burden only adds to the significant strain on the hospice, which is currently funded by the NHS for just 28% of its budget. It is therefore reliant on the generosity of charitable donations for the remainder. If the Government fail to see sense and exempt hospices from this hike, structural deficits will only continue to grow in the sector, pushing many over the cliff edge altogether and forcing those who remain open to cut their services to the bone. While the announcement of additional funding is appreciated, it does not address the root of the problem. The Government’s approach is dangerously akin to tackling a leaking roof with a mop and bucket. The Secretary of State spoke last week about the need to shift the focus of healthcare from the hospital to the community, yet I fear their treatment of the hospice sector has done exactly the opposite. Due to the limited funding that St Raph’s receives, it has been forced to cut its hospice at home scheme, a vital service where staff directly attend to patients in their own homes in the local community. Those on the Government Front Bench say they want community-based palliative care like that under the hospice at home scheme, but the scheme has been cut further due to their actions. These issues show why they must bring forward a long-term funding arrangement for hospices, if the Government intend to keep their promise. My Hospices and Health Care (Report on Funding) Bill, presented last year and due for Second Reading in July, sets out ways for the Government to consider those options to deliver a long-term funding deal. However, I sincerely hope that by July the Government will have listened and the Bill will not need to be debated at all. I urge them to please make my Bill completely redundant.

21:07:00

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this debate. Like many Members here, I am here to talk about my local hospice. Just over the constituency border in Whittington, St Giles hospice has been doing its vital work for more than 40 years. However, 2024 was a challenging year for the hospice, with rising costs, plus the impact of the cost of living crisis making fundraising more difficult, leading it to make some impossibly hard decisions last summer. St Giles had to close one of its wings and make a number of redundancies among its clinical staff. That was due not to reduced need across Lichfield, Burntwood, the surrounding villages and further afield, but only to the financial situation that the hospice faced. I commend my constituent Sean Collins, who is leading St Giles’s urgent funding appeal. The hospice supported Sean and his children following the loss of their mother and wife, Felicity, at just 38 years old. I am not sure I would be strong enough to turn that tragedy into something as positive as Sean has, but he has all my support. The generous donors to St Giles do so much to care for people they have never met with their donations. In a recent meeting with Elinor Eustace, the CEO of the hospice, she mentioned how much she values all that they do, but said that she does not want to have a fully funded model, because of the value that fundraising brings to the entire community around the hospice. Having said that, Government support is essential to making sure that hospices across the country can continue to do everything they do for all our communities, so I welcome the £100 million of additional funding that the Government announced just before Christmas. However, we must find ways to ensure that all hospices remain sustainable in the long term. St Giles receives just 18% of its funding from the NHS, which is less than £1 in every £5 when the national average is £1 in every £3. Levelling that playing field cannot come fast enough. In addition, St Giles has to deal with five different integrated care boards. That is five different NHS organisations for five different geographies, all with different funding formulas, different grant processes, different reporting mechanisms, different key performance indicators and different timescales. That is all for grants that add up to nothing more than an administrative nightmare. Simplifying and standardising that process will ensure that St Giles can spend less time securing grants from the NHS and more time on caring for the community in my constituency and further afield. I ask the Minister to look very closely at that point, because there is a real opportunity to secure significant benefit for hospices across the country.

21:09:00

I thank the hon. Member for Wimbledon (Mr Kohler) for bringing this important debate to the House tonight. I congratulate him, but it is unfortunate that it was not held in Government time, because this issue was raised on a number of occasions during the debate on assisted dying. The debate has highlighted the importance of the discussion around palliative care. The All Ireland Institute of Hospice and Palliative Care conducted a recent study of 500 people in Northern Ireland, which indicated that more than one in three think that they only had days to live if their doctor or healthcare professional talked to them about palliative care, and more than one in four would feel that their doctor was giving up on them if they talked about referring them to palliative care. This debate and the previous debates that we have had raise the importance of these discussions with family and the wider community. Work has been done in Northern Ireland on conversations about advanced care planning, where families, health professionals and all parts of the society are involved in those open conversations. Much has been said about the fundraising model for hospices and palliative care providers, and it is no different in Northern Ireland. We talk about the need for a funding model, but the Department of Health and the entire health service in Northern Ireland have been relying on year-on-year budgets since 2016. That puts stress not only on our national health service, but on palliative care providers, hospices, GPs and community pharmacies. There is a desire from the rest of health and social care in Northern Ireland to see a recurrent, guaranteed budget that we could use to make those transformation decisions. I pay tribute to the hospices and palliative care providers in Northern Ireland, especially the people who work in them. Much has been said today about funding care models, how they are managed and all the rest of it, but often we forget that at the heart of every care package, every delivery, every door that is knocked and opened and every cup of tea that is made for someone in one of those conditions are those healthcare professionals. They have the strength and the ability to move on to the next patient and family, to give them the same level of dedicated professional support. Finally, I pay tribute to the staff in the Macmillan specialist palliative care unit in Antrim area hospital. I had the honour and privilege of visiting them many times as Health Minister in Northern Ireland, but especially when they were providing support and care to Shirley Smyth almost this time last year—a fantastic supporter and grandmother of one of my councillors, and a fantastic lady.

21:13:00

I join colleagues in congratulating the hon. Member for Wimbledon (Mr Kohler) on securing this important debate. Bolton hospice had been facing a funding gap of £1.2 million, which could have meant cutting as many as a third of its beds. We should remind ourselves what each bed and every penny lost actually means: in many cases, the real-life impact of these numbers is the prolonged suffering of the most unimaginable kind for the individual, and the heart-rending experience of having to witness it for family and friends. Let us not forget that 300,000 people depend on hospices every year. Bolton hospice, in part following a fantastic campaign from The Bolton News and the huge generosity of the people of Bolton, was able to cut its deficit to £400,000—still a large amount. I did my level best to contribute to that campaign by traipsing up Mount Kilimanjaro. Frankly, hospices are so important to so many people that they should not have to rely on the kindness of strangers. That is why I was pleased to learn just before Christmas that Bolton hospice is in line to receive a slice of the once-in-a-generation £100 million national funding boost announced by the Health Secretary. Such investment pays for itself in many ways, by supporting the Government’s plan to shift more care into the community and keep people who need not be there out of hospital, and, importantly, by ensuring that people can die in a place of their choice with the care that they need. However, more funding will inevitably be required as we cope with an ageing population with increasingly complex care needs. Given the pressures on public finances and the cost of living crisis, we must look for creative and innovative solutions. With that in mind, I want to raise the work of my constituents Corin and Tricia Dalby, who, through tireless campaigning, have secured the support of 30 hospices, 36,000 petition signatures and more than 100 parliamentarians in raising the profile of hospices’ financial pressures, with a petition presented to No. 10 Downing Street last month. Corin and Tricia’s petition calls Government to redirect the first £100 million of fines levied by the Financial Conduct Authority on banks and other financial services firms to the hospice sector. Since April 2012, the money collected from FCA fines has gone to the Treasury, and can then go to charitable donations. We need to think carefully about how to ensure hospices are put on the sustainable funding platform they so desperately need, but I urge my colleagues, including the Minister, to carefully consider this proposal. Finally, it would be remiss of me not to mention the private Member’s Bill of my hon. Friend the Member for Spen Valley (Kim Leadbeater) on assisted dying. Palliative care provides the relief so urgently needed for hundreds of thousands of people around the country and their families, and we absolutely must make sure it is the best it can possibly be.

21:16:00

Like other Members, I begin by paying tribute to our hospices and to everyone who works and indeed volunteers in palliative and end of life care, providing such amazing support to patients and their loved ones around their death—that most difficult time of life—and helping people to have a good death. As many Members have said, that work is so crucial. I would particularly like to mention St Michael’s hospice, Hereford, in my constituency. It is a place I have had an association with for many years, as it has provided amazing care to friends of mine who have died there. It is so well loved in the community. Is it not such a shame, as so many colleagues have said today, that palliative care is so dependent on charitable funding? As the hon. Member for Huddersfield (Harpreet Uppal) said, it is integral to our healthcare system—except it is not, because it is not fully funded by our healthcare system. It is not actually free at the point of need, except thanks to the grace and kindness of strangers and charitable funding. Government Members have made mention many times this evening of the £100 million capital injection from the Government, which is absolutely welcome; it has been so frequently mentioned, in fact, that one might think the Whips have gently encouraged its mentioning. However, the problem is that this £100 million is a short-term capital injection, when what is needed is a long-term revenue funding solution. Despite the amazing efforts of fundraisers, revenue budgets in hospices are under extreme pressure. That has been made worse by the rise in employer national insurance contributions; St Michaels will have an additional bill of £240,000 next year because of it. That is a problem. The current funding model for hospice care is a problem. It is good that there is now a statutory requirement for ICBs to fund palliative care, but there is a complete lack of parity across the country. Hospices have to negotiate individually with ICBs all across the country every year. A hospice leader said to me that they have no sight of the future; another said that when they are considering redundancies, it is no use telling people they are going to be resurfacing the car park with the new capital funding. We need a sustainable revenue funding solution for hospices—a clear, fair, multi-year, long-term funding solution—with parity across the country, to provide those doing that amazing work to support patients and the patients themselves with the support they need and deserve.

21:19:00

Twenty years ago this month, both my parents died aged 60, of cancer. They died just one week apart, but that is where the similarities ended. My father died a horrible death, receiving very poor—if any—palliative care. My mother won the postcode lottery, if you like, and passed away in the Royal Stoke, in Stoke-on-Trent, where she received superb care and died a dignified death. I live with the twin legacies of those deaths. I stress to the Minister the importance of ensuring that trained palliative care staff are spread equally throughout the country. It is vital. It makes a difference. Stoke-on-Trent has also won the postcode lottery in a way, with our excellent hospice, the Dougie Mac. Having merged with the Donna Louise children’s hospice, it now provides care for all people of all ages across north Staffordshire. It provides many innovative services, including a dementia care service and a rapid response ambulance service, which responds for patients at the end of their lives. Instead of taking them to A&E, they travel to the hospice. That saves the local hospital 350 A&E visits a year, saving on ambulances and saving the trust money. Unfortunately, the hospice does not receive any funding to help deliver that service. I want to take the opportunity to put on the record my thanks to the chief executive, who I spoke to at great length recently, to all the staff across both sites, in Blurton and Trentham in my constituency, for all the work they do, and to all the amazing volunteers in the shops throughout Stoke-on-Trent. I welcome the Government’s commitment to funding hospices and the £100 million injection, but like everyone else I support ending the postcode lottery. We must end inequality in the delivery of service and we must provide a more sustainable model in future.

21:21:00

Hospices and palliative care are not just about easing physical pain; they are about dignity, compassion and humanity. How we care for those approaching the end of their life reflects who we are as a society. As has been mentioned by right hon. and hon. Members, palliative care should be an integral part of our wider NHS. Over half a million people die each year in the UK, yet too many of them do so in conditions that fail to meet their needs or respect their wishes. Hospices, the very sanctuaries of peace and care, are stretched to breaking point. Palliative care teams staffed by dedicated professionals and volunteers do extraordinary work, but they are increasingly underfunded, under-resourced and overlooked in policy debates. Those challenges are not the fault of those on the frontline; they stem from systemic issues in how we prioritise end of life care. Funding for hospices comes primarily from charitable donations, with only about a third provided by the NHS. That is not sustainable and nor is it fair. We would not dream of asking our hospitals or schools to rely on bake sales and fundraisers for their survival, so why should hospices be any different? I do not have hospices in my constituency, but I want to pay tribute to the local hospices that care for my constituents. The Kirkwood hospice has budgeted for a near £1 million deficit for 2023-24 and it expects the same level of deficits to continue in subsequent years. The picture is the same for the Forget Me Not children’s hospice in Kirklees, which also faces a £1 million shortfall and has put out an urgent appeal for public donations. Another issue is access. Palliative care should be a universal right, yet we know that availability varies widely depending on where we live, and one’s age and condition. Too many people, particularly in deprived areas or from minority communities, face barriers to receiving the care they need. That inequality is unacceptable in a society that prides itself on fairness and must be addressed by the Government. In conclusion, we must ensure secure, long-term funding for hospices and palliative care services. That requires a shift in how we think about end of life care: not as an optional extra, but as a core part of our healthcare system. The Government must step up and provide the sustainable financial support these services need to thrive now and for the future, and be able to support all communities equally.

21:24:00

Let me first pay tribute to the hon. Member for Wimbledon (Mr Kohler) for bringing this debate to the House. Hospices such as Compton Care in my constituency provide invaluable palliative care, not only in terms of pain and symptom control but in providing psychological, social and spiritual support, support for people who wish to die at home, and rehabilitation, financial advice and support for family members, including bereavement support. However, the funding that hospices receive from ICBs across the country is inconsistent, and often does not reflect the cost of the services that they provide. As has already been mentioned, only a third of hospice funding comes from the Government, with the rest coming from charitable donations. As of May last year, at least a fifth of UK hospices had either cut their services in the previous year or were planning to do so. When hospices cut services the need for care is still there, but it has to be met by the NHS. If they are given the long-term support they need, that can ease the pressure on the NHS. Sector leaders estimate that the need for palliative care in the UK will increase by 25% over the next 25 years. However, I welcome the £100 million that the Government have provided, which will improve buildings, equipment, accommodation and digital upgrades, as well as the £26 million revenue funding for children and young people’s hospices that will be provided in 2025-26. There has been a lot of discussion about assisted dying this evening and when we discussed the assisted dying Bill, there was a lot of discussion about palliative care. Now we have an opportunity to take action, and we need to seize it to improve palliative care. If the assisted dying Bill does become law, we need to make sure that people in the future do not have to make a decision between assisted dying and palliative care.

21:26:00

Palliative and end of life care is about dignity, compassion, and giving every person their right to live their final days in comfort and peace, as the hon. Member for Wimbledon (Mr Kohler) observed when compassionately describing his parents’ last moments. However, I agree wholeheartedly with the hon. Member for Stoke-on-Trent South (Dr Gardner) that access to high-quality care is a postcode lottery across the UK. Only a third of local NHS areas in England can provide 24/7 end of life care at home, which leaves nearly 100,000 people every year without the care and support that they deserve during their most vulnerable moments. We must address this disparity. Every patient deserves a personalised care plan that respects their wishes and supports their physical, emotional, social and spiritual needs. Care plans should also offer non-clinical help, such as financial advice and opportunities for people to participate in meaningful activities while they can still do so; and let us not forget the families who require respite care during this period. Hospices play a vital role in such care, but, unlike the NHS, hospice care is not fully funded by the Government. Hospices receive only about a third of their income from the state; the rest is raised through charitable donations, which is pitiful. This model is unsustainable. As a result of rising costs, which have not been helped by the national insurance increases, the sector faces a £60 million deficit this year alone. As demand for hospice care grows owing to an ageing population and advances in medicine that help children with life-limiting conditions to live longer, the strain on hospices will only increase. Without immediate action they will struggle to meet this growing demand, leaving more people without the care that they deserve. We need bold and decisive steps to fix that. First, we need fair and sustainable funding. The Government must create a national plan to secure consistent funding for hospices. Emergency funding is urgently needed. Secondly, we need a national standard for care. National quality standards and agreed outcomes for palliative and end of life care are essential. Every integrated care board must meet minimum standards to provide fair access to care nationwide. Thirdly, we need support for underserved communities in areas where people are currently missing out. There should be access to palliative care in homes, care facilities and hospitals, ensuring that no one is left behind. Fourthly, the £26 million children’s hospice grant must be ringfenced. Let me end by thanking the incredible teams at the two hospices in my city that serve my constituency: LOROS, which assists 2,500 people a year, and Rainbows, a fabulous organisation that cares for young people with life-limiting conditions. I want to thank them both.

21:29:00

I thank my hon. Friend the Member for Wimbledon (Mr Kohler) for bringing forward this important debate, and all hon. Members for speaking with such compassion. Although the £100 million for hospice capital projects is to be welcomed, it is cash that is most needed. Julia’s House, a children’s hospice in my constituency that has already been mentioned, will find itself out of pocket by £242,000 per year because of the rise in national insurance. Dorothy House hospice, which is also in my constituency, will lose even more. That is a lot of sponsored walks and parachute jumps—perhaps too many—if the hospices are to avoid cutting their services. I urge the Minister to think again, and to provide the funds that our hospices need.

I call the Liberal Democrat spokesperson.

21:30:00

I thank my hon. Friend the Member for Wimbledon (Mr Kohler) for securing today’s important debate, and all hon. Members for approaching the conversation with the compassion and thoughtfulness that this topic deserves. Examples shared across the House show that hospices are a vital part of our healthcare system. They provide outstanding care for patients approaching the end of their lives, offering dignity, comfort and support to families, and they are often driven by hundreds of volunteers, alongside the paid staff. Hospices will play a key role in meeting this Government’s objective to move care from hospitals to the community. This debate is very timely, given that the front pages of the newspapers are reporting today that half a million people were left languishing on trolleys in A&E and in corridors in 2024 because there were not enough beds to admit them. Hospices, such as the extraordinary St Wilfrid’s in my constituency of Chichester, are the cornerstone of community care. I was blown away during my recent visit to St Wilfrid’s, and I am not ashamed to admit that I was brought to tears by the accounts of the family members, patients and staff I met that day. I applaud the hon. Member for Stoke-on-Trent South (Dr Gardner) for her show of emotion, because it is an emotive topic. St Wilfrid’s provides comfort and compassion to patients and their families during life’s most challenging moments—both directly in the calm and idyllic surroundings of the hospice and out in the community, providing palliative care for 300 people in the comfort of their own homes. It is St Wilfrid’s belief that everybody should be afforded a good death, and it strives to ensure that there is beauty in every day for patients and their loved ones, yet its service is being crippled by rising costs and a lack of sufficient Government support. Hospices are in the process of setting their upcoming budgets, and many are having to make difficult long-term decisions to cut palliative care because they lack a long-term solution to address the growing financial strain. As the hon. Member for North Herefordshire (Ellie Chowns) mentioned, it is all well and good being able to say you have a lovely car park when you do not have any nurses to park in it. Only 17% of the overall cost of St Wilfrid’s hospice is currently covered by NHS grant funding—well below the minimum requirement across the country. One of the biggest components of hospice costs is the salary of their expert clinical and other staff. Hospices are trying to match NHS salary increases to ensure that staff can afford to stay with them, and to remain competitive. In addition, they are now burdened with paying increased national insurance contributions, whereas direct NHS providers are exempt. For St Wilfrid’s, the rise in national insurance contributions will cost an additional £210,000, which is a significant financial burden. Although we Liberal Democrats and hospices alike welcomed the capital investment announcement in December 2024, that funding does not address the challenges of day-to-day spend, so there is still a vast gulf between rising expenses and available income. As the hon. Member for Birmingham Erdington (Paulette Hamilton) said, the funding must be the start, not the end. Hospice UK has warned that around 300 hospice in-patient beds—14% of the total—are currently closed or out of use due to a lack of funding and chronic staff shortages, meaning that fewer patients are able to access the end of life care that they need at one of the most vulnerable times in their lives. My hon. Friend the Member for Twickenham (Munira Wilson) mentioned the Marie Curie report, as did other Members across the House, which stated that one in four people who need hospice care cannot currently get it. The term “bed blocking” is not one I am particularly comfortable with, but if adequate palliative care is unavailable in the community or in a hospice, those people will remain stuck in hospital, and those hospitals cannot provide the expert care that a hospice can. Our hospices are ready and willing to take on those patients, but they need the support of this Government to do so. As my hon. Friend the Member for Wimbledon (Mr Kohler), who brought forward this debate, said, people do not want to die in hospital. They want to die at home or in a specialised setting such as a hospice. That is why the Liberal Democrats are calling for hospices to be exempted from the rise in national insurance contributions. This targeted measure would provide immediate relief for a sector that is struggling under the weight of rising costs, and prevent further reductions in capacity or even closures. We must think long term. Hospices need a sustainable funding model that guarantees they can continue their vital work of providing care for patients, supporting families and easing the pressure on the NHS. Hospices must also be a part of the conversation in the Government’s upcoming 10-year plan for the NHS, and that must include sustainable hospice funding reform. Examples from across the House today showed a shared recognition of the importance of hospice care. Now we need the Government to match that recognition with action for the patients, for the families and for a health service that depends on hospices.

I call the shadow Minister.

21:36:00

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this debate. I was going to test the patience of the House by reading out all the hospices that have been named, but we got to 45 and I realise that time is short, so I will not do so. It is, however, a testament to those hospices’ services that so many Members have spoken so fondly about them. On behalf of His Majesty’s Opposition, I would like to discuss three areas: the conversation about death; palliative services and the ecosystem; and some specific technical questions. It is rare in this House that we debate a topic that impacts literally everyone, and it is an honour to play my part in highlighting something I have long argued is not talked about nearly enough—that is, death and dying. We all know that the only certainty is death, but there is a variable, which is the quality of death. That has been the focus of today’s debate. After all, it was Woody Allen who said: “I’m not afraid of death, I just don’t want to be there when it happens.” Palliative care services dedicate their lives to making sure that people who will die do so with dignity. Many people think of hospitals or hospices in relation to death, and their staff do fantastic work, but we must not forget the pivotal role played by the likes of district nurses and GPs in ensuring there is palliative care in our nation. In my constituency, I am blessed with hospice care from Loros for adults and Rainbows for children, both of which are much loved by the public and, most importantly, supported by armies of volunteers. Those people deserve this House’s and the public’s recognition and respect for what they contribute to our society. Dying can be a difficult subject to talk about, as I know from my clinical days, but that does not make it any less important. I pay tribute to this House for the way in which it handled and discussed the assisted dying debate. Whatever position people take, it is fantastic to see a national debate now taking place across dinner tables up and down this country. So my first question to the Government is: what is being done to ensure that people look to plan their deaths better? When we talk about the wider ecosystem, we have to consider the roles of hospices, hospitals and primary care providers such as district nurses, who are all key stakeholders, and the nature of how they have ended up being involved in palliative care and the different journeys they have made to do so. That is beyond the scope of this debate, but it is important because it informs the make-up and patchwork of palliation across this country. As we have heard, there is a balance between charitable funding and NHS funding, and even this House is divided on what that formula should look like and whether it should be solely state funded or charitable. My second question to the Government is: will they consider consulting on a long-term funding model that allows this debate to take place, so that we have a better balance between the two? Building on that, looking at it from the clinical point of view, part of the issue at play is what the provision should even look like. My third question to the Government is: will they commit to establishing agreed basic standard criteria for service-level provision, and to getting a national agreement on the provision of palliative care services and what they look like for whatever a person should choose? On the record of the last Government, we legislated in the Health and Social Care Act 2022 to ensure that commissioning was taking place. As part of the NHS response to covid, £350 million was given to support hospices in those difficult times. NHS England also put in grant funding for a 24/7 single point of access for palliative care support. As we have heard, the last Government also increased the funding for the children’s hospice grant from £15 million in 2020-21 to £25 million, and I am pleased to see the Government continue that trajectory. To help manage staff, the last Government brought forward the first ever NHS workforce plan, and I commend this Government for continuing to commit to that. With the debate about assisted dying and the concerns expressed by the Health Secretary about provision, however, my fourth question to the Government is: what assessment have they made of the impact of assisted dying on provision? I believe the Secretary of State was commissioning work on this, so when will the results be released? On assisted dying and the ability to provide the services, this is not the right place to suggest whether they are right or wrong, but whether or not the Bill passes, I hope we will not let it distract us from the mission of continuing to improve palliative care and end of life services, for which there is momentum in the House and among the general public. On the specific questions from the sector, it would be remiss of me not to raise the concerns about Labour’s Budget and its impact on the palliative care sector. The employer national insurance contribution increases are a tax on charities—fact. Charities are not covered by the NHS exemption. Hospices are charities, so they are being taxed—fact. GPs provide palliative care and support. They are not covered by the NHS exemption, so they are being taxed—fact. Hospice UK has estimated that an additional £30 million will need to be found. This means that charities and non-profit organisations such as Sue Ryder, Macmillan and Marie Curie are being hit with additional wage bills, requiring more money just to provide the same level of care. The Government have said that they will give £100 million to hospices, but it has been made abundantly clear in this debate that it is for capital expenditure only, unless the Minister would like to correct me. What assessment have the Government made of what the spending review will look like when it comes to palliation? It is hard not to see this as a Labour Government giving with one hand while taking with the other—taxing GPs and hospices in order to give them money back in a way that they do not want. On staffing and contracts, some staff are employed by the NHS, while others are directly employed by the hospices. Have the Government made an assessment of the impact that will have on recruitment? For example, palliative care consultants face a postcode lottery of terms. Will the Government consider looking at that? Palliative care consultants’ contractual arrangements throw up another oddity in the sector: some NHS palliative care consultants have Crown indemnity, while others employed by hospices do not, costing them thousands of pounds. Will the Government consider looking at that? On the allocation of funding process, Together for Short Lives has called on the Government to confirm whether the £26 million will be ringfenced for children’s hospices and distributed centrally to avoid delays. Previously, the decision was made to give it to ICBs to better help local decision making. Although well meaning, that has resulted in delays. Are the Government aware of this issue and, if so, will the Minister commit to working to smooth it out? There is much more that I could say on the topic, and I sure that the same is true for many others. The UK has an ageing population, and demand for palliative care will continue to rise in decades to come. In this House, we have the opportunity to make a difference for all who come after us. At the heart of looking after the dying is compassion. True compassion means not only feeling another’s pain, but being moved to help relieve it. This Government have the power to do that, and I hope they will.

21:44:00

I pay tribute to the hon. Member for Wimbledon (Mr Kohler) for securing the debate and making such a powerful and thoughtful opening speech. I thank hon. Members from across the House—there are too many to list. It would be impossible to capture the richness of the contributions made. Something like 28 Back-Bench Members made speeches—I am sure Madam Deputy Speaker will correct me if my numbers are not quite right. It was an excellent debate, and I thank everybody for their contribution. I thank all those who work or volunteer in the hospice and palliative care sector for the deeply compassionate care and support that they provide to patients, families and loved ones when they need it most. This Government are committed to building a society in which every person receives high-quality, compassionate care, from diagnosis through to the end of life. We will 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. The reality is that we have a mountain to climb. Our health and care services are on their knees, but this Government will strain every sinew to build them, and to create a health and care system that is once again fit for the future. 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 that duty, NHS England has published statutory guidance and service specifications. While 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 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 each charitable hospice receives varies both within and between ICB areas. The variation is dependent on demand in the area, and on the totality and type of palliative and end of life care provision from NHS and non-NHS services, including charitable hospices, within each ICB footprint. We understand the financial pressures that hospices have been facing, which is why last month I was truly proud that this Government announced the biggest investment in hospices in England in a generation. It will ensure that hospices in England can continue to deliver the highest-quality care possible for patients and their families and loved ones.

I also welcome that, and congratulate the Minister on getting that money out of the Treasury, but will he acknowledge that there is a difference between capital and revenue? Hospices urgently need support for their day-to-day running costs, not just more money to support the capital. They also need capital support, but that is less crucial.

I take the hon. Gentleman’s point, but hospices face a range of pressures. The capital expenditure injection that we have provided will help them in the round. Clearly, anything that helps a hospice with its budget in the round, be it capital or revenue, will help the hospice. We are supporting the hospice sector through a £100 million capital funding boost for adult and children’s hospices, to ensure that they have the best physical environment for care. There is also £26 million in revenue funding to support children and young people’s hospices. The £100 million in capital funding will deliver much-needed improvements—from refurbishments to overhauling IT systems and better facilities for patients and visitors—during the remainder of 2024-25 and throughout 2025-26. The investment will help hospices to improve their buildings, equipment and accommodation, so that patients continue to receive the best care possible. Hospices for children and young people will receive a further £26 million in revenue funding for ’25-26 through what was known until recently as the children’s hospice grant. That investment demonstrates the Government’s recognition of the importance of integrating services to improve the treatment that patients receive. Furthermore, through our plans for neighbourhood health centres, we will drive the shift of care from hospitals to the community, which will bring together palliative care services, including hospices and community care services, so that people have the best access to treatment through joined-up services.

Money is not always the only solution, so will my hon. Friend confirm how the commission on palliative care that the Government announced last month will improve end of life care?

The Government announced a commission on the future of adult social care. A separate commission was announced by my hon. Friend the Member for York Central (Rachael Maskell) on palliative care. We will certainly monitor the findings of that commission very closely. We will set out details of the funding allocation and distribution mechanisms for both funding streams in the coming weeks.

In my contribution, I made the House aware that the Northern Ireland hospice has to cut its beds from seven to six for five days of the week, and at the weekend, there are only three. The Minister knows that I respect him greatly. It is all very well to have capital money available, but there has to be money to run the system and provide beds. Otherwise, we can buy beds, but might not be able to keep them and run a service. There must be something seriously wrong with what he is putting forward.

As I said in a previous answer, hospices face a range of pressures that financial contributions from the Government will help to ease. The funding will, of course, have a knock-on impact on hospices budgets in the round. In spite of the record-breaking package that we have announced, we are certainly not complacent. There is more work to be done, and through the National Institute for Health and Care Research, the Department is investing £3 million in a policy research unit on palliative and end of life care. The unit launched in January 2024 and is building the evidence base that will inform our long-term strategy. A number of hon. Members requested a long-term strategy and plan, which is sorely missing after 14 years of Conservative neglect and incompetence. I agree that we need a long-term plan, and assure Members that conversations are taking place between my officials and NHS England. The research needs to be based on evidence and facts, which the unit will help us to get.

It is important that this debate is not a political ding-dong, and I really appreciate the tone that all Members, including the Minister, have taken. On evidence and facts, will he look into the impact of the national insurance contribution rises on hospice care and provision, how many hospices are running a deficit, and how many will likely go into deficit as a result of his policies?

The hon. Gentleman will not be surprised to know that I have a section in my speech on employer national insurance contributions. I will get to it. A number of colleagues raised concerns about regional variations. Facts and evidence are very important in that context. To address that issue, NHS England has developed a palliative and end of life care dashboard, which brings together all the 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.

Will the Minister give way?

I will, but I have to finish at 9.58 pm, so there is only about five minutes left of my contribution.

It is generous of the Minister to give way, so I shall be brief. Would funding continue to be produced through ICBs, or will the system be funded centrally?

That is precisely the topic of conversation for officials in my Department and NHS England, who are looking at this issue in the round and deciding how we will work. We need a system that empowers ICBs to deliver at the coalface, but we also need accountability from the centre to ensure that things are delivered. Getting the balance right is never easy, as I am sure the hon. Gentleman will understand; that is what we are trying to navigate. Alongside NHS England, my officials and I will continue to proactively engage with our stakeholders, including the voluntary sector and independent hospices, to understand the issues that they face. In fact, I will meet the major hospices and palliative care stakeholders, including Hospice UK, early next month to discuss potential solutions for longer-term sector sustainability. That will inform our 10-year health plan.

On the children’s hospice grant, will the Minister confirm that it will be ringfenced, and that it will go beyond the one-year settlement?

Again, that is on the agenda for discussion with officials. Having inherited a disastrous situation, we are using 2025-26 to stabilise and to try to enable the sector to survive. The hon. Lady will understand that as well as doing that, we are looking at long-term reform solutions, but when we came into power on 4 July, it was one minute to midnight, and we had to rescue the sector. That is what we are doing, and we will look at the long-term issues in due course. A number of Members have raised the concern around employers’ national insurance contributions. Since we came to office in July, we have been completely focused on repairing the catastrophic legacy of 14 years of Conservative neglect and incompetence. The first step was to fix the foundations of the public finances at the autumn Budget, and that enabled the spending review settlement of a £22.6 billion increase in resource spending for our health and care system. Our approach to ENIC exemptions has been consistent with the Office for National Statistics definition and the approach taken by previous Governments. It does not include an exemption for independent contractors, including charities like hospices, although December’s record funding announcement was a clear recognition of our commitment to financially supporting this vital sector more broadly. I ask Opposition Members from all parties who luxuriate in criticising the means by which we have raised the record funding for hospices what they would do. How would they have raised the £22 billion that our autumn Budget delivered? Which taxes would they raise? Which public services would they cut? Answer comes there none. The Government recognise the need to protect the smallest businesses and charities, such as hospices, which is why we have more than doubled the employment allowance to £10,500, meaning that more than half of businesses and charities with ENIC liabilities either gain or see no change next year. While the debate is not about assisted dying, I want to say a word on the matter. My hon. Friend the Member for Spen Valley (Kim Leadbeater) put forward her Bill, and it has received its Second Reading. It is vital that our approach to end of life care and patient choice is holistic and driven by an in-depth understanding of patient need. I thank everybody across the House for this excellent debate. Actions speak louder than words. This Government have acted to deliver the biggest financial contribution to hospices in a generation.

21:57:00

I thank everyone for contributing today. This is a vital issue, and the sheer number of Members who spoke at such short notice shows how important it is to the House. We have heard many excellent contributions, but I will not try your patience, Madam Deputy Speaker, by listing those who spoke. The one motif running through the speeches was the need for a long-term funding plan. I heard what the Minister said about the £3 million NIHR investment and establishing a long-term strategy. I fear that it sounds like a plan for a plan, but I look forward to the 10-year health plan, because we absolutely need a strategy for the next 10 years, not the next two years, and I will hold him to his word. Question put and agreed to. Resolved, That this House has considered hospice and palliative care.