The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I thank the hon. Member for Liverpool, Walton (Dan Carden) for the way in which he has approached this debate. I commend him on making an excellent speech, as he could not have been better at articulating the positive contribution that hospices make. I do not think there was anything in his speech with which I disagreed, which is quite unusual.
I was struck by the hon. Gentleman’s description of hospices as places where people go to live. When I visit hospices, I am struck by the very real efforts that their staff go to to make them comforting places. It can be a more difficult time for the loved ones than it is for the person who is ending their life, but they really are comforting places, and the hon. Gentleman is right to pay tribute to all the staff who work in them.
The hon. Gentleman powerfully praised the efforts of his own hospice, Woodlands, which is clearly providing an excellent service. I am grateful that he has given me the opportunity to address some of the concerns and make it clear how much we value the contribution that hospices make to the NHS.
It is testament to the excellence of our hospice sector that last October’s “State of Care” report by the Care Quality Commission showed that 70% of hospices are rated as good and 25% as outstanding. Those figures are higher than for any other secondary care service, which illustrates the significance of hospices’ contribution. Woodlands Hospice received a good rating in the CQC report. Like the hon. Gentleman, I congratulate its hard-working staff and volunteers on ensuring that patients get the personalised care and support that they need.
NHS England has advised that Liverpool clinical commissioning group, which is the main commissioner for the hospice—I hear what the hon. Gentleman says about there being more than one CCG, which probably adds to the strain on the hospice with regard to long-term funding—provides £900,000 of funding a year. Sefton also provides £240,000 per year, which brings the total amount provided to the hospice to over £1 million a year. As the hon. Gentleman outlined, the CCGs of Liverpool, South Sefton and Knowsley are in the process of reviewing their end-of-life care provision. They are taking into account population need, service demand, and all providers of that care, including Woodlands Hospice.
I am sure that the hon. Gentleman welcomes, as I do, the attention that local healthcare planners are giving to this important area of care. I suggest that the commissioners should pay close attention to what the hon. Gentleman and his colleagues have said tonight, speaking on behalf of their communities, about the value they place on this service. I hope that the commissioners will also take note of my comments when I say that the hospice sector, and this particular hospice, are making a very real contribution to people at the end of their life.
I know that many Members have hospices in their constituencies that they support and champion, so I thought that it might be helpful if I set out the broader position on hospice funding. As the hon. Gentleman outlined, the sector is characterised by strong voluntary contributions and philanthropic activity, which is to be celebrated.
We have 223 registered independent hospices and small number of public hospices that are run internally by NHS trusts. Around three quarters of hospices provide adult services, with the remainder caring for children and young people. The hospice movement was established from charitable and philanthropic donations, so the vast majority of hospices rely heavily on charitable income for the lion’s share of their budgets, but they do receive some statutory funding from CCGs and the Government for providing local services. As the hon. Gentleman suggested, the statutory funding varies from place to place for a wide number of reasons—he highlighted deprivation as one of them—but adult hospices receive an average of 30% of their overall funding from the NHS.
Funding remains a local decision, which I think is right, and the hon. Gentleman will be aware that we take deprivation into account when making our allocations to CCGs. He referred to long-term funding stability and the importance of knowing how much the Government will provide, and I will reflect on that important point. It would be good practice to give as much certainty as possible, which is a principle of our health funding more generally, so that will bear examination.
Mr George Howarth (Knowsley) (Lab)
I am grateful that the Minister has committed to reflect on the thoughts of my hon. Friend the Member for Liverpool, Walton (Dan Carden) about a national framework, but the difficulty in having locally determined support from CCGs is that that will inevitably vary from place to place. Some CCGs are under much more financial pressure than others, which is why it is important that we have some kind of national framework.
Jackie Doyle-Price
I would not want to depart from the principle that this is for local decision makers, but that is not to say we do not make clear our expectations about what CCGs should be delivering as we develop our national policies on end of life, and support for hospices forms part of that. Given the number of people who pass away in hospices and the care that they receive, we would encourage CCGs to carefully consider the extent to which they support hospices.
In addition to NHS funding for locally commissioned services, children’s hospices receive £11 million through the children’s hospice grant, which is awarded annually and administered by the NHS. Children’s hospices tend to receive smaller amounts of statutory funding because of how they have developed and the services that they provide. Unlike adult hospices, which tend to be more focused on end-of-life care services, children’s hospices can provide support for much of a child’s life, and that can involve not only more clinical care, but much more support for families.
It is worth highlighting the point made by the hon. Member for Liverpool, Walton that philanthropic support does not just mean money. I pay tribute to all those involved in volunteering in hospices. That is a fantastic example of how communities come together to bring out the best in people, so I thank everyone involved in that work.
Members may be reassured to hear that, to improve commissioning arrangements, NHS England is making a new palliative care pricing system available in April. That should help local areas to plan services, and it will also encourage more consistency and, perhaps, transparency in how much CCGs are supporting the sector.
While hospices are, of course, an important feature of end-of-life care provision in this country, it is important to see them within the wider context of our ambitions for such care. As the hon. Gentleman mentioned, the Government have published the end-of-life care choice commitment, which is designed to transform end-of-life care, and the hospice sector is an important partner in that process. We are determined to significantly improve patient choice by enabling more people to die in the place of their choice, be that at home, in a hospice, in a care home or in hospital. Our commitment is to set out the further action that we will take to deliver high-quality, personalised end-of-life care for everyone, including by delivering advance care planning and ensuring that we have the necessary conversations earlier. I draw Members’ attention to the reference to hospice care at home, which is a significant aspect of the programme. We need to make sure that more people are aware of what their options are, and we need to encourage innovation in end-of-life care. In collaboration with partners from the voluntary sector, including key hospice and end-of-life charities, the Government and NHS England have been working to make sure that the quality and availability of end-of-life care services continue to improve and that our end-of-life care commitment is delivered.
As I have already mentioned, the Government believe it is right that CCGs have the autonomy to shape local services according to local need, but it is important that we do more to provide commissioners with the tools, evidence, support and guidance to demonstrate the benefits of delivering our vision for end-of-life care. A crucial part of that is strengthening the provision of end-of-life care services outside hospital and in the community so that people can make the choice of where they wish to end their life.
To deliver this, we are working with sustainability and transformation partnerships so that there is tailored information to assess where we need further investment, commissioning and intervention. NHS England is also a member of the national palliative and end-of-life care partnership, which is made up of charities and organisations from across the health and care system that have together developed a framework for improving end-of-life care at a local level. More guidance will be published through that body soon.
NHS England has also commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. I fully anticipate that could be a good news in support of the hon. Gentleman’s arguments. Although many such care models exist across England, there is poor data on what are the most effective approaches, which makes it rather more difficult for CCGs to confidently commission such services. The project will examine hospice-led initiatives that appear to be having a positive impact on where people are cared for, as well as on where they die. The Department and NHS England will pay close attention to the findings when they are made available, which should be next month.
We fully acknowledge that more needs to be done if we are to meet our ambition to reduce variations in end-of-life care and to ensure that the system works effectively to support more people to die in the place of their choice. However, I am confident that through NHS England’s programme board for end-of-life care, with all key system partners and stakeholders, including the hospice sector, we have the best opportunity to continue delivering the progress in end-of-life care that we all want, however and wherever it is provided. I cannot emphasise enough that hospices are central to our commitment. Local commissioners will wish to reflect on all the comments that were made in this evening’s debate when they come to make their allocations, and I wish Woodlands Hospice every success in the future.
Question put and agreed to.