The Minister for Social Care (Helen Whately)
I thank my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this debate. The number of speeches this evening reflects the strength of feeling, and the support, for hospices across the country. As the Minister with oversight of end of life care, I share the passion of many hon. Members for hospices and for what they do, caring for people towards and at the end of life, providing respite for carers and supporting families both before and after the death of a loved one. Many hon. Members have rightly praised the work of the hospices that serve their constituents and made special mention of the extraordinary work of hospices for children and young people. I also thank the hospices for all they do, and for all they are doing right now, as their staff work around the clock.
Beyond that, I thank everyone who gives palliative and end of life care, as part of hospice teams but also working in the NHS. How you die, how your loved ones die or how you live towards the end of your life, matters. As the hon. Member for Birmingham, Erdington (Mrs Hamilton) said so eloquently earlier this evening, and as all of us here this evening know, that is why palliative and end of life care matters. It matters when that care is provided by the NHS, as it is for the majority of people, and when it is provided by hospices. I emphasise that point, because there is sometimes a misunderstanding, which I have heard a few times this evening. The fact is that most palliative and end of life care is provided by the NHS, whether in hospitals, by primary care or through community trusts. Alongside and in addition to that, hospices do the wonderful work that they do. Recognising the importance of palliative and end of life care, we specified in the Health and Care Act 2022 that integrated care boards must commission these services to meet the needs of their populations.
Some hon. Members have argued this evening for hospice funding to be centralised, taken away from integrated care boards and, I assume, allocated by either NHS England or the Department of Health and Social Care. While I understand their motivation in making that call, I do not agree. We purposefully set up ICBs to understand the healthcare needs of our local communities, to plan and commission services to meet those needs and, in so doing, to reduce health disparities. Our communities and their needs, and the services they already have in place, are different, and rarely is a one-size-fits-all decision made in Westminster the right answer. I stand by a more localised approach, in which there is, of course, variation.
Another source of variation is historical. The hospice movement has grown organically, and the location of hospices has not been planned to meet demographic need, for instance. There are, therefore, inequalities in access to hospice services, especially for those living in rural and more deprived areas. This variation in access to hospice care has to be taken into account by ICBs in the decisions they must make to ensure that people have access to end of life care, whether or not they live in an area served by a hospice.
Peter Gibson
My hon. Friend makes an important point about the organic way in which our hospices have developed and emerged. Does she agree that our ICBs have the opportunity to use our hospices to address those shortfalls in certain communities by directing funding specifically to them to meet needs that have not previously been met?
Will the Minister further clarify one small point? She has made a clear distinction between NHS-provided care and hospice care, but there are many cases around the country where the NHS is funding, in full or in part, specific services from hospices. How would she distinguish between them? Is it NHS care or hospice care if it has been fully commissioned and fully funded by the NHS?
Helen Whately
I will pick up on a few of those points.
On the NHS providing palliative and end of life care, I have heard a misunderstanding in some speeches, both this evening and on other occasions, that all end of life and palliative care is provided by hospices. It is more mixed. Integrated care boards do, indeed, commission hospices to provide care, but hospices also provide care independently, and NHS services do so, too. These teams also work together collaboratively. That diversity is a strength.
In seeking to address inequalities, ICBs can look to hospices to do more in underserved areas, for instance. At other times it may be more appropriate for them to look to NHS services. It will vary by area, which is one reason why these decisions should be localised, rather than made by somebody sitting in my place saying, “This is how it should be done across the whole country.”
Although I do not agree with centralising hospice funding, I am working on the transparency and accountability of ICBs to their communities and hon. Members, as representatives. That is why I have regular meetings with NHS England leads on palliative and end of life care, and it is why I am pleased to have secured NHS England’s commitment to including palliative and end of life care in the topics discussed at its regular performance meetings with ICBs. It is also why I am pushing NHS England and ICBs to improve the data they collect on the access to and quality of palliative and end of life care.
NHS England has developed a palliative and end of life care data dashboard to help ICBs understand the needs of their populations and then address and track inequalities in access to end of life care. This is progress, but I want the transparency to go further so that we all have the data we need to assure ourselves that our ICBs are commissioning the care that our constituents need.
I have heard the calls for more funding for hospices and the stories of some fantastic fundraising efforts, from the “star trek” night walk and the “Santa sprint” to the magnificent marathon runners who have joined us in the Chamber tonight fresh from yesterday’s London marathon. I congratulate those who ran, and particularly those who did so on behalf of hospices, which is timely for this debate.
That said, I disagree with the hon. Member who said that people running a marathon for hospices is “sad”—it is not; it is a wonderful thing. It is a sign of the tremendous support that hospices have in our communities and that people are willing to choose to fund hospices, not just when the taxman comes along; they are choosing to have a hospice providing services to people in their area. It is a good thing because that fundraising gives hospices an independent funding stream, the freedom that goes with that to serve their communities as they see fit, and the strong ties with their communities and with all those people who fundraise for their hospices.
Caroline Ansell
My hon. Friend is so right in what she is saying. In my constituency of Eastbourne, people are not just prepared to run for the St Wilfrid’s Hospice, but they will walk over coals for it. Will she congratulate them on their outstanding work?
Helen Whately
I do congratulate those people on their fundraising efforts; although I hope their feet are all right!
As hon. Members know, the Government have provided dedicated additional funding to hospices; in the pandemic, when I played a part, we were helping them with energy bills and through the children’s hospice grant, which the NHS has confirmed will go to hospices for this financial year too.
Looking ahead, I fully appreciate the ask for longer-term certainty of funding—of course I understand that. However, funding for hospices, end of life care and many other things beyond the current financial year depend on a future spending review. I am sure that all hon. Members will understand that I cannot pre-empt such a review, and ICBs similarly will not know their funding until that review. Although committing funding beyond the spending review period is not in my power, I am pushing for our healthcare system to encourage and enable more advance planning by individuals to consider and set out what they want at the end of their life. Inevitably, some of us will die in hospital, and for some of us that will be the right place, but given a choice many people would rather die at home. We should all be setting out a plan that includes our preference of place of death and what sort of treatments we do and do not want. As my right hon. and learned Friend the Member for South Swindon (Sir Robert Buckland) and my fabulous health colleague my hon. Friend the Member for Colchester (Will Quince) said, we should talk more about death and plan for it.
To conclude, there are no easy answers to the questions raised this evening—there rarely are. I do not have a pot of money otherwise going unspent for hospices; neither do ICBs and nor does NHS England. I will, however, continue working with NHS England to ensure that palliative and end of life care is given the attention it deserves and needs so that it is considered important, just as we consider services that prolong life important, and that the NHS is held to account for doing that. I will continue to agree with hon. Members on the importance of hospices and the important work they do. I see this as a Minister, as a constituency MP and from my own family experience; I will never forget saying goodbye to my grandmother in a hospice near Yeovil, and I will always be grateful.
Madam Deputy Speaker (Dame Rosie Winterton)
I call Sally-Ann Hart to wind up.