The Minister for Care (Stephen Kinnock)
I thank the hon. Member for Beaconsfield (Joy Morrissey) for securing this important debate. I wish to take this opportunity to thank all those who work or volunteer in the hospice and palliative care sector for the care and support that they provide to patients, families and loved ones when they need it most.
This Government want a society in which every person receives high-quality, compassionate care from diagnosis through to end of life. We are determined to shift more care out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting. Palliative and end-of-life care services, including hospices, will have a vital role to play in that shift.
In England, integrated care boards are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local population. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. Although the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at the end of life, as well as to their loved ones.
Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding that each charitable hospice receives varies, both within and between ICB areas. This variation is dependent on demand in that area and on the totality and type of palliative and end-of-life care provision from both NHS and non-NHS services, including charitable hospices within each ICB footprint.
This Government understand the financial pressures that hospices have been facing, which is why we have announced the biggest investment to hospices in England in a generation. We are ensuring that hospices in England can continue to deliver the highest quality end-of-life care possible for patients, and for their families and loved ones. We are supporting the hospice sector with a £100 million capital funding boost for adult and children’s hospices, to ensure that they have the best possible physical environment for the care they give.
We are pleased to confirm that the Government have released the first £25 million tranche of the £100 million capital funding, with Hospice UK kindly allocating and distributing the money to hospices throughout England. An additional £75 million will be allocated in the coming weeks for use in the 2025-26 financial year. The £100 million capital funding will help hospices to provide the best end-of-life care to patients and their families in a supportive and dignified physical environment. Funding will help support hospices and will enable much-needed improvements, including refurbishments, the overhauling of IT systems and improvement of facilities for patients and visitors.
We are also providing £26 million in revenue funding to support children and young people’s hospices. This is a continuation of the funding that, until recently, was known as the children and young people’s hospice grant. ICBs will once again administer the funding to their respective children and young people’s hospices on behalf of NHS England. This is in line with NHS devolution policies, and it promotes a more consistent national approach by supporting commissioners in prioritising the palliative and end-of-life care needs of their local population. I am pleased to confirm that NHS England has now communicated the details of the 2025-26 funding allocation and dissemination to individual hospices.
I do accept that there is unwarranted variation and inequality in access to, and quality of, palliative and end-of-life care in England, but we are working to reduce these variations. NHS England has published statutory guidance and service specifications to support commissioners in prioritising palliative and end-of-life care. It has also developed a palliative and end-of-life care dashboard, which brings together all relevant local data in one place. The dashboard helps commissioners to understand the palliative and end-of-life care needs of their local population, enabling ICBs to put plans in place to address and track the improvement of health inequalities and to ensure that funding is distributed fairly, based on prevalence.
NHS England has also published the ambitions framework, which sets out our vision to improve end-of-life care through partnership and collaborative action between organisations at a local level throughout England. Additionally, NHS England has developed an assurance system with specific steps and deadlines to ensure the timely dissemination of the £26 million revenue funding to children and young people’s hospices, because we know that there were some quite significant problems last year with the transmission from NHS England through the ICBs to hospices. These steps include regular oversight sessions with ICBs, regions and hospices and giving ICBs a hard deadline within the first quarter of the financial year by which they are expected to disseminate the funding to hospices, including escalating to NHS England if any ICB is unable to meet the deadline. If the deadline is missed, NHS England has put steps in place to ensure that all hospices receive the funding within the timescales outlined.
We, alongside key partners and NHS England, will continue to engage proactively with our stakeholders, including the voluntary sector and independent hospices on an ongoing basis to understand the issues they face. In fact, I recently visited Katharine House hospice in Stafford and heard from staff how important our record investment has been to them. More widely, in February I met key palliative and end of life care and hospice stakeholders in a roundtable format to discuss long-term sector sustainability in the context of our 10-year health plan.
I recognise the concerns that hon. Members have raised about funding and employer national insurance contributions. In July last year we inherited public finances in their worst state since the second world war, and we took the necessary decisions to fix the foundations in the public finances at the autumn Budget, enabling the spending review settlement of a £22.6 billion increase or uplift in resource spending for the Department of Health and Social Care from 2023-24 out-turn to 2025-26.
I gently point out to the Conservative party that while I believe it has welcomed that unprecedented settlement, to my knowledge it has been silent on its preferred means of generating that revenue. I gently say that Opposition Members cannot have it both ways. They cannot welcome the £22.6 billion on the one hand but, on the other hand, condemn the way in which the money is to be raised without coming up with their own plan and proposals for how they would raise those funds.
Rachael Maskell
We have to recognise that the hospice sector is in quite a difficult place financially. However, if there is good advance care planning, money currently spent in secondary care could be invested in the hospice sector and in more community provision. Surely that must be a first step that would not only get better clinical outcomes but be better for the whole of the palliative care pathway.
Stephen Kinnock
My hon. Friend speaks with tremendous and deep knowledge of the sector. I welcome the work that she is doing on the commission on palliative and end-of-life care, and we very much look forward to seeing the outcomes and results of that.
My hon. Friend is right that if we are to make the three big shifts at the heart of our 10-year plan—the shifts from hospital to community, from sickness to prevention, and from analogue to digital—the delivery of that will require a left shift in terms of both funding and reform. It is absolutely right that we take a hard-headed look at funding across our NHS and ensure that funding is going to where it is needed. She will know that the share that hospitals get of overall NHS funding has gone up dramatically since the early 2000s, to the detriment of primary care, community care and palliative care—all the things that happen outside hospital. That is something that we must address and shift upstream, because we will never solve the considerable challenges that our NHS is facing until we make that left shift.
I note that the funding announcement was warmly welcomed by the sector. Toby Porter, chief executive of Hospice UK, said:
“Today’s announcement will be hugely welcomed by hospices, and those who rely on their services. Hospices not only provide vital care for patients and families, but also relieve pressure on the NHS. This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need, when and where they need it.”
I hope that the measures I have outlined in my response to the hon. Lady will go some way to reassuring all Members of this Government’s unwavering commitment to the sustainability of the hospice and wider palliative and end-of-life care sector.
Joy Morrissey
I thank the Minister for outlining what the Government are doing. Will he consider looking at the exemption to the national insurance increase for workers and at allocating more funding directly to hospices so that they can conduct the palliative care that is needed in the out-of-hospital care provision? Although the Government may want to give it to palliative care, there is no directive that does so at this time, aside from capital expenditure. Therefore, could more money be allocated to hospices for operational costs?
Stephen Kinnock
The definition of where employer national insurance will be levied is based on the Office for National Statistics’ definition of where it should be, and it is the same definition used by previous Governments. I do not think that point is up for debate.
Joy Morrissey
To clarify, the NHS and the staff within it are exempt from the changes. How is that part of the national statistical average, when everyone in healthcare who is under the NHS umbrella is exempt from the changes? All I am asking is for hospice care, which is out-of-hospital care provision and which technically falls within adult social care, to be incorporated into the exemptions already given to the NHS.
Stephen Kinnock
The exemption was given to 100% full-time workers within the NHS; in essence, hospitals. As regards GPs, dentists and care providers, ENICs are being levied on those other parts of the health and care sector. Every aspect of my portfolio is therefore seeing ENICs being levied.
Rachael Maskell
A suggestion to the Minister would be to integrate the staff working in hospices into the NHS payroll. It would be that simple to exempt them from those national insurance increases.
Stephen Kinnock
The decisions on ENICs and where they are being levied have been made. I think it was made very clear that the line was drawn where it was drawn. Any attempt to try to reverse engineer where that line should be drawn would not really be aligned with the policy decisions that were made at the Budget.
Sir Bernard Jenkin
Was it the Government’s intention to put an additional tax on hospices? Is that exactly what the Government intended to do, or is that an unforeseen consequence?
Stephen Kinnock
I would not dare to speak from this Dispatch Box on behalf of the Chancellor, but I am absolutely clear that when she did the autumn Budget, she knew that she had to dig us out of a very deep hole indeed, and that required levying taxes that she had to levy. The line had to be drawn somewhere and that is where the line was drawn.
On the other questions asked by the hon. Member for Beaconsfield, the funding has gone through Hospice UK, so it is not direct funding in that sense. Hospice UK has kindly co-ordinated the process because it is extremely well informed about which hospices across the country have opportunities to upgrade their infrastructure, whether that be IT infrastructure, refurbishment or whatever it might be. It has reviewed those proposals, worked at tremendous pace and, as a result, we have managed to deliver the entire £25 million of the first tranche. We are now working closely with Hospice UK on the £75 million and I am confident that that money will be out of the door and into hospices in very quick time this year, based on the outstanding performance on the first £25 million tranche. I therefore hope the hon. Lady will be reassured on that point.
In closing, I hope that we at least have a consensus on the vital importance of hospices. The Government are committed to working at pace to ensure that we secure a sustainability and solidity for the sector going forward. I thank the hon. Member for Beaconsfield once again for securing this important debate. I also thank and wish everybody in this Chamber all the very best for the recess, and I look forward to seeing them all on the other side.
Question put and agreed to.