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Jim Shannon (Strangford) (DUP)
I beg to move,
That this House has considered the ageing community and end of life care.
I thank the Backbench Business Committee for selecting this subject for debate. I declare an interest as the son of Mona Shannon, who is 94 years young and resides in a nursing home near Killyleagh in my constituency. Along with most other middle-aged sons or daughters—in my case, maybe a wee bit more than middle-aged—I am acutely aware that time is marching on and so are my mum’s needs.
The wee five-foot-nothing lady who kept three six-foot sons under control is no longer to live alone, but she is as sharp as a tack and I am thankful for the wisdom she gives me when I visit her twice weekly. Indeed, I suspect that every Friday and every Sunday I get a wee bit of wisdom—and maybe a wee bit of a telling off. She always likes to know what happens in this House and I am able to tell her that, but she will also give me her opinion, which I never ignore—indeed, I probably keep to it as much as I can.
Those visits to the nursing home, coupled with the focus on assisted dying, have highlighted to me with greater effect the changes that are needed in how we handle our older generation and their needs. I have spoken with representatives of both Sue Ryder and Marie Curie not simply to highlight the difficulties that most of us will be aware of, but to offer some ways that we can improve.
I am pleased to see the Under-Secretary of State for Health and Social Care, the hon. Member for Glasgow South West (Dr Ahmed), in his place. He and I are becoming a bit of a tag team, because on three days this week he has been the Minister responding to the debates that I have been involved in. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), has been there as well, so he should not be left out.
According to Marie Curie, in the next 25 years in Northern Ireland—I know it is not the Minister’s responsibility, but I want to give the stats, because they are important— there will be 20,500 people requiring this type of care, which is a rise of 32%. That includes a doubling of need by those aged over 85. It is also projected that the number of deaths in the community in Northern Ireland could rise by 74% during that time. Approximately 60% of the cost of care delivered through the independent hospice sector in Northern Ireland is reliant on charity. That is unsustainable. A new palliative care strategy for Northern Ireland that takes account of demographic changes and associated requirements for service transformation and investment is urgently needed.
That is what is happening in Northern Ireland, and in the mainland, things are very similar. Marie Curie has highlighted that as the population ages, more people will be living with and dying with multiple complex conditions. Every week in my office, when it comes to assisting those of my mum’s generation—and perhaps some of my own—with benefits, I see people with multiple complex needs more than ever. It is not just one thing that people are suffering from, but a multitude of things.
By 2050, the number of people in need of palliative and end-of-life care in the UK will rise by 147,000 to over 745,000 every year, and that increase will be driven by a growth in the number of people dying over the age of 85. These are really important stats, and we cannot ignore them; indeed, I believe the Minister will be focusing on them. Around 90% of the people who die each year need palliative care, but one in four of them is missing out. Older people, and particularly those with a non-cancer diagnosis, are at risk of missing out on the palliative care they need at the end of life. Research indicates that most people want to receive care at the end of their life and die at home. Elderly people tell me that all the time—they want to be at home.
Sir Julian Lewis
I am grateful to the hon. Member for giving way; I know he is pressed for time. The charity Together for Short Lives points out that where children’s palliative care is concerned, there is wide variation across different regions in the country. Is he afraid that this applies to the ageing population as well—that there is no consistency in the amount of palliative care available?
Jim Shannon
I thank the right hon. Member for his intervention and for the wisdom that he brings to all the debates he participates in. The Minister is listening, and he is a good Minister, so I know he will come back with the response we hope to have.
How often have we listened to family members who are past themselves with exhaustion and guilt about how they are caring for their loved one and who feel unprepared and yet unwilling to let them go into nursing care? With more support, their lives would be easier and their loved one’s life happier. This knowledge is why I was not surprised to learn that almost £12 billion of public funds was spent on healthcare for people in their last year of life, 81% of which was spent in hospital, with only 11% spent on primary and community care.
Access to a 24/7 palliative care advice and support telephone line has been recommended as a minimum service requirement for nearly two decades, but research shows that very little has happened, which underlines the issue that the right hon. Member for New Forest East (Sir Julian Lewis) raised. Only seven of the 42 integrated care boards in England said they have a dedicated 24/7 single point of access to palliative and end-of-life care advice, guidance and onward referral to other services, when needed—those are all important factors.
Despite the introduction of a new legal duty for ICBs to commission palliative care services in the Health and Care Act 2022, the urgency and importance of ensuring that everyone has the best possible care and support at the end of life has yet to be recognised as a national priority. I hope the Minister will be able to provide assurance on this, because that is what Marie Curie wants, it is what Sue Ryder wants, and it is what every mum, dad and family member wants as well.
Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)
The day I get to intervene on such an amazing Member is a remarkable day. I live in a very rural area where there are places with real socioeconomic deprivation. I know for a fact that there is huge inequality in those kinds of areas when it comes to palliative care. Does he agree that the Minister and the Government need to look at how to reduce that inequality over the next 10 years?
Jim Shannon
The hon. Member is absolutely right. Politics aside, I want the Minister and the Government to do the job. It does not matter who the politician or the political party is; let us just give our people some hope. That is what I wish to see come out of this.
What assessment have the Government made of the need for a national strategy for palliative and end-of-life care? How will the Government ensure that palliative care specialists are included in neighbourhood health centres? What progress are the Government making on ensuring that every person with palliative care needs in the UK has access to a 24/7 support and advice line?
I believe that we can find a route towards an acceptable standard of life not simply for those who can afford private healthcare, but for all in our ageing communities. I understand that the Minister has a copy of my notes, and my seven points will be in there. To realise the 10-year plan objectives, which I have clearly said I support and want to see happen as soon as possible, palliative and end-of-life care must be recognised as a vital part of our health and social care system. Without making palliative and end-of-life care a priority for health reform, the Government will not achieve their bold ambition to provide more care in the community. I want the Government to achieve that ambition.
Ms Julie Minns (Carlisle) (Lab)
I spoke earlier to the hon. Gentleman to ask if he would take an intervention. When earlier this year my mum was placed on end-of-life care—she was put into the local hospital to receive that care—I had to repeatedly ask hospital staff to transfer her to our local, excellent Eden Valley hospice. It took three days for that request to be actioned. Does the hon. Gentleman agree that one change we could make is that, when someone in our hospitals is placed on end-of-life care, their families could be immediately apprised of the alternative provision that exists in our communities?
Jim Shannon
The hon. Lady is absolutely right—by the way, that is one of my seven points. We have spoken, but not exactly about that. The debate brings us together with our requests for the Minister and the Government; we are thankful for that.
Only 38% of those who died aged 85 or older received care from palliative care specialists, compared with 51.5% of those aged 65 to 84 and 59.3% of those aged 18 to 64. To the point made by the right hon. Member for New Forest East, most aged 18 to 64 spent most of their final months in a private home, but fewer than 50% of those aged 65 or older did so. One in seven people—15%—who died in hospital had been in there for less than 24 hours. When someone is coming to their last days, many complex needs are involved—there are also the problems for the family—but they will have to deal with two things in particular: pain, and probably breathlessness.
Almost two thirds of unpaid carers felt anxious most or all the time about the dying person’s illness or treatment. Shifting care from the hospital to the community would benefit older people, support the shift from hospital to community—analogue to digital—and prevent avoidable emergency care admissions. Those are all things that the Government must develop in a national strategy for palliative and end-of-life care.
The strategy must deliver on these seven points. First, an integrated whole-system approach is needed enabling patients at the end of life to move seamlessly through services as their health changes. Secondly, the Government must place palliative care at the centre of plans for neighbourhood health centres and ensure the inclusion of palliative care specialists. A key benefit of including palliative and end-of-life care in neighbourhood health centres will be the earlier identification of palliative care need and greater uptake of advance care planning.
Thirdly, the Government implement models of emergency and urgent care that can minimise avoidable accident and emergency visits. That would provide financial savings for the NHS as well as giving better care in a better system. That also comes to the input of the families, which is the very thing we all wish to see.
Fourthly, the Government need to strengthen the statutory guidance on the legal duty to commission palliative care services in the Health and Care Act 2022. Holding integrated care boards to account for the delivery of this duty must be part of that. Fifthly, we must introduce national quality standards for palliative and end-of-life care that must be met in all health and care settings. That would strengthen accountability while catalysing the 10-year health plan’s targeted shift from hospital to community for patients at the end of life. They must also support more equitable implementation of the vision set out in the ambitious national framework for local action.
Sixthly, there must be access to 24/7 support—the very thing being asked for—by creating a universal gateway to 24/7 specialist palliative and end-of-life care advice, guidance and support through NHS 111. In my constituency, we would say “yin, yin, yin.”
Seventhly, there must be a long-term, sustainable funding solution for palliative and end-of-life care that can reduce reliance on charitable fundraising and ensure parity of esteem for the NHS and non-NHS palliative care workforce. A transformation fund must also be created to invest in innovative and integrated models of care to meet different community needs. The Minister is probably saying, “My goodness, is it just seven points?”, but yes, I will stop at those seven, although I would like to comment on Sue Ryder if I may.
All of these stats can become figures on a page, but when I read them I think of the wee mummy lying on her bathroom floor after a fall, all night in tears; I think of my constituents who sob in my office, begging for help with their dying parent; I think of carers who are run ragged and know that a 15-minute call with that elderly person cannot possibly cater to their hygiene needs as well as feeding them; I think of district nurses who are late home because they would not leave their elderly patient upset after a wound change, and who made them a wee cup of tea and stayed for that comforting chat that time had not been allocated for.
Professor Jugdeep Dhesi, president of the British Geriatrics Society, said:
“Everyone should have access to high quality care until the end of their life, including palliative and end of life care when they need it. Sadly, this is not the case for many older people across the United Kingdom.”
Sue Ryder also asked me to highlight some issues. It is working to create a new ecosystem around palliative and end-of-life care, and to unlock hospital productivity through swiftly shifting care to the community in a progressive way that is sensitive to the resources available across the wider system, and focused on genuine collaboration at a local, place, and system level. The envisaged ecosystem would absorb patients from across the acute setting and increase referrals to community settings, helping our wonderful NHS to use its bed capacity more effectively, and relieving strain on the discharge system. The Sue Ryder model will shift care into the community by increasing hospice-at-home services and virtual wards, funded in line with national currencies and fast-track CHC reform. It is believed that this new approach to hospital care will develop dedicated care, alongside suites on NHS sites to provide compassionate, tailored care for those approaching the end of life, and to relieve pressure on hospital teams.
We must increase support for people in their own homes—that is what I want, what the hon. Member for Carlisle (Ms Minns) wants, and probably what we are all seeking. It is about expanding care in the community through partnerships, virtual wards, and increased hospice-at-home services to help more people die at home and reduce emergency admissions. We must aim to make full use of hospices’ expertise and space to support people with complex multi-morbidities and those in the last 1,000 days of life, preventing emergency admissions and helping people to live well.
I will keep to your timescale, Madam Deputy Speaker; I am coming to the end. The end of life is not a happy topic, but I believe it is a necessary conversation. We must open that conversation to ensure that people feel able to record their wishes for the end of life, so that more of their needs are met by the people involved in their care. We must ensure that there is information, and above all funding to deal with the growing pressure—the family issue that the hon. Member for Carlisle referred to—because how we treat the most vulnerable in our society is the measure that we will all be judged by.
I am no better than anybody else, but as elected representatives you and I, Madam Deputy Speaker, and everyone in the Chamber want to do the best for our people. Today we ask for the best for our people. I work alongside my mum to ensure that her last time on earth is the best we can make it, and I know I can safely say that it is the desire of this House and the Minister to provide that for every person in the United Kingdom of Great Britain and Northern Ireland. But we cannot do it without Government buy-in, or without help from the Minister, and from the Labour Government and those in power. The hospice sector is looking for a way to do things better, so I ask the Minister to join those who know this issue inside out, and find a route to help our ageing community and those in end-of-life care. That is also from Marie Curie, Sue Ryder and Professor Dhesi—all those people, and all of us as MPs on behalf our constituents.
Thank you for your time, Minister, and I look forward to your response.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
Order. Before I call the first speaker, Members will have noticed that we are pushed-ish for time, so I ask them to keep their comments to around eight minutes.
Anna Dixon (Shipley) (Lab)
I thank the hon. Member for Strangford (Jim Shannon) for securing this debate, and I draw the House’s attention to my entry in the Register of Member’s Financial Interests. I am an officer of the all-party groups on carers, and on housing and care for older people, and I was formerly chief executive of the Centre for Ageing Better.
As ageing is a subject close to my heart, I decided to check out my latest personal life expectancy projection according to the Office for National Statistics life expectancy calculator, and it turned out that I have a one in four chance of living to 95. Many people would think, “Oh, how fantastic!” Yes, we all want to live longer, but not everybody will enjoy that same life expectancy. We know that there is a significant gap—about 19 years—in life expectancy between the most and the least deprived. That gap is reflected across the country, as well as in my own constituency, between Wharfedale and Windhill and Wrose.
Despite the tech bros trying to defy ageing and death through all sorts of techniques, in reality we are mortal and we will all face death at some point. More of us will die at older ages because of increased life expectancy. To be honest with hon. Members, death is a boom industry, and if they have not already invested in a funeral director, that might be something to look at. The post-war baby boomers are now in their 60s, 70s and heading into their 80s, so more of us will be dying in the coming decades.
Society needs to change in a number of ways to respond to our ageing society. Departments across Government are looking at related issues, including working for longer, which is a matter for the Department for Work and Pensions, and ensuring that we build new homes that are accessible. I will be speaking to the Minister for Housing and Planning, who summed up in the previous debate, about bringing in new regulations to make homes more accessible.
In addition, we need to reform end-of-life care. By 2050, it is projected that an additional 147,000 people will die per year, bringing the total to 745,000 per year. As the hon. Member for Strangford said, the people who miss out on end of life care are more likely to be older, from black and minority ethnic communities, from lower socioeconomic communities or to have a non-cancer diagnosis. There is a lot to do to close the gap in access to palliative and end-of-life care, particularly for older people.
An example of really good practice in Bradford is the REACT model—the Responsive Emergency Assessment and Community Team model. If you have not already visited, Madam Deputy Speaker, you may wish to do so. It is a partnership between the Marie Curie hospice and Bradford Royal infirmary. A palliative care doctor is embedded in A&E, so when people who are at the end of life are hitting the accident and emergency department, they get an intervention, assessment and referral back to a proactive multidisciplinary community-based team. The results are staggering in reducing the number of hospital bed days that people at end of life experience.
As we have heard, most people do not want to die in hospital. I commend the shift that this Government are looking to make from hospital to community, which I hope is as true around end-of-life care as around other services. However, there is a huge lack of consistency between integrated care boards in how and what they commission. There is much to do to support better care in the community, including providing better support to GPs, particularly those with a specialist interest in end-of-life care; having district nurses working more closely with primary care teams and embedded within the new neighbourhood health teams; more examples of hospice at home and multidisciplinary community teams; more training for care home managers and staff; and the innovative use of unused hospital wards to provide hospice services in hospital, where appropriate.
As has been mentioned, we must ensure that there is a 24/7 hotline for patients and, importantly, for their carers, so that when they find themselves in crisis at home, they can get access to the advice that they need. The National Institute for Health and Care Excellence has said they should have had access to such advice since 2011, but according to Marie Curie, only one in three areas has such a 24/7 hotline.
While there are examples of good practice, there is much to do. It is good news that more of us are living longer, but society has to adapt. I am pleased that we are doing things as a Government—we have a pensions commission and the Casey review looking at social care—but I say to the Minister: now is the time to have a national strategy for palliative and end-of-life care. We are an ageing society and we need that, along with reform of continuing healthcare. In his response, I hope he will set out how we ensure that everybody dies well in old age and has a good death.
Dan Aldridge (Weston-super-Mare) (Lab)
I thank the hon. Member for Strangford (Jim Shannon) for securing this debate. It has been a pleasure to see his passion for his community and for the people of Northern Ireland, especially as a member of the Northern Ireland Affairs Committee.
Care at the end of life and ensuring dignity, compassion and community in every chapter of life is so incredibly important. I pay tribute to Weston Hospicecare, and particularly to Paul Winspear and his amazing team, who are an extraordinary example of what compassionate, community-based care can achieve. Their current director of patient services, John Bailey, retires in December after 30 years of dedicated services. Paul, the chief exec, describes John as a “truly exceptional” person, and I absolutely agree.
Founded in 1989, Weston Hospicecare supports more than 1,000 patients and families each year, serving a population of around 225,000 people from Clevedon to Burnham-on-Sea and from Cheddar to Weston-super-Mare, Worle and the villages that surround my constituency. It is hard to find somebody in my town whose life has not been touched by Weston Hospicecare’s dedicated team; my family is no exception. Weston Hospicecare helped us during some of our darkest times. I have a personal mission to help safeguard the future of this important facility. Its dedicated team provides in-patient, day hospice and community nursing services alongside physiotherapy, counselling and bereavement support, all free of charge.
Weston Hospicecare truly embodies the spirit of my home town—caring, community-minded and determined to do the right thing—but it is important to acknowledge the pressures that it faces daily. Weston Hospicecare receives only around 18% of its operating costs from the NHS, compared with a national average closer to 29%. The rest must be raised through community fundraising, shops and donations. The generosity of our community is remarkable, but it is being stretched to its limit, despite some of the most innovative approaches to fundraising that I have witnessed. I am genuinely, truly impressed by what Weston Hospicecare has been able to achieve.
Over recent years, hospice funding increases have fallen well behind inflation. The national living wage increase has rightly lifted incomes, and I am entirely in favour of it, but that and other factors have increased staffing costs for many hospices. Weston Hospicecare faces an annual deficit of £500,000—roughly 10% of its £6 million budget—and it has had to dip into reserves, which now stand at less than six months’ cover. For such vital services that mean so much to my community and to the communities around us, we must find a better way.
Despite that, Weston Hospicecare continues to deliver outstanding value. It provides care for patients with complex, multi-morbid conditions who would otherwise occupy hospital beds or require costly community nursing, and it is relieving pressure on the NHS in my town. Weston Hospicecare saves the health system money while delivering really outstanding outcomes for patients and families.
The Government’s recent £75 million capital investment in hospices has been so important. Weston Hospicecare has benefited from it, and is particularly grateful for it, as am I, but we all recognise that while one-off capital investment is welcome, it cannot by itself secure the future. We need a sustainable commissioning model and fair funding for the essential, specialist care that hospices provide, while allowing them to continue raising community funds for services that are so often seen as optional, but which are in reality vital, such as family support, bereavement care and the holistic and therapeutic services that help people to live and die well.
This issue is also about the wider fabric of our communities. In coastal towns such as Weston-super-Mare, where we have higher proportions of older residents, fewer large employers and sometimes higher levels of isolation, hospices—in particular my hospice—are part of what hold our communities together. They offer not just care and employment, but training, volunteering and opportunities for young people to build meaningful careers in care. One of my best friends, John Williams, has been a carer his whole life. All too often, what I consider to be a vocation—a profession—is undervalued. That is something that we must change.
When we talk about ageing and end-of-life care, we must see it not as a burden, but as a mark of who we are—a society that values every life at every stage, and sees worth in all human life. Weston Hospicecare is a beacon of that principle, and with the right long-term funding framework, I believe it and other providers like it across the country can continue to serve our communities for decades to come.
Madam Deputy Speaker (Judith Cummins)
I call the Liberal Democrat spokesperson.
Helen Maguire (Epsom and Ewell) (LD)
I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate.
It is well known that our population is ageing, with the latest census showing that people aged 65 and over account for 19.1% of the total population in Surrey. That figure is predicted to increase to 25% by 2047. In my constituency of Epsom and Ewell, there are brilliant charities working to support the older population, including Age Concern, which empowers older people to live the most fulfilling lives they can while providing services, including advice, medical transport, social support and befriending. Organisations such as Age Concern are a vital lifeline for many, especially following the Conservatives’ failure to fix social care and invest in preventive measures that support older people to stay in good health.
Our older and ageing communities also need to be able to access public services, including GP provision. According to Age UK, the number of full-time equivalent GPs, including trainees, increased by just 2.5% between 2023 and 2024, which is not keeping pace with the population growth of older people aged 75 and over. Many GPs are heading towards retirement, leaving an even bigger gap, so the Government must go further with plans for recruitment. There needs to be a concerted effort to build a strong, resilient GP workforce that prioritises retention and delivers services that stop older people from ending up in hospital due to delays in primary care.
Along with GP provision, access to social care services is vital. With an ageing population, we are seeing more and more older and frail carers supporting their spouses, putting a further strain on the carer’s own health. We need to do more to support, protect and empower older people, so will the Minister commit to reversing the Conservatives’ cuts to public health funding and facilitate a social care system that is accessible to older people, encourages preventive care, and tackles key issues such as loneliness and frailty?
As our population ages, more people will be living with—and dying with—multiple complex conditions. Marie Curie reports that by 2050, the number of people in need of palliative and end-of-life care will rise to over 745,000 people per year, which is 147,000 more than at present. One local family in Epsom and Ewell have shared their experience of struggling to access hospice care for a loved one with a terminal illness. Despite their efforts, no hospice place was available, and delays in pain relief made their loved one’s final days distressing, something that could have been alleviated by better funding and co-ordination of end-of-life services.
Funding cuts and years of neglect under the previous Conservative Government have led to reduced services, which has a direct impact on patients and their families, who deserve dignity and support in their final days. The Liberal Democrats have proposed exempting health and care providers from increases in employer’s national insurance contributions, yet the Government have ignored that proposal and have not provided much-needed support to the social care sector. In a further damning development, a report released just this week by the National Audit Office revealed that nearly two thirds of independent hospices in England reported a deficit in 2023-24. As a result, services have been slashed and hospices have been forced to cut the number of beds available, due to a lack of Government funding.
With hospices and care services under strain, people desperately need support, and families often have no place to turn. There have been a number of successful and ongoing pilots by local NHS trusts of dedicated phone lines for palliative and end-of-life care needs. The Thames Valley pilot advice line led to a reduction in ambulance conveyances, a 35% reduction in referrals to out-of-hours primary care, and a fourfold increase in calls closed with no further intervention required. NHS 111 is a brilliant service, but it is not always appropriate. Access to a specialised palliative care expert can alleviate patient anxiety, streamline support and facilitate better care. That is something that I urge the Minister to investigate.
Will the Minister commit to ending the postcode lottery of funding for palliative care, create a dedicated hospice workforce plan, expand carer’s allowance, and provide guaranteed respite care before end-of-life care eligibility begins? As we manage the ageing population and navigate end-of-life care, this Government must put patients first and prevent a devastating erosion of public services, tackle dangerous understaffing, and support people to age well in their community.
Dr Luke Evans (Hinckley and Bosworth) (Con)
I yet again thank the hon. Member for Strangford (Jim Shannon). He should be proud of Mona Shannon, and she will be proud of him not just for raising this topic today, but for all the work he does across this House talking about health, because he is assiduous and dedicated to timely health interventions, and that should be applauded across the House and this nation. I am indebted to him for securing this debate.
In the hon. Member’s speech, he mentioned who he had spoken to. I, too, have met the organisations Sue Ryder and Marie Curie, including at party conference, and I have met many other organisations, including LOROS and Rainbows, that cover my area. When I saw the title “Ageing Community” for this debate, I must admit that I thought the hon. Member should have applied for a five-day debate, considering what we could cover. I also notice the expertise in this debate. We have a secondary care surgeon, someone with public health experience at the back and me as a GP. It is turning into a multidisciplinary team, and there is a lot to unpack, whether it is prevention, mitigation, healthy lifestyles or looking at the best examples across the world. I recently travelled to Japan and Korea and saw how they look after their elderly and their approach to the lifestyle of the elderly. There is a lot to be learned out there, as across the world we all grapple with an ageing population.
There are other topics that we could talk about, and some were touched on. On social care, it is a shame that there has been a change from cross-party talks to an independent commission. I note that Baroness Casey is being taken back to the Home Office, which means she is spread thinly. There is a wider debate to be had on social care, which is: what do the British public actually want? Often we look at the Scandinavian model, but say that we do not want to pay the taxes for it. We want the household or family approach, like the Bangladeshi or Pakistani model, but we certainly do not actually want grandma or grandpa coming to stay with us and we want to stay working. Therein lies the problem in British culture. We are not 100% sure what we want when we cross over from the NHS into social care, and we are not sure how to provide it.
Some hard evidence of policies on an ageing community has been talked about, and unfortunately I have to raise the issue of winter fuel. In the Government’s analysis when they took away winter fuel payments—despite all the warnings—they knew that it would put 50,000 people into absolute poverty and 100,000 people into relative poverty. We can contrast that with the Opposition and our recent announcement on stamp duty. Jackson-Stops estimates that in the first year alone, up to 500,000 people above the age of 55 would consider downsizing because of that policy. I do not call that downsizing, as we heard in the debate on stamp duty—it is right-sizing, because it gives a real chance not only for more families to go upwards, but for people to move into more appropriate accommodation as they age.
There is a lot to be said in the debate about an ageing population, as the hon. Member for Shipley (Anna Dixon) pointed out, but I will focus my comments on the three questions that I think I caught from the hon. Member for Strangford: the assessment of the need for a national strategy for palliative care; what the Government are doing to ensure that palliative care is included in neighbourhood health centres; and the progress being made on 24-hour support.
I will start with the national strategy and funding, and let us give credit to the Government where it is due. When it comes to children’s hospice funding, they have continued the payment and extended it, which is welcome, although it does not offer enough mitigation for national insurance contributions. The Government will say that when it comes to adult funding, they have given £100 million. That is capital funding, though, and as one hospice worker put it to me, there is no point in having new curtains and a lick of paint if there are no staff.
As the Liberal Democrats pointed out, the National Audit Office report on the hospice sector that came out only yesterday states:
“DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector”,
or what the real impact of Government funding is. It continues:
“In 2024-25, 11 independent adult hospices in England reported service reductions or staff redundancies, and other hospices announced plans to reduce services, in response to reduced income or increased costs. Cuts appear to be across all types of services offered by hospices. Most hospices reported the increase in the costs of service delivery within the palliative and end-of-life care sector as being the primary reason for service reductions…Six hospices have been designated by ICBs as ‘commissioner requested services’, a mechanism to forewarn ICBs of potential difficulties with services that, should they discontinue, would have significant impact on the local population”.
Hospice UK responded to that, saying:
“unfortunately the whole hospice sector is…struggling, just as demand for their services is rising. Surging costs mean 2 in 5 English hospices are planning cuts this year, and 20% ended last year with a deficit of over £1m.”
What does that actually look like in real life? In my area, LOROS is facing a deficit of £2 million. It has already had to reduce its in-patient capacity from 31 to 20 beds, and it is reducing its day therapy and cutting its physiotherapy, occupational therapy, social work, chaplaincy and complementary therapies, and closing the volunteer home-visiting service.
It is not just my region that is affected: a cursory look at Hansard will show that the Kirkwood hospice in Kirklees has made 19 redundancies; the Ashgate hospice in Derbyshire has 52 jobs at risk, with beds cut from 21 to 15; St Catherine’s hospice in West Sussex is looking at 40 job cuts, with half of its new rooms being mothballed; Weston Hospicecare—highlighted both here today by the hon. Member for Weston-super-Mare (Dan Aldridge), and by others, including my hon. Friend the Member for Bridgwater (Sir Ashley Fox) at other times—faces an increased national insurance bill of £139,000; the Arthur Rank hospice in Cambridgeshire is losing £829,000, which is forcing the closure of nine beds, 40% of its capacity; and Marie Curie has pointed out that its national insurance contribution costs have risen by £2.9 million.
Through all this, we have still never heard whether the Health team knew that this was going to happen and chose to push it through, or whether it was simply an oversight when it came to challenging the Treasury. Ever since the Budget, we have never heard an answer to that. At the time of the Budget, the CEO of Marie Curie, Matthew Reed, said:
“The Health Secretary himself has acknowledged that palliative and end of life care is not good enough, so we are shocked by the lack of measures in the budget to fix it. Palliative care needs are projected to rise by 25% over the next 25 years, around 147,000 more people each year, yet this government lacks a strategy to tackle the magnitude of this challenge.”
Have the Government made an assessment of how much the NICs increase has impacted the hospice sector? As has been mentioned, Together for Short Lives estimates that the average hospice is facing a bill of about £133,000.
I raised a lot of these questions in a debate in January, and the Minister for Care kindly wrote to me in response. It is not just about the financial side; we are looking at the structural aspect too. He wrote:
“As you are aware, integrated care boards…are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. In addition, the National Institute for Health and Care Excellence…has published quality standards and guidelines to support commissioners to carry out this duty. While the NICE guidelines are not legally binding, they act as a regulatory benchmark for best practice in palliative and end-of-life care…Whilst 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, also play in providing support to people at the end of life and their loved ones.”
So there is a grey area about where hospices are covered, and that fits in with the NAO report.
Anna Dixon
As the hon. Member rightly says, ICBs are under a legal duty to commission palliative care services. Does he not recognise that the problems we are having, not just with hospice care but with the lack of availability of palliative and end-of-life care, often come down to poor commissioning—ICBs failing to commission in line with that statutory guidance—and the confusion that arises between charitable donations and that which should be commissioned by the NHS?
Dr Evans
The hon. Lady is spot on; that is exactly the point that I was getting at. While there is a legal duty in terms of palliation, what that palliation looks like is important. Her question was also raised by the hon. Member for Strangford, who asked whether it is now time to have a strategy dedicated to palliative care, given the rise in demand.
The letter goes on to say:
“Charitable hospices are autonomous organisations that provide a range of services that go beyond that which statutory services are legally required to provide. Consequently, the funding arrangements reflect this.”
We are in a grey area, and a palliative care strategy could well be a way to unlock this problem. I will be interested to hear what the Government have to say on this issue.
However, it is not just about finances and commissioning; it is also about the workforce. That is partly addressed in the letter:
“As set out above, we have committed to develop a ten-year plan to deliver an NHS fit for the future. This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”
By my calculations, we are coming up to Halloween and even bonfire night, and we still have not seen a workforce plan. My question to the Government is: when are we likely to see that?
That leads me on to my next point: how do the Government intend to ensure that palliative care specialists are included in neighbourhood health centres? The 10-year plan is laudable, and I think there is agreement across the political spectrum on its contents, but the one thing it is missing is a delivery chapter. How are we going to do it? The shift is correct, but we do not know how we are going to get there, so I would be grateful if the Minister could address that. The 10-year plan explicitly talks about public-private partnerships, and there is concern on both sides of the House that we could see PFI mark 2. If Members need to have their memory jogged, private finance initiatives brought in £13 billion to build hospitals and services, but at a cost of £80 billion to taxpayers.
Why does this all matter? In my last few moments, I will turn to the final question that was posed by the hon. Member for Strangford, which was about access to 24-hour support. I will quickly read out a couple of comments from one of my constituents, whose husband Mat sadly passed away from a brain tumour. She highlights this issue:
“During the day, the support was outstanding because I could call the community nurses and the palliative nurses, and they would always call me straight back. They would visit Mat daily to administer the medications needed in his syringe drivers. They were kind, caring and so supportive to us and our family.
The night times were different and frightening. Often during the night when I was trying to get support, he could see how scared and stressed I was, which made him more scared, often telling me he was okay just to try and not make me worry. Every night I used to be thinking what might happen tonight—will Mat have another seizure? Will he be in so much pain again? Will they call me back if I need support? How long will it take to get help to arrive?”
Marie Curie points out that only seven of the 42 ICBs in England have a single point of access. I raised this issue with the Minister in a letter in August, and he kindly responded in September. He pointed out that integrated care boards must commission on this basis. There is NICE guidance on “End of life care for adults”, under quality standard 13, and on “End of life care for adults: service delivery”, under NICE guideline 142, which talks about the fact that there should be some form of 24-hour care, but at no point did the letter address the issue of the phoneline. When I asked the Department about data, I was told in a letter:
“Regarding data about palliative care helplines, such as average waiting/response times, the Department does not collect or hold this information.”
Will the Minister look at that and consider whether the Department should hold such information?
The letter went on to say:
“We recognise that more could be done to support the palliative and end-of-life care sector. I have tasked officials within the Department and at NHS England to look at how improving the access, quality and sustainability of all-age palliative and end-of-life care to ensure that their proposals are in line with the ten-year plan.”
I would be grateful if the Minister could ask the Minister responsible whether there is indeed an update and what that looks like. At the end of the day, we are concerned not necessarily about inputs, but much more about outputs.
We know that death is certain for us all; only our willingness to face it seems optional. This is very much a British mentality, and I believe we need to change that when it comes to talking about death and our mortality. We need to speak more openly and candidly about what an ageing population looks like, for that is what we are. That is why the hon. Member for Strangford brought forward this debate, and he reminds us that we chase the days ahead while never quite noticing how swiftly they turn into years behind us. That leads me to reflect on the fact that, as politicians and as a society, we build a world to live longer, yet we all too easily forget to ask: how do we want to grow old?
The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)
I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this debate. The range of topics about which he is knowledgeable never ceases to surprise me. We are grateful for his contribution to this House, and I wish his mother well.
I am also grateful for the speech of my hon. Friend the Member for Shipley (Anna Dixon). She is too modest to say so, but she is indeed an expert in social care and ageing, and her calls for a national strategy for end-of-life care and ageing have been heard. I thank my hon. Friend the Member for Carlisle (Ms Minns) for sharing her powerful story about her mother—that cannot have been easy, so I am grateful for her bravery. Like my hon. Friend the Member for Weston-super-Mare (Dan Aldridge), I pay tribute to the hospice in Weston and the dedicated team there. I will be happy to pass on any correspondence required regarding the issues that the hon. Member for Epsom and Ewell (Helen Maguire) highlighted about the 111 service.
The planning, funding and delivery of health services are devolved matters, but I am delighted to answer on behalf of the Government on what we are doing to improve palliative care and end-of-life care in England. I would like to take this opportunity to thank all of those who work and volunteer in palliative care, both in the NHS and in our hospice sector, for the support they provide to patients, families and loved ones. It would be remiss of me not to mention the Prince & Princess of Wales hospice in my own constituency, which recently took such good care of my cousin as she passed away from breast cancer.
This Government want a society in which every person receives high-quality, compassionate care from diagnosis through to the end of their lives, irrespective of their age, condition or geographical region. As the hon. Member for Strangford has adumbrated, end-of-life care and palliative care is much more than cancer care; it is about ageing and ageing well. We recognise that there are currently a high number of hospital admissions and bed days at the end of people’s lives, and the last year of people’s lives accounts for 15% of emergency admissions and approximately a third of all bed days.
Sam Carling (North West Cambridgeshire) (Lab)
I am passionate about ensuring that older people in medical settings are not subjected to coercion over their medical decisions. I have recently been contacted by a whistleblower from the Jehovah’s Witnesses, who has expressed concern that some of the religious assistants who come in to support patients with their decisions are actually coercing them. Will he offer any thoughts, more broadly, on how we can ensure that people are not being subjected to coercion in older care settings?
Dr Ahmed
I am very concerned to hear what my hon. Friend has reported to the House. Clearly, coercion is unacceptable in all forms. Safeguarding is taken very seriously by the national health service and by the Department of Health and Social Care, and as the Minister with responsibility for patient safety, I am very happy to look into that further and to take it up with him after the debate.
As set out in the 10-year health plan, we are going to shift more care out of hospitals and into communities, and make care more personalised. If there is anywhere where that is most important it is palliative care and end-of-life care. Palliative care and end-of-life care, including hospices, have a big role to play in that shift, and they were highlighted in the 10-year plan as an integral component of neighbourhood health teams.
In England, integrated care boards are responsible for the commissioning of palliative care and end-of-life care to meet the needs of the local population. To support ICBs in this duty, NHS England has produced statutory guidance. That includes the need for 24/7 access to palliative care and advice, and a palliative care and end-of-life care dashboard that brings together all relevant data in one place. The dashboard helps commissioners understand the palliative care needs of the local population. Of course, the majority of palliative care and end-of-life care is provided by NHS staff and NHS services, and that has benefited from the record funding in the NHS that the Chancellor delivered in the last Budget.
I will not be able to address all the points made by the hon. Member for Hinckley and Bosworth (Dr Evans), as he was in a typically verbose mood, but if he wills the ends, he must will the means, and if he does not agree with the means, he must present his thesis as to the alternative model of funding that he wishes to see. Otherwise, it is a case of cutting services.
However, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at the end of their lives and to their loved ones. In recognition of that, £100 million of capital funding has been made available to hospices in England to ensure that they have the best physical environment for caring. That includes helping hospices to provide the best end-of-life care to patients and their families in a supportive and dignified environment. It includes funding to deliver IT systems and provide refurbishments and facilities for patients and visitors, so that they can see their family members at the end of their lives in a dignified environment—much more than just a lick of paint.
Dr Evans
Given the recent National Audit Office report and the fact that the tax increase to national insurance contributions has had the biggest impact on the voluntary sector, has an impact assessment been carried out into how much the cost has gone up for hospices in England to provide their services? If not, will the Minister consider it?
Dr Ahmed
The hon. Gentleman knows that the NAO report covers a period both when his party was in government and beyond. I go back to the point about NICs. If he wills the end, he must understand the means. I am very happy to have that conversation with him at length after the debate, respecting the confines of the time that I have—I do not want to test your patience, Madam Deputy Speaker.
I am delighted that the first £25 million of the £100 million fund has been passed to Hospice UK and has been spent on capital projects already. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), visited Katharine House hospice earlier this year, Wigan and Leigh hospice in July, and Noah’s Ark children’s hospice earlier this month to see directly for himself how that record investment is making a meaningful impact on the ground. We can confirm that the Department of Health and Social Care has now transferred the rest of the £75 million to Hospice UK for onward spending in 2025-26. We are also providing £26 million of revenue funding to support children and young people’s hospices. This is a continuation of the funding that, up until recently, was known as the children’s hospice grant. That funding will see circa £26 million allocated to children and young people’s hospices in England each year via local integrated care boards on behalf of NHS England. This amounts in total to £80 million of hospice funding over the next three years.
For many of us who are in good health, managing complexity and ageing seems a distant idea. The Government recognise that the number of people with palliative care and ageing needs is projected to rise significantly over the next quarter of a century. That is why we are shifting more healthcare out of hospital and into communities through our plan for change. That is why we are investing, through the National Institute for Health and Care Research, over £3 million in a policy research unit in palliative and end-of-life care. The unit launched in January 2024 and is building the evidence base on palliative care and end-of-life care.
Earlier this year the Minister of State for Care and, more recently, the Secretary of State met key palliative care and end-of-life care and hospice stakeholders at dedicated roundtables, and focused that discussion on long-term sector sustainability within the context of the 10-year plan. Following the recent publication of the plan, the Minister of State for Care tasked officials to work at speed to generate proposals to improve the access, quality and sustainability of all-age palliative care and end-of-life care as we start to implement the plan.
In closing, I hope that those measures assure the hon. Member for Strangford of the Government’s seriousness to build a sustainable palliative care and end-of-life care sector for the long term.
Dr Ahmed
I will not, in the interests of time.
I reiterate my thanks to the hon. Member for Strangford for bringing forward this vital issue, and I thank all hon. Members who have spoken today. He can be assured that he has raised the voice of those who deserve dignity at the end of their lives, and that his call has been well and truly heard by the Government.
Jim Shannon
I thank all Members who have taken part in the debate, including the right hon. Member for New Forest East (Sir Julian Lewis), and the hon. Members for Carlisle (Ms Minns) and for Doncaster East and the Isle of Axholme (Lee Pitcher). The hon. Member for Shipley (Anna Dixon) brought her knowledge to the Chamber, as did the hon. Member for Weston-super-Mare (Dan Aldridge) and I thank him for that.
It is good news that we are living longer, but there is a cost factor and we understand that. The hon. Member for Weston-super-Mare referred to hospices holding the community together, and he is absolutely right. They are always there and always available, and it is good to have that. The hon. Member for Epsom and Ewell (Helen Maguire) reminded us that there is better care in our latter days, and that is what we all need to see.
I am very pleased, as always, to see the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), in his place. I always look forward to the contributions he makes in debates and enjoy his company. He spoke about cuts across all hospice services and the impact of that, which cannot be ignored. He made a comment about how end-of-life care is provided in Japan. There are lessons we can learn from other countries, which is an important point that I had not thought of.
I thank the Minister for his positive, heartfelt and honest response. He referred to moneys in his speech—some £100 million for hospices and some £26 million for children’s hospices, which the right hon. Member for New Forest East also mentioned. We are seeing palliative care and end-of-life care being central to the Government’s 10-year plan. Not one of us in this Chamber will not welcome that plan; if it brings forward what our people want, it is the right plan. With that in mind, I thank the Minister and I thank you, Madam Deputy Speaker, for your patience.
Question put and agreed to.
Resolved,
That this House has considered the ageing community and end of life care.