Palliative Care
(1 day, 9 hours ago)
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Madam Deputy Speaker (Caroline Nokes)
I call Rachael Maskell, who will speak for about 15 minutes.
Rachael Maskell (York Central) (Lab/Co-op) [R]
I beg to move,
That this House notes the findings of the Independent Palliative Care Commission; calls on the Government to implement its recommendations in full, including to establish a comprehensive and specialist palliative care service that is equally accessible to everyone and properly funded, as well as a new commissioning framework that secures a service across all settings and is available from the point of a terminal diagnosis, the advancement of a life-limiting illness or latter stages of a chronic condition; and further calls on the Government to have a focus on workforce planning and training, to provide a comprehensive palliative care service, and to ensure that patients are empowered through future care plans to articulate what they want to happen towards the end of their life, while also establishing bereavement services for all.
I am grateful to you, Madam Deputy Speaker, and to the Backbench Business Committee for granting today’s debate on the future of palliative care. Although I applied for it last summer, it could not be more timely, as the Government consider their modern service framework.
Dame Cicely Saunders said:
“How people die remains in the memory of those who live on.”
By addressing what she called “total pain”—physical, psychological, emotional, spiritual and social pain—palliative medicine could transform not only the way we approach death, but how we embrace life. Her legacy has since driven palliative medicine, with dedicated teams delivering care. Someone told me in York that they did not know
“that such outstanding care was even possible.”
Every complexity is embraced and addressed.
In 2024, 532,000 people died in England. Marie Curie evidence published two weeks ago showed that one in three people fail to get the interventions they need. Despite requiring specialist palliative care, over 100,000 people received none. Demand is rising, and will grow by 42% in a decade. Where someone dies, on what day or at what time determines the care that they receive. Some 42% of all deaths occurred in hospital, 28% at home, 21% in care homes, 5% in hospices and 4% in other settings, such as prisons. According to Sue Ryder, just 50% died in the place of their choosing.
I have had the sheer privilege of working with leading academics and clinicians, health leaders, international experts, charities and people with lived experience, in establishing, with Baroness Finley, the independent commission on palliative and end-of-life care, which is chaired by Professor Sir Mike Richards. We sought solutions to establish equitable access to high-quality palliative and specialist palliative care. I am beyond grateful; I have been inspired and I have learned much.
I am also indebted to Professor Fliss Murtagh from the Wolfson Palliative Care Research Centre at the University of Hull. I make particular mention of Professors Katherine Sleeman and Irene Higginson of King’s College London; Oxford consultant Professor Bee Wee; Hospice UK; Marie Curie; Sue Ryder; the Association for Palliative Medicine; Together for Short Lives; my local hospice, St Leonard’s; and so many more. We held 10 evidence sessions and eight roundtables, received 506 written submissions from experts, and spoke to 129 witnesses. We then presented our report to the Minister.
Now that the Government have progressed to the modern service framework, they must commission a single pathway across all settings, focused on excellence, crisis prevention and investing in the community. We found that early identification for access to high-quality specialist interventions was transformative for patients. At the point of terminal diagnosis or increasing frailty, a serious illness conversation undertaken by well-trained clinicians—as recommended by Professor Sir Chris Whitty—injects an honest understanding to ensure the best patient-centred care, while capturing the patient’s wider social needs, priorities and goals. It facilitates good clinical planning. Co-produced, personalised and optimal care is supported with palliative medicine.
In York, the frailty hub brings all sectors, clinicians and services together. When that is intersected with palliative care, crisis admissions are avoided. Emergency services do not escalate without cause; rather, medicine integrates with the hospice at home team—one team, one set of records, one plan. Avoiding the need for crisis management avoids distress. In the last three months of life, however, almost half of people visited their emergency department, and one in eight spent more than 30 days in hospital. Placing palliative care professionals in emergency departments furthers the model, and allows patients to be triaged to the right service. Clinicians at the back door discharge into community palliative care teams. On the wards, hospital specialists connect with patients, introduce palliative care where appropriate, and seek to discharge to the community, hospice or special hospital unit, reducing hospital deaths and improving disease management.
As our bodies fail, high-stakes interventions add little to the quality or quantity of life, yet they carry risk—as do hospital stays—through infection, deconditioning and disorientation. In a far cry from what happened on the Liverpool care pathway, the focus is on enhancing life, not hastening death.
GPs have a significant role, and I ask the Minister to review the retiring of the palliative care register, which focuses GPs on identifying patients for palliation early, so that interventions can be considered. Can she set out how she will still achieve those aims? People are identified far too late for palliative support—just 56 days prior to death for cancer, and 27 days for non-malignant disease, like respiratory, neurological, renal or cardiac disease. Those with conditions like dementia are rarely ever referred.
While there has been a move away from prognostication of life expectancy, due to its unreliability and often significant inaccuracy, recognition of palliative needs early is key. Marie Curie’s “Better End of Life 2024” report identified that 40% of families had no conversation about deterioration or possible death; 20% were alerted in the last three months of life, and 15% in the last week. Its report, “Measuring unmet need for palliative care”, highlighted that one in three people do not receive specialist care. Its post-bereavement survey in 2024 showed a doubling of unmet need, compared with the 2015 VOICES—views of informal carers: evaluation of services—post-bereavement survey by the Office for National Statistics, which should be reintroduced. That highlights the fact that there is higher demand and poorer access.
Furthermore, we know that those from low socio- economic and ethnic minoritised communities are significantly disadvantaged, and face late identification of needs and poor palliative care access. Without agency and advocacy, outcomes are worse, and that is also the case for those with physical and intellectual disabilities. Such injustice demands change.
Variation exists across integrated care boards. The responses to Hospice UK’s freedom of information requests showed that spend ranged from just 23p to £10.33 per person. The National Audit Office’s report on this subject shows the inequity, too; figures range from one hospice bed per 2,900 patients to one per 54,300, yet provision is mandated by the Health and Care Act 2022. At night and over weekends, 75% of the time, the availability of advice and interventions available to relieve distress, difficulties and discomfort is inconsistent, although 24/7 services are needed. By day, a single point of contact is essential, as the Association for Palliative Medicine has impressed upon me.
Specialist palliative care from highly trained professionals must be commissioned to manage complex pain and symptoms through effective drug titration and interventions like palliative radiotherapy, nerve blocks and neuromodulation, which are often not available. The commission advised rapid escalation of complex cases to specialists, to improve outcomes across all settings. Psychological support is pivotal, yet only 19% of hospices can access clinical psychology. Early assessments can palliate depression or anxiety and their consequences.
Young people with life-limiting and life-threatening illnesses must have equal access to care. Paediatric palliative care differs from adult care but is as ambitious in driving excellence. Tailored, age-appropriate care is needed, and expert parents need recognition for their advocacy, too. I particularly note the concerns about transition into adult services; special attention is needed to get that right.
I turn to training. Family carers provide £28.7 billion-worth of care annually. They need training and support, to be listened to, and, above all, space to love, be and spend time. In addition to training and accreditation of the whole palliative health and social care workforce in domiciliary and residential settings, hospices and hospitals, we need a workforce plan for the whole pathway. All undergraduate programmes must have palliative care content. Specialist training to support GPs aspiring to consultant status needs dual accreditation, and the commission heard that overseas-trained staff need specific orientation to palliative medicine, as each jurisdiction approaches death differently. Across the whole service, we need high standards and united objectives.
In 2024, the cost of dying in England was £24,222. The total for England was £12.8 billion, and 78% of that was spent in hospital settings. By contrast, just £1,017 is spent per person on specialist palliative provision, and £862 on community nursing. Research published today shows that specialist palliative care can save the NHS £7,908 per patient when delivered at home, and £6,480 per patient in hospital. That would save around 1.5 million bed days, or £817 million. Funding for hospice provision—essential healthcare—can no longer depend on bake sales and parachute jumps. Two in five hospices are making cuts, and 380 beds have been lost in a year, according to Hospice UK. Staff reductions and redundancies have occurred. Paediatric palliative care faces a £310 million shortfall, and there has been an overreliance on charitable funding, which is inherently inequitable.
Monica Harding (Esher and Walton) (LD)
The hon. Member is making such a powerful speech. I wish to draw attention to Princess Alice hospice in my constituency. It receives 20% of its funding from the Government, and the rest through selling woolly jumpers. Most constituents are not aware of this, but the hospice says that it can provide only a quarter of the provision that is needed in Esher and Walton because of the state of its funding. Does the hon. Member agree that the situation needs to change, not least if we are to make things equitable for everybody in our society?
Rachael Maskell
The hon. Member makes such a powerful case. We are talking about essential medicine. We would not do this in any other field of medicine, yet we are dependent on charities, which do phenomenal work to fund essential healthcare. We must ensure that we fund it properly. I will come on to make a few suggestions about that.
Although I recognise the dedication of St. Leonard’s hospice in my constituency, and the whole community around it in York, which is both generous and caring, it receives less than 24% NHS funding. This year, it got just a 2% uplift from the integrated care board. To invest in equipping it, in staffing in the community, and in building the capacity to meet need, funding will be needed, and there is already a significant shortfall. Without that funding, transition will slow and the model will fail. The sector agrees. ICBs have no transition funding, and without a health transformation fund, how will the Minister be able to deliver proper care for everyone? If patients are moving into domiciliary or hospice settings, funding should follow. Clinical staff, pharma, capital, utilities, and other essential costs should be covered by the NHS, since patients are now transferred from secondary care into the community. The modern service framework is due for publication in a matter of months, and implementation is due in April 2027. It requires a strong framework of accountability and governance, and it would be helpful for the Minister to set out how the MSF will be evaluated, and how outcomes will be measured.
Martin Vickers (Brigg and Immingham) (Con)
I congratulate the hon. Lady on the work that she has done on this issue. Two hospices serve my constituency—Lindsey Lodge in Scunthorpe, and St Andrew’s in Grimsby—and the percentage of funding that they get through the NHS, as opposed to from charity, varies dramatically. Does she agree that, at very least, we must regularise the proportion of funding that hospices receive from the Government?
Rachael Maskell
The hon. Member is right, and we know how much palliative care, including specialist palliative care, costs. That must be built into the commissioning process at population level, so that we see equity. I am sure that many in his constituency will see certain demographics in his community excluded from being able to access that specialist care. We must drive the model, and if we do not have the funding, resources or staffing, it will be very difficult to deliver the comprehensive service that everybody deserves at the end of life, should they need palliative care.
Gideon Amos (Taunton and Wellington) (LD)
I am sure the whole House congratulates the hon. Member for York Central (Rachael Maskell) on her immense work on this topic—I certainly do. I am sure that she would sympathise with one of my constituents, whose case was brought to my attention by Marie Curie. The lack of a doctor on duty over a weekend meant that proper palliating medicine could not be prescribed, resulting in a distressing death. Does she agree that as well as consistency in funding, we need care to be consistently available seven days a week and 24 hours a day?
Rachael Maskell
I am grateful to the hon. Member for raising 24/7 provision, and provision in the evenings and at weekends. Research shows that only a small proportion of services are available at those times and access to them is inequitable across the country. We need to ensure that a specialist is available at the end of the phone to support clinicians, family members and patients themselves, and that we have the workforce available to come out to deliver changes to medication or an escalation in care. It is crucial that this is not a nine-to-five service, but a 24/7 service.
Finally, I want to mention bereavement. Bereavement support varies and is often underfunded, if funded at all. Grief costs the economy £23 billion a year, but it costs individuals far more. It can be complex and have a profound impact, especially on children. It is vital that we commission appropriate bereavement support, including counselling and, for some, social prescribing.
In conclusion, palliative care affirms life and regards death as a normal process. It neither hastens nor postpones death. However, to date, access to palliative care has been inequitable. This debate must be a catalyst to providing outstanding care. Our ambition must go beyond the modern service framework. Our duty is to secure excellence in life, until the final breath is taken.
Several hon. Members rose—
Madam Deputy Speaker (Caroline Nokes)
Order. If Members confine their remarks to five or six minutes, we will get everybody in, but I do not intend to introduce a formal time limit yet.
Sir Julian Lewis (New Forest East) (Con)
I begin by congratulating the hon. Member for York Central (Rachael Maskell) most warmly on her exemplary record in campaigning for better palliative care. I will address just one segment of her panoramic presentation, namely the work done by the charity that she briefly mentioned, Together for Short Lives. It provided me with a detailed briefing and I apologise in advance if I make some points that others, who may have received the same briefing, anticipate making.
Children’s palliative care enables babies, children and young people with life-limiting conditions, life-shortening conditions or severe medical complexity to live as well as possible until they die. Palliative care for children and young people is defined by the charity as
“an active and total approach to care, from the point of diagnosis throughout the child’s life, death and beyond.”
By embracing physical, emotional, social and spiritual elements, children’s palliative care helps to achieve the best possible quality of life and care for every child with a life-limiting or life-threatening condition and their family.
Giving families an opportunity to set out what they need and want is key to this approach. Children’s palliative care is holistic and is provided by a network of services in hospitals, homes and children’s hospices by the NHS and the voluntary sector, including children’s hospices. These services should be planned, funded and provided in a way that enables children and families to access them when and where they need them.
The key problem is the one that I am about to set out:
“In England, integrated care boards have a legal duty to commission palliative care for children, young people and adults that it considers necessary.
Across England and the wider UK, there is huge variance in the extent to which palliative and end of life care for seriously ill children and young people is being formally planned, funded and provided in ways that meet national and regional standards.
Of particular concern is children and families’ access to end of life care at home”—
we heard this from the hon. Member for Taunton and Wellington (Gideon Amos)—
“24 hours a day, seven days a week, provided by nurses and supported by advice from consultant paediatricians who have completed sub-specialty training in paediatric palliative medicine (also known as GRID training).
Despite some improvements, freedom of information…requests published in March 2025 have revealed that less than a fifth…of ICBs currently commission these services on a formal basis. Meanwhile, over a third…are still failing to meet this established national standard.
As a result, many families feel abandoned by a complex system which should support them to provide care once their child is diagnosed.”
I have been asked by the charity to raise a rather large number of questions, which I am going to cut down to just six, if I can manage to squeeze them in. The charity stresses the fact that the Government’s decision to allocate up to £80 million in ringfenced NHS funding for children’s hospices in England over the next three years is very welcome, but many challenges remain.
These are the six questions that I have picked out of more than a dozen and a half that I was presented with. First, will the Minister confirm that the modern service framework for palliative and end-of-life care, which we heard about from the hon. Member for York Central, will explicitly acknowledge the difference between adult and children’s palliative care and ensure that the needs of seriously ill children are not overlooked?
Secondly, can the Minister confirm that the framework will take a holistic approach and address the wide-ranging needs of seriously ill children and their families, including medical, emotional, social, psychological and practical needs?
Thirdly, will the Minister commit to using the upcoming 10-year workforce plan to examine how the existing children’s palliative care workforce can be used as equitably as possible, organising services into NHS-commissioned children’s palliative care operational delivery networks, such as I gather are used in neonatal care services, in order to help to achieve that?
Fourthly, can the Minister commit to increasing investment in specialist paediatric palliative medicine training by £2.4 million annually to address the funding gap identified by the charity Together for Short Lives?
Fifthly, do the Government support the call of the Royal College of Nursing for nurse-to-patient ratios in all health and care settings? Will they commit to tackling the shortage in NHS community children’s nurses?
Finally, with ICB funding for children’s hospices varying significantly across England, how is the Minister ensuring that every seriously ill child and their family, regardless of where they live, has equitable access to palliative care?
Mary Kelly Foy (City of Durham) (Lab)
Palliative and end-of-life care is one of the clearest tests of a health and care system. It is about whether people can live their final months, weeks or days with dignity, comfort and choice, and whether families are supported, rather than left to cope alone. It should never be a lottery, yet too often people still experience palliative care as something that arrives too late in a crisis and only after families have reached breaking point. Referrals are delayed, honest conversations are postponed and advance care plans are created at the point when somebody is already too unwell to meaningfully shape them. Families describe repeating the same story to multiple professionals, not knowing who to call at 10 pm on a Sunday evening, and watching distress escalate because there is no rapid response available. That is not what a compassionate system looks like.
I will make three substantive points. First, we must confront the reality of variation and fragmentation. Access to specialist palliative care, hospice-at-home services and community nursing support still vary widely between integrated care boards. In some areas, there is a reliable 24/7 advice line and rapid response within hours. In others, support is limited, particularly out of hours, and families are told to ring 111 or attend A&E.
Funding arrangements contribute to that variation. Adult hospices, which provide extraordinary care, still rely heavily on charitable fundraising, alongside NHS funding. The balance differs significantly between areas, which creates instability and inequity. Hospices such as St Cuthbert’s hospice in Durham do remarkable work supporting patients and families across our community, but like many hospices it remains heavily dependent on charitable fundraising. St Cuthbert’s has recently had to make difficult decisions, including on redundancies and reducing dementia services, as funding pressures grow. At the same time, much of the Government’s announced support has been directed towards buildings and capital investment, at a time when hospices and organisations such as Hospice UK have repeatedly warned that the real pressure is on staffing and day-to-day service delivery. If we are serious about reducing health inequalities, we cannot accept such stark differences in something as fundamental as end-of-life care.
Secondly, palliative care is not simply about the last days of life; it is about quality of life from the point of diagnosis of a life-limiting condition. Early specialist input can provide for symptom control, reduce unplanned hospital admissions and help people to make informed choices about where and how they wish to be cared for. That is why I welcome the emphasis in the NHS 10-year plan on shifting care away from hospitals and into the community, because for many people facing serious illness, the most compassionate and effective care is delivered at home or close to home, supported by community teams.
Thirdly, there are practical steps that the Government can and should take. We need a clear, fully articulated national strategy for palliative and end-of-life care, with measurable standards and transparent reporting. Every area should be required to demonstrate that it provides equitable access to specialist advice, rapid response and co-ordinated care planning, so that the ambitions set out in the 10-year plan to strengthen community-based care are genuinely realised for people at the end of life. We should move towards a model where every part of the country has guaranteed 24/7 access to specialist palliative care advice, backed by community capacity to respond quickly when symptoms escalate.
Workforce is central. Generalist staff in primary care, acute hospitals, community services and social care must feel confident in recognising when someone is deteriorating, in managing pain and other distressing symptoms, and in initiating compassionate conversations. That requires investment, training and protected time, not simply guidance on paper. We must also recognise that hospice and social care services rely on the contributions of migrant workers. Recent changes to visa rules and the right to remain are making recruitment and retention even more difficult, at a time when these services are already under immense pressure.
We must not forget the strain on hospice care for children, as the right hon. Member for New Forest East (Sir Julian Lewis) said. Provision in this area remains uneven, and the stakes are extraordinarily high. Recent campaigning on Hugh’s law has also highlighted the importance of ensuring that families caring for seriously ill children are properly supported and not left navigating complicated systems while dealing with unimaginable circumstances.
Debates on assisted dying are now taking place in this Parliament. I am clear in my opposition to that proposal. I believe that the foundation of a compassionate society must be strong, universal access to high-quality palliative care and end-of-life care. When people are properly supported, when pain is managed, when families are helped and when the highest standard of care is available close to home, the fear and desperation that often drive these debates are significantly reduced. If assisted dying were to become available on the NHS, it would raise important questions that are already being asked by professionals in palliative care and across the health system about our priorities for healthcare. Access to compassionate and properly resourced end-of-life care should never become the secondary option. I ask the Minister to set out how the Government will reduce the postcode variation, strengthen community and out-of-hours provision, provide stable funding frameworks—particularly for hospices—and ensure that workforce development is prioritised.
This is not an abstract policy area. It is about whether, at the most vulnerable point in someone’s life, the system is fragmented and reactive or calm, co-ordinated and compassionate. We owe it to patients and their families to get this right.
Ms Marie Rimmer (St Helens South and Whiston) (Lab)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for securing this vital debate. Her knowledge, understanding and compassion for people are outstanding and cannot be matched.
Most people, when they are seriously ill, want to be at home, surrounded by the people who love them and whom they love. I know this personally from my own family’s experience. When my mother was dying, we were told that she had only a short time to live. She lived for another 22 days. During those 22 days, her hand was never left unheld by one of her children. Not once was she left alone. We laughed and talked, and we were able to be there with her. That experience stayed with me and all my family, and we treasure it.
However, not everyone has that support. Some people reach the end of life alone, and we have a duty as a society to care for them too. That is one of the reasons I helped to establish the Willowbrook hospice in St Helens. Like many hospices, Willowbrook was created by the community itself. It was founded in 1993 by people who, like me, believed that families in our area deserved the same compassionate end-of-life care as those anywhere else. Today it is a wonderful place, with beautiful surroundings and gardens, and care that focuses on comfort, dignity, compassion, and people’s family and friends. It is rated outstanding by the Cheshire and Merseyside ICB, and provides short-term in-patient care for people with complex needs, alongside outreach, outpatient care, therapy and education services. The hospice has supported more than 10,000 patients since opening its doors, and it now receives over 1,000 referrals each year.
Hospices exist to care for the individual person and their family. They give people a choice about where and how they spend the final part of their lives. They allow people to be treated not simply as patients, but as people—surrounded by family and friends, supported with compassion and dignity, and cared for in a way that recognises the humanity of those at the end of life. However, the reality is that, as charities, hospices are under enormous financial pressure.
At Willowbrook, around 30% of funding comes from the ICB; the remaining 70% must be raised locally. That comes from 10 charity shops in St Helens and Knowsley, donations, the occasional legacy gift and, of course, sponsored walks. It costs £3.8 million each year to run the in-patient unit alone. In a community that is not particularly affluent, raising that level of funding year after year is incredibly challenging. The hospice is currently facing a large deficit. If this pattern continues, it could be forced to close within five years. The annual increase from the ICB was 2.2% last year and is 2.3% this year, but it is dependent on efficiency savings. The increases do not keep pace with inflation and are confirmed to the hospice partway through the year, which is very late, forcing it to set its budget without certainty. In truth, it is operating on a knife edge. The solution must be fairer funding.
Patients who are medically fit for discharge, but who have no care package available at home, will be told that they do not meet the criteria for residing in a hospital, which is there for patients receiving treatment. Not many people know this until they get to that stage. There is no ready solution for people at the end of their lives if they are not receiving treatment in hospital or at home. We need funding for Willowbrook because it cannot meet the NHS nursing pay awards and is losing staff to NHS employers that can offer higher salaries, yet it is delivering NHS-commissioned care. The funding must reflect that reality, and it should pay NHS rates for hospice staff.
However, we also need wider reform. The Government must get down to facing our end-of-life care crisis. It is not good enough to finance existing hospices, although such finance is needed, because a holistic infrastructure must be developed. Hospices are established only where individuals have developed them; they are not equally distributed everywhere. That means we need a clear national strategy for end-of-life and palliative care, including a national service framework; better data to understand where care is needed most; clear goals for improvement; and proper palliative training and resources for health and palliative care staff.
Hospices such as Willowbrook show what compassion and end-of-life care can look like. Many people want that at home, and as I know, it can be provided at home, but without sustainable funding and a coherent national approach, such a service cannot continue to do the extraordinary work that so many families depend on and that the staff in nursing homes and hospices provide.
Ben Coleman (Chelsea and Fulham) (Lab)
I am very grateful to my hon. Friend the Member for York Central (Rachael Maskell) for calling this vital debate.
As the right hon. Member for New Forest East (Sir Julian Lewis) did, I will talk about children, and I would like to start with Amy. Amy had Cockayne syndrome, which is a severe, fatal, multi-organ genetic disease. She lived with it for 28 years, and for much of that time her family felt utterly lost. They were navigating a health system that simply did not know how to help them. What changed everything for her was a specialist NHS clinical service, where she got a co-ordinated team who understood her condition. They knew her, and they became a genuine lifeline.
I met Amy’s wonderful mother, Jayne, and sister Louise on Monday at a rare disease day at St Thomas’ hospital, just across the river. I must thank Dr Shehla Mohammed and the Rare Disease UK team, including Dr Bob Sarkany, for a truly inspiring visit. Jayne told me when I met her that, if this specialist service had existed for Amy when she was diagnosed at the age of 14, so much would have been different and so much would have been easier.
Amy’s condition was rare, but her experience was not. Right now, there are 99,000 children in this country—babies, toddlers, teenagers—who are living with life-limiting or life-threatening conditions. Their families are navigating the same fear, the same confusion and the same desperate need for someone to show up and know what to do, but too often what they need just is not there.
We have recently been talking in this House about the Government’s very welcome new special educational needs and disabilities strategy, which promises to end the battles that disabled children and their parents face to get the support they need. That is exactly right, but it must apply equally to palliative care.
What does that support look like? This was mentioned by the right hon. Member for New Forest East. Children’s palliative care is not just about death or bereavement; it runs from diagnosis to the end of life. Sometimes, it runs from birth to early adulthood and beyond, and, yes, to bereavement. However, it is not about giving up. It is about making sure that, however long a child has, and it may be many years, they can live their life and their families can live their lives as well as possible.
The rare diseases centre at St Thomas’ hospital showed me what is possible when we get this right. It calls its multidisciplinary clinic a carousel, which is a nice word. It means that patients see every specialist they need in one appointment, rather than having to travel across the country trailing from hospital to hospital over months. That is great when it exists, but the problem is that, as has been said, children’s palliative care is planned, funded and provided inconsistently across the country.
That was confirmed by a report of the independent expert panel’s “Evaluation of Palliative care in England”, published last November. It was commissioned by the Health and Social Care Committee, of which I have the honour to be a member, along with my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton). The report cites Together for Short Lives, which is the leading charity supporting seriously ill children and their families. It told the panel that more than a quarter of families today feel poorly supported, and that nearly one in 10 families feel altogether unsupported. In addition, only a third of existing paediatric palliative care teams are properly staffed, despite the National Institute for Health and Care Excellence guidance on staffing. The Government response to the report is encouraging. It commits to the modern service framework for palliative care and acknowledges that they must improve services for children. It will come as no surprise to the Minister that I and the Select Committee will be holding the Government to that, as we will integrated care boards across the country.
Within services for children who need palliative care, children’s hospices stand out as a beacon of what can be achieved. They are absolutely irreplaceable. They provide specialist nursing, symptom management, short breaks for exhausted families, and emotional and bereavement support. I hugely welcome the £80 million that the Government have given to children’s hospices over the next three years, so that they can plan ahead more easily, but hospices are scattered geographically. Most families access palliative care through the NHS, which is not providing this care consistently.
What needs to improve? I suggest that five things need to improve so that people get what they need, where they need it. First, we need 24/7 care. At the moment, families are alone at 2 in the morning and they do not know who to call. There have been pilots where hospices and NHS services work together to provide round-the-clock care at home, so it can be done. The NHS needs to adopt that model. Secondly, we have workforce issues. There are shortages of specialist nurses in paediatric palliative care and of properly trained generalists. That is a systemic problem, so I look forward to the NHS workforce plan, which I hope will specifically address children’s palliative care.
Thirdly, we need to consider neonatal palliative care. Neonatal deaths account for 41% of all childhood deaths. Just before Christmas, I had the unforgettable experience of visiting the neonatal unit at Chelsea and Westminster hospital in my constituency. Since 2015, it has run a most extraordinary national neonatal palliative care programme. It is on track to have trained every neonatal network in the UK from Chelsea and Westminster hospital by 2029. There has been a remarkable partnership at the unit between the NHS, the True Colours Trust and CW+, which is the hospital’s charity. I want the NHS to keep going with that.
Fourthly, we have patient groups. Their work, together with the NHS, can be life-saving. They need to be recognised and funded. Finally, as NHS England is abolished, we need to protect the roughly 80 highly specialised services on which the rarest and most complex cases depend. When NHS England goes, we need a national commissioner with the authority to fund these services nationally and to step in when local pressures threaten them.
I have set out a number of good examples, and there is real proof of what can work when the system wraps around families. Amy did not get that from the start. Jayne told me how different things could have been if she had. In future, I hope that we can make sure that every Amy—every one of those 99,000 children—gets the palliative care that they need.
Paulette Hamilton (Birmingham Erdington) (Lab)
I thank my hon. Friend the Member for York Central (Rachael Maskell), who I love dearly, for leading this important debate. Palliative care is about dignity. I saw the value of this care every day during my 25 years as a nurse in the health service. I still see it now in representing my constituency, particularly through the experience of John Taylor hospice, which is now part of Birmingham hospice. John Taylor hospice is a beacon of compassion. My constituents tell me consistently how the hospice supported them and their loved ones through the most difficult moments of their lives. But like so many hospices across the country, it is a charity, heavily dependent on voluntary contributions, and when donations dry up, it is patients and families who pay the price. Despite providing an outstanding service in 2024, John Taylor hospice was forced to reduce in-patient beds and cut the equivalent of 45 full-time roles—14% of its workforce. That means losing specialist nurses; it means losing the staff who hold the hands of the dying. That is the human cost of financial uncertainty.
I welcome the Government’s recent funding of £100 million in capital for hospices and the £26 million per year for children’s palliative care, and I am glad Birmingham hospice has successfully accessed over £1.1 million from that funding, but we must be honest with ourselves: a one-off grant is simply a short-term sticking plaster. Palliative care cannot survive on a diet of gap-filling and bake sales. It cannot be sustained by charity alone.
Adam Jogee (Newcastle-under-Lyme) (Lab)
Can I take my hon. Friend up the M6 from Birmingham to Newcastle-under-Lyme and, through her, pay tribute to the wonderful Dougie Mac hospice? For many years, it has served people in Newcastle-under-Lyme, Stoke-on-Trent and across north Staffordshire. The staff there are committed, caring and compassionate, and they deserve a shout-out in this debate.
Paulette Hamilton
I am sure that every Member in the Chamber has a local hospice that they really appreciate and cannot do without. I thank my hon. Friend for giving his local hospice a shout-out. I am sure it will be appreciated.
Palliative care is a core medical need and it requires core funding. Let us look at the numbers. It is estimated that in England and Wales, by 2040, demand for palliative care is expected to increase by between 25% and 47%. We are heading towards a cliff edge, yet we are funding these services as if they are an optional extra. We must ensure that hospices receive proper, recurring funding from the NHS and the Government. Staff must be retained and patients must have equitable access to care. We need a long-term financial strategy so that no family, in Birmingham Erdington or anywhere else in this country, suffers because services are cut back.
We must also talk about access. Just as we have seen with GP appointments, accessing hospice care is becoming harder. If we cut beds and staff, we close the door on dignity. That brings me to the assisted dying Bill. I am concerned that it is not clear where the funding for the proposed new system will come from. If it is drawn from the same limited pot as palliative care, we risk starving the very services that provide the positive alternative: a death free from suffering. We need to close the door on that dilemma. We need hospices embedded not as a charitable extra, but as core partners in the NHS: funded for the long term and resourced to be there for everyone. The people of Birmingham Erdington and across the country deserve to live and die with dignity.
Tom Collins (Worcester) (Lab)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for leading on this topic.
I have seen palliative care fail. My mum, Alison, had ovarian cancer. She died lonely and in dreadful indignity in a hospital ward intended for recovering liver and kidney patients. She felt a burden to a nursing team who were used to people getting better. She was waiting for a hospice bed, but, as it turned out, the waiting time was longer than she had.
In my constituency, we have hospices with superb facilities. Both Acorns children’s hospice and St Richard’s hospice are beloved institutions in our city, but they are struggling and it is vital that we support them. Clearly, we need more hospice capacity, but the deficiencies in palliative care are vast, and my lurking, uneasy suspicion is that many of them are not hospice-shaped, but reflect deeper deficits across our NHS.
Ms Julie Minns (Carlisle) (Lab)
My hon. Friend raises an important point about the NHS. In my limited but painful experience of hospices, one problem is that even when there is a hospice bed available, NHS staff do not refer end-of-life patients to the hospice because the palliative team is 9 to 5, Monday to Friday. Does he agree that we have to get to a point where palliative support in our NHS is available 24/7 so that those referrals can take place?
Tom Collins
My hon. Friend is entirely right. We need far better integration across those services. I was heartbroken to see that the palliative care that my mother was receiving seemed to have been outsourced to charities, and was not being provided by the NHS at all. That specialist care ought to be something that is native to our NHS.
I was recently talking to a couple of GPs in Worcester. Speaking with them is a refreshing change. While their work is in diagnosing and treating illness and, to a good extent, preventing it and promoting healthy lives, for them, palliative care is not an exception; it’s a Monday. With an ageing population, end-of-life care is really an emerging flavour in medical care. Bodies do not last forever, and the balance of benefits of treatment versus the very human costs of pain, inconvenience and indignity starts to change.
Medics dealing with palliative care understand that our bodies are intermingled, complex systems, and that they are one part of what we are: complex, intermingled physical, psychological, social and spiritual beings with rich tapestries of relationships, values, perspectives and experiences. “See the problem, name the problem, fix the problem” just does not cut it as an approach. We must treat the whole person, or we risk mistreating them. Sadly, our urgent and acute systems of diagnosis and treatment are simply not designed for this approach. Palliative care is by and large out of mind and out of scope. Care is siloed into specialties, patients become units of flow and relationships are substituted out for transactions.
This is reflected in the stories I hear from constituents in Worcester: stories from people with multiple complex conditions who are locked in the flip-flop between specialisms, where alternately one gets managed well and the other slips into neglect; stories of people who feel unheard, unvalued and anonymously shipped to different hospitals in different areas under different trusts; and stories of people who, when their wellness takes a dip, do everything they can to avoid calling an ambulance and the inevitable prodding, poking and a long, cold night in A&E corridors that follows. This has to change.
Addressing our gaps in palliative care demands a fundamental shift in the way our NHS thinks and works. Here and there, there will be a place for the cut-and-shut quick surgical procedure, a course of antibiotics, or a cast, a sling and a suggestion not to do it again, but the primary role of healthcare needs to be one that sees the human being and works in relationship for their wellbeing. In fact, best practice in palliative care is often remarkably similar to treatment for recovery: setting small, achievable goals and working with patients to fulfil them. An NHS informed by this approach would most likely be more effective across the board. With that foundation, the opportunities for a better, more holistic and properly resourced approach to palliative care can start to open up.
I would like to touch on the topic of assisted dying. I found debate on the Bill difficult to navigate, largely for the reasons I have discussed. The overwhelming message I have heard from medical professionals is that we need to improve the way we navigate the end of life as things stand today, break the taboo of death and develop care that meets the practical, physical, psychological, spiritual and social needs of patients and their families, and make that available to all.
As we do that, treatments that shorten but enhance life would undoubtedly play a role, but they must sit at the apex of a well-developed practice in end-of-life care that we do not yet have. This should be a major and urgent priority for us, not least because the drive towards excellent palliative care can only improve our systems and approaches overall, enabling us to deal better with complex needs, putting patients’ perspectives at the centre of system design, and plugging gaps so that patients are no longer able to fall through them. By taking proper ownership of palliative care, we can end experiences like my mum’s, and in doing so, we will also make a better NHS.
Mary Glindon (Newcastle upon Tyne East and Wallsend) (Lab)
I am very sorry to hear about the mother of my hon. Friend the Member for Worcester (Tom Collins).
This is a topic of deep personal importance to me, to many of us in the Chamber and to many of our constituents, but it took a private Member’s Bill on assisted dying to bring the debate on palliative care into the foreground. I am relieved that the subject is now getting the attention that it deserves, but this has been needed for far too long.
Let me take this opportunity to commend in the strongest possible terms my hon. Friend the Member for York Central (Rachael Maskell). She rose to meet the challenge and convened the brightest minds in their respective fields to think about how palliative care could be done differently; I thank her. To say that was a necessity is no overstatement. New research commissioned by Marie Curie shows that almost one in three dying people have unaddressed symptoms and concerns, and limited or no access to GP services. This is a system in crisis, and demand for specialist palliative care is set to increase significantly. People in the UK are living longer, with complex needs, and this is a mounting pressure on services that are already patchy and under strain.
According to a widely cited study published in BMC Medicine, the demand for specialist palliative care services could increase by 42% by 2040. For those who access specialist palliative care, a referral can be an incredibly daunting experience. People are forced to stare their life- limiting illness directly in the face. Patients often take each day as it comes, and before they know it, they face forms and terminology that they have never encountered before.
I welcome the Government’s commitment to develop a palliative care and end-of-life care modern service framework. This will be the first such national plan in two decades. As part of the strategy, I hope the Minister will look closely at the practical support provided to patients and families as they navigate referral. It can be a minefield, and people must feel confident that their care plan is right for them.
I hope the Government will seize the opportunities of the forthcoming NHS workforce plan. The sharp rise in demand that lies ahead of us must be met by a resilient and comprehensive workforce. Making the shift from hospital to community will require investment in general practice, community and district nursing, and specialist palliative care professionals. I would be grateful if the Minister could set out whether palliative care services will be a key component of the workforce plan.
The Commission on Palliative and End of Life Care underlines the hard yards that we need to do on training. It highlights that a
“lack of training available to clinicians in undergraduate and postgraduate programmes”
is leading to
“poor confidence and competencies...in knowing how best to engage in care planning conversations.”
It is crucial to note that it is not just specialists who have a vital role to play; palliative and end-of-life care must become a compulsory part of training for all health and social care workers.
Greater health literacy in this area would also improve earlier identification. This would not only improve outcomes for patients, but reduce costs for our broader health system. Given these clear opportunities, will the Minister commit to implementing mandatory training for all health and social care staff in undergraduate programmes from September 2026? Will she also commit to ongoing and specialist-level training for those already part of our NHS workforce? We must thank all those who currently work in the palliative care world. Their work is nothing short of awesome.
I wish to end my speech with a reflection on what our overarching focus must be. A person is never more vulnerable than when they are told that their life will come to an end. When that happens—when nature makes that choice—we must enable people to maximise the precious time that they have left. Today, too many people are not afforded the opportunity to do that. I urge the Government to be bold as they set a new direction for palliative and end-of-life care.
Liam Conlon (Beckenham and Penge) (Lab)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for securing this debate. Discussions around assisted dying have divided this House, yet I think we can all agree that the prominence that palliative care has been given as a result is incredibly welcome. Before I discuss policy and funding, I repeat the words of Dame Cicely Saunders, the founder of the modern hospice movement, who said that palliative care is about more than just bricks and mortar.
Many of the benefits of proper palliative care and hospice support are not easily quantified, and certainly cannot be captured on a balance sheet. At St Christopher’s hospice in my constituency, established by Dame Cicely, there is a real focus on living fully until the end of life, as well as on allowing time for spiritual reflection and reconciliation at the end of life. St Christopher’s was the first modern hospice in the world for end-of-life patients that combined medical care, research and teaching. Every family in Beckenham and Penge has been touched by St Christopher’s hospice. Speaking to them about the care that their loved ones received, I truly began to understand the meaning of holistic care.
To use just one example, patients are given access to a specialist adapted gym and physiotherapists, with a focus on retaining practical movements to maximise quality of life. To give another example, St Christopher’s invites out-patients into the hospice for art classes and therapies, providing them with community and enjoyment. It also ensures that the hospice is a familiar and safe place, meaning a more comfortable experience should they become an in-patient at the hospice in the future.
The care extends beyond patients to the families. St Christopher’s offers bereavement support to families after a death, and encourages conversations towards the end of life that facilitate reconciliation, honesty and peace. The impact of St Christopher’s hospice can be seen in the enthusiasm of our community for supporting the hospice at various fundraising events throughout the year.
It is so important that those benefits, as well as the savings that hospices can generate for the NHS, are recognised by the Government, but we know that recognition alone is not enough. The number of people with palliative care needs is projected to rise significantly over the next 25 years, putting more pressure on a system that is already squeezed. Marie Curie estimates that by 2048, the number of people with palliative care needs will be 25% higher than in 2023. We also have a postcode lottery for palliative care in this country. Because the hospice movement grew organically over the decades, locations were not planned with the aim of providing even access. Where a person lives should never determine the dignity of their death or their ability to access the support I described.
Even in one place, significant disparities exist between groups. The barriers to accessing care are unacceptably high for ethnic minority communities and those living in poverty. A lack of culturally tailored care, language barriers, and a historical disconnect between some communities and traditional hospice services mean that many families carry the burden of end-of-life care entirely alone, unaware of the holistic support that they are entitled to. We need providers and the Government to begin to address that.
I am glad that the Government have begun to relieve some of the problems. Last year, they announced record funding—a £100 million boost for adult and children’s hospices, including £1.6 million for St Christopher’s. This is the biggest investment in end-of-life care in a generation. It has enabled and supported the construction of the Nuffield ward at St Christopher’s, which is the first of three wards to be refurbished. I was incredibly proud to visit the hospice in December, along with the Health Secretary, to officially open the ward.
I ask the Government to continue in the spirit of that recent success. As Steve Smith, chief executive of St Christopher’s, said following the latest funding announcement,
“while this investment is deeply appreciated and has already helped modernise facilities, it cannot stand on its own. We must ensure the long-term sustainability of our hospice sector.”
I therefore welcome the news that the Government are developing a palliative care and end-of-life care service framework for England. Unbelievably, it will be the first national plan for this vital area of care to be delivered since 2008.
From speaking to friends at St Christopher’s and Hospice UK, I know that there is a real desire to engage with Ministers on shaping this vision. In order to meet the Government’s ambitions in the 10-year health plan to shift care out of hospitals and into the community, this framework must commit to a fairer long-term funding model.
Adam Jogee
My hon. Friend is making a really important speech, which I am enjoying, as I am sure others are. He set out the challenges facing the palliative care system. Does he agree that rather than proceeding with changes to bring in assisted dying—a change from zero to hero that would only make the challenges he set out worse—the resources, effort and time of civil servants, the NHS and all of us should be focused on getting the palliative care system fit for the 21st century?
Liam Conlon
I agree with my hon. Friend. When it comes to palliative care, a postcode lottery does not offer people a real choice, either; I made that point during the debate on assisted dying.
Crucially, the framework must also address the regional and socioeconomic inequalities that plague the system, so that across the whole country, people can access the high-quality, compassionate palliative care that I know my constituents value so dearly at St Christopher’s.
Let me finish by thanking all the trustees, staff and volunteers at St Christopher’s hospice for caring for families with unrivalled professionalism, dedication and empathy. Dame Cicely said:
“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”
She would be incredibly proud of the staff and volunteers at St Christopher’s hospice today, whose work enables that to happen.
Brian Leishman (Alloa and Grangemouth) (Lab)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for bringing the debate to the House, and for all the campaigning that she does. She is a force for getting palliative care the funding that it truly needs.
Laura and Keith Turner and their daughter Kate are at the heart of the community spirit that makes Sauchie such a special place. The Turners shared the story of their son, Kate’s younger brother Calum, who was just 16 when diagnosed with Burkitt lymphoma. No family should face what the Turners did with Calum’s illness.
When the Turners were told that no more could be done, Calum made the decision that he wanted to pass away somewhere familiar—at home. The family did everything they could to make Calum’s final days comfortable and as peaceful as possible, but the Turners experienced a system designed for adults. District nurses and adult hospice services, dedicated as they are, are more equipped to care for elderly patients, not a 16-year-old boy. The sensitivity and understanding required for caring for a young person at that stage of life is very different from that required for caring for someone in their later years. While Calum had the bravery, attitude and confidence of an adult, he was still a child.
Traumatically, the Turners waited more than seven hours for morphine, and were negatively judged for taking the decision to bring Calum home, but that changed when Children’s Hospices Across Scotland became involved. CHAS nurses brought dignity and understanding. They listened. They treated Calum as a young person, not as a patient. Crucially, they allowed his family to stop being carers and simply be mum, dad and a loving sister in those precious final days.
Families deserve a system that recognises that young people at the end of life are individuals, with a unique set of needs. I ask the Minister to please listen to Calum’s story and invest further in palliative care, so that other families do not find themselves in the same position as Laura, Keith and Kate. There is not a pounds-and-pence figure in any budget that can be put on giving families the best treatment and comfort possible at the time they need it most.
Josh Newbury (Cannock Chase) (Lab)
I pay tribute to my hon. Friend the Member for York Central (Rachael Maskell) for securing this debate and, more importantly, for her work and advocacy on palliative care throughout her time in the House. Last August, I visited St Giles hospice in Whittington, just over the border in the Lichfield constituency; I am hugely grateful for that visit. The hospice is so well loved by my constituents, not least by the thousands of people who fundraise for it every year.
We often judge our health services by how they treat illness, but the test of a good health service is also how it supports people when treatment is no longer the answer. The people I met at St Giles were doing extraordinary, skilled work. Their day-to-day is managing complex symptoms, while turning to steady a husband or reassure a daughter. That balance of clinical excellence and guiding family and friends as their loved one’s life nears its end showcases the immense skill that those nurses, doctors and support staff possess.
At St Giles, I met the chief executive officer, Elinor Eustace, and saw the fruits of recent funding that they have had from the Government, and from the Francis and Eric Ford Charity Trust, which enabled them to create a new family lounge. The space gives people the chance to spend time with their loved ones away from their room, including cooking up a storm in the kitchen, nattering over a brew, or playing in the children’s area—because, heartbreakingly, St Giles is seeing more and more terminally ill people who have young children.
Like all hospices, St Giles faces stark financial challenges. With only around a third of hospice funding coming from the NHS, the vast majority must be raised from donations, sponsorships and legacies. Though hospices fiercely defend their charitable mission and independence from the NHS, it is clear that the NHS and hospices have a close relationship, and always will, so public funding is critical.
Having listened to hospices and the families who have relied on their world-class care, it is clear to me that the funding model for palliative care, and the recognition of the costs that hospices face, need a major shake-up. At St Giles, Elinor told me that although hospices are not bound by NHS pay scales, terms and conditions, they have to keep up with them, or they will lose many of their staff. They want to recognise the outstanding care that their highly skilled workforce provide, but the reality is that the payments they receive from the NHS often do not keep pace with increasing costs; the squeeze is tighter every year. It is the same story for many other hospices that serve my constituency, such as Acorns and the Dougie Mac.
A stark example of this pressure can be seen at St Giles, where a third of beds are closed due to funding constraints—most definitely not because of a lack of demand or need. In previous years, that spare capacity has been given over to the NHS to help with winter pressures. Any hon. Members who have worked in the NHS will know that extra capacity is essential in the cold winter months; however, the amount paid for lower-level care than St Giles typically offers meant that the hospice made a loss on those beds. Donations were effectively subsidising NHS care, so, sadly, that arrangement had to be stopped.
We Labour Members have to be honest that chief among the cost pressures faced by hospices in the last year has been the increase in employer national insurance contributions, which has cost St Giles £400,000. I continue to believe that given the vital role that hospices play for people at a critical time in life, and the pressures that they take off the NHS, hospices should be exempted from that increase. Not exempting them will continue to restrict the availability of end-of-life care, and will cost the NHS more in the long run.
Like many in the Chamber, I devoted lots of time to the assisted dying debate, poring over heart-wrenching letters, and speaking with constituents and professionals on both sides of the argument. That debate showed me that, whatever views people hold, we need far more focus, discussion and funding for care at the end of life. When hospices have to cut their services, the people who need them do not just disappear; instead, they go to the NHS, or they are among the quarter of people who could benefit from specialist end-of-life care but never receive it.
With stable long-term funding that reflects the full costs of specialist services, hospices could not only maintain their services, but expand their role to meet growing demand and the various challenges ahead of us. We all deserve a good death, but many of us do not get that. That must and can change, and I look forward to working with everyone in this Chamber, and with the incredible people who provide palliative care, to ensure that it does.
Douglas McAllister (West Dunbartonshire) (Lab)
The hospice sector in Scotland is under severe and growing financial pressure, with two thirds of hospices making cuts or planning to do so in the near future. That is due to underfunding that has left hospices stretched to breaking point; many are forced to cut services at a time when they are needed more than ever. Nowhere is that reality clearer than in my constituency of West Dunbartonshire, which is home to Scotland’s oldest and largest hospice, St Margaret of Scotland Hospice, as well as CHAS Robin House, which provides specialist care to babies, children and young people with life-limiting conditions.
I note the findings of the independent palliative care commission, and I strongly support its call for a comprehensive, specialist palliative care service that is properly funded, accessible to all and available from the point of terminal diagnosis or advanced chronic illness. That vision reflects what families in my constituency need and deserve.
St Margaret’s has served generations of families in West Dunbartonshire and beyond, and I am grateful for the formidable and irreplaceable stewardship of Sister Rita Dawson and her team of wonderful staff and volunteers. It is undertaking a £6 million refurbishment, and the work is almost complete, but there remains a funding shortfall. So far, all the money has been raised through donations and fundraising efforts. Modernisation is urgently needed to ensure that patients receive care in dignified therapeutic surroundings fit for the 21st century, yet the hospice continues to face a funding gap.
Robin House provides extraordinary children’s palliative care to families facing the unimaginable. Its services embody precisely what the commission describes: holistic specialist care that extends beyond the patient to the whole family, including bereavement support. However, like adult hospices, it relies heavily on charitable income alongside statutory funding that does not always reflect the true cost of delivery.
I understand that the findings of the commission relate to England specifically and to the Government’s 10-year NHS plan. I welcome the fact that the UK Government have committed significant investment to hospice and palliative care services in England as part of our long-term health planning. That funding recognises that palliative care is an essential part of our healthcare system for those receiving end-of-life care and their families. Having spoken to representatives from hospices in West Dunbartonshire, it is clear that there has been very little indication of the help that was promised under the Scottish Government’s palliative care strategy announced last September.
Hospices in my constituency are struggling. They deserve clarity and transparency on where this much-needed funding is. West Dunbartonshire has some of the highest levels of health inequality in Scotland. That makes equitable access to specialist palliative care even more critical. A postcode should not determine the quality of someone’s final months, nor should hospices be left dependent on community fundraising to complete essential building works while additional public funding sits somewhere else in devolved budgets.
Given the capital and revenue investment announced for palliative care in England, I ask the Minister whether she has held discussions with her Scottish counterpart to ensure that the Barnett consequentials are properly reflected in Scotland’s approach to hospice funding. In particular, will the Scottish Government set aside their Barnett share of the capital for hospice building improvement works announced by the UK Government? Will she commit to continuing engagement to ensure that the vision set out by the independent palliative care commission is realised not just in one part of the United Kingdom, but across all of it?
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for this important debate. I pay tribute to her political expertise in this area and for everything she has done.
Dame Cicely Saunders—much quoted in this debate—was the founder of the hospice movement in this country. She understood that medicine is not only about curing illnesses; it is about dignity and ensuring that people are supported compassionately at the most vulnerable moment of their lives. It was her work that transformed how we think about care at the end of life, and today hospices all over the country continue that legacy. In my own work as an ear, nose and throat surgeon dealing with patients with advanced cancers in the head and neck, I am well aware of the importance of hospices.
I also pay tribute to Dr Eric Wilkes, who was a brilliant general practitioner and founder of the hospice movement in Sheffield. He was one of my teachers and one of the first people to understand the importance of integrating end-of-life care into community and hospital settings at St Luke’s hospice. The term “palliative care” was invented only in 1990—some 20 years or so after I first met Dr Wilkes—and the Sheffield model has been completely crucial to this development.
I would like to talk about palliative care in my constituency of Bury St Edmunds and Stowmarket, and in particular the remarkable work of St Nicholas hospice, its wonderful chief executive Linda McEnhill and all her staff. The hospice provides essential support for those approaching end of life and for their families and loved ones. What makes that hospice a little unusual is that it sits right on the campus of West Suffolk hospital, an arrangement that facilitates help for the patients in the hospice from all the services within the hospital. If, for example, a patient falls and fractures a leg, or needs an ear surgeon, support is available rapidly and nearby. Most hospices simply do not have access to that level of clinical support, and that is a real advantage for the Bury St Edmunds hospice.
St Nicholas hospice also illustrates a wider challenge facing palliative care across the country. As we know, demand for hospice services is increasing. St Nicholas lately increased its capacity by about 33% to meet the needs of patients and families in the local community. To expand, more staff need to be recruited, so we must do something to increase training capacity across the hospice service, particularly because we must ensure that we have a seven-day service. If we need to increase the service from a five-day service to a seven-day service, we need two sevenths more people.
Palliative care is a crucial part of a healthcare system. The problem, as we have heard on many occasions, is that hospices rely on charity and legacies. That is obviously admirable, but it raises an important question—one that I think was first asked by Baroness Finlay in the other place. We do not expect a maternity service to require charitable funding. If we needed a new maternity service, we would expect the NHS to put it up. Yet for some reason, if we need a hospice, we expect a charity to raise the funds for it and to run it. Being born and coming to the end of life are just inevitable parts of life, so I think we need a paradigm shift—a philosophical change—in the way we think about palliative care, which must be regarded as a core part of our national health service. If we genuinely believe that dignity at the end of life matters, let us make palliative care core.
Madam Deputy Speaker (Caroline Nokes)
That brings us to the Front-Bench contributions. I call the Liberal Democrat spokesperson.
Alison Bennett (Mid Sussex) (LD)
I thank all hon. Members for their thoughtful and moving contributions this afternoon. The hon. Members for Worcester (Tom Collins) and for St Helens South and Whiston (Ms Rimmer) spoke so movingly about their own very personal loss. Of course, we would not be holding the debate were it not for the hon. Member for York Central (Rachael Maskell), who set out the frame of this debate so brilliantly and has done so much outside the Chamber to strive for better palliative care.
The hon. Member for York Central concluded her remarks by talking about bereavement support, and that is where I will begin mine. Last week, I was out in Burgess Hill. I saw an elderly gentleman who was standing by the edge of the pavement holding on to a walking frame. I got talking to him, and it turned out that he was waiting for a lift to St Peter and St James hospice, where he was going to a bereavement café. He told me that he had lost his wife two and a half years ago, but he had no recollection of the first two years following her loss—I think it had been a blur for him. For the past six months, he has been going back to St Peter and St James for the bereavement café, and he is beginning to feel a little better with that support each week. My thanks go to St Peter and St James, and to all the hospices that support our constituents, for what they do.
Our palliative care system is at tipping point, with a funding cliff edge approaching. Some 75% of hospices are running a deficit, two in five are planning reductions in clinical services in the year ahead, and 380 hospice beds across England lie empty, not because there is no need for them, but because there is no funding to staff hospices, as many hon. Members have said. Around 300,000 people are cared for by hospices every year, yet around 100,000 more need it. One in three of those who need hospice care miss out, and demand is rising sharply.
Over the next decade in England, just over 5.75 million people will die. Around 90% of them—an estimated 5.18 million people—will have palliative care needs. New research commissioned by Marie Curie and published earlier this month showed that nearly one in three dying people have both unaddressed symptoms and concerns and insufficient access to GP services at the end of life. That equates to nearly one person dying with unmet needs every three minutes. Without intervention, around 44,400 more people are projected to have unmet palliative care needs in 2050 compared with 2025. That is the scale of the challenge before us.
Hospices are essential pillars of our health and care system, especially at a time when the NHS is under such immense strain. The economic case for funding them properly is overwhelming. Approximately 15% of all emergency hospital admissions in England involve people in their last year of life—nearly 1 million admissions in 2023 alone. Those patients account for around 30% of all emergency hospital bed days. In the last six months of life, around 360,000 people spent a total of 8.4 million days in hospital. With the average acute bed day costing around £500, and with roughly 40% to 50% of the NHS budget concentrated in acute settings, the potential for a more appropriate allocation of resources is obvious.
Around 69% of people are admitted as in-patients in the final six months, with a median stay of 13 days, and 80% of those who die in hospital had an emergency admission in their final month of life. These are real people—people who, with better planning and properly resourced hospice, community nursing, GP, pharmacy and paramedic services, might have experienced a calmer, more dignified end of life and spared the NHS considerable cost. But the very sector that relieves this pressure is itself under extraordinary strain. Between 2022 and 2024, there was a £47 million real-terms cut in hospice funding. As the hon. Member for Cannock Chase (Josh Newbury) noted, the disastrous rise in employer national insurance contributions alone is costing hospices in England an estimated £34 million a year.
Hospices collectively raise about £1.4 billion themselves. Government funding amounts to just over £500 million—barely a quarter of the income—and in some areas, hospices receive as little as 8% of their funding from NHS grants. There is no robust national methodology underpinning these variations. It is a postcode lottery and, as the right hon. Member for New Forest East (Sir Julian Lewis) noted, the variation in funding for children’s hospices is even more acute than that in the adult hospice sector. Access to compassionate end-of-life care should not depend on geography, the strength of an area’s ability to raise funds or whether someone is an adult or a child.
Hospices, of course, welcome the capital funding from the Government, but it quite simply does not pay nurses’ salaries. Staff account for around 70% of hospice costs. Without revenue funding for core services, capital investment does not keep beds open or prevent service reductions. This is a national, structural problem, but it is also a very real one for all our areas across the country, particularly for my area in Sussex, where the Southern Hospice Group is consulting on how to cut its costs.
Marie Curie and others have warmly welcomed the Government’s commitment to developing a palliative care and end-of-life care modern service framework, with an interim report expected in the spring and a final report in the autumn. It will be the first national plan for palliative and end-of-life care since 2008. That is, of course, good news. The Government have rightly identified five core challenges: delays in early identification, inconsistent commissioning, workforce shortages, gaps in 24/7 provision, and limited uptake of personalised and advance care planning. But those are not new problems that need solving—we have known about them for some time—and if this framework is to succeed, it must go further.
My Liberal Democrat colleagues and I are campaigning to double the funding for bereavement support payments, reversing the last Conservative Government’s cuts since 2017. We would also reduce isolation following a bereavement, by improving access to social prescribing and through the work of a dedicated Minister for tackling loneliness. We would improve support for children who have lost a parent by appointing a Cabinet member for children and young children, and extend pupil premium plus funding to children in kinship care. The Government must provide stronger national leadership and oversight, and they must place palliative and end-of-life care at the heart of plans for a neighbourhood health service, looking beyond hospices. They must deliver a new funding and commissioning model that ends the postcode lottery. They must invest properly in the workforce, and scale up proven models of care that shift support from hospital to community, improving patient experience and delivering better value for taxpayers.
The Government seem happy to talk about moving care from hospitals to the community, but we need a material change. The Liberal Democrats believe that the Government have a choice: they can allow hospices to drift from crisis to crisis, with beds closed, staff lost, and unmet need rising year after year, all while still struggling to plug gaps left by the struggling NHS; or, they can seize the moment, through the modern service framework, to build a sustainable system that matches funding to need and delivers dignity for all. No one should face death in avoidable pain, no family should be left unsupported, and no responsible Government should ignore the evidence that properly funded palliative care is both the compassionate and the economically responsible choice.
Madam Deputy Speaker (Ms Nusrat Ghani)
I call the shadow Secretary of State.
Stuart Andrew (Daventry) (Con)
May I begin by congratulating the hon. Member for York Central (Rachael Maskell) on securing this important debate, and the independent commission on palliative and end-of-life care on the amazing work that it has undertaken? Its report certainly provides an important contribution to the discussion about how we ensure that people receive compassionate and high-quality care at the end of life.
This debate is important. There is a saying that nothing is certain in life other than death and taxes, but it seems that we spend an awful lot of time in this place talking about taxes, and until recently we have not really talked about death. I agree with the hon. Member for Newcastle upon Tyne East and Wallsend (Mary Glindon), who said that we have gone into assisted dying but rather missed or leapfrogged the important debate around palliative care. I pay tribute to the hon. Member for Newcastle-under-Lyme (Adam Jogee) for his tribute to Dougie Mac, and to all colleagues who have made representations and congratulated hospices on the amazing work that they do around the country. We also heard moving contributions from the hon. Members for St Helens South and Whiston (Ms Rimmer), and for Worcester (Tom Collins). These debates are even more powerful when we talk about personal experiences that we have been through, and I thank them for sharing those.
For me, palliative care is about dignity, compassion and choice at the most difficult moments in people’s lives. When it works well, it relieves suffering, supports families, and allows people to spend their final days in the place and manner that they choose. Before coming to the House I had the privilege of working for 16 years in the hospice movement in both children and adult hospices, and with organisations supporting families whose loved ones were edging towards the end of their life. Many of those were supporting the families of children who had life-limiting conditions. That experience has stayed with me and informed how seriously I take this debate, because I saw first-hand the extraordinary compassion and professionalism of the people who provide such care, and the profound difference that it makes to families facing unimaginable circumstances.
When it comes to children, no parent expects to outlive their child. Often those parents would say to me that when they realised that their child was living with a life-limiting condition, it meant that their dreams and aspirations changed. Suddenly they were not thinking about their child’s first day at school or university, or their wedding day; they were changing their whole aspect and plan for that child’s life. That is why hospices and palliative care services are so important, and they support more than 300,000 people every year.
Much has been said about the wonderful Dame Cicely Saunders, but we should also pay tribute to Sister Frances Dominica, who set up the first children’s hospice in the UK. There was a wonderful saying in children’s hospices that I always used to relay: they cannot add days to their lives, but they can add life to their days. That shows how important hospices are to so many families.
Hospices are a vital part of our health system because they are relieving pressure on hospitals and providing specialist care in communities across the country. Hospices are not an optional extra in our health system—they are a core part of how our compassionate healthcare should work. Seeing adults and children get the care that they needed at the end of their lives, as I did at Hope House children’s hospice, East Lancashire adult hospice and Martin House children’s hospice, was phenomenal. It is no wonder that our hospice movement has been world-leading.
However, the sector is under increasing strain. Hospice leaders report rising costs, workforce shortages and growing demand for services at the very moment that they are struggling. Across the country, we are seeing reductions in services, bed closures and significant financial pressures. As many hon. Members have said, Hospice UK has warned that two in five hospices are now cutting or reducing services. I know that concerns every Member of the House.
The Government will point to recent announcements about capital funding for hospices and the continuation of the children’s hospice grant, and those investments are welcome. But capital investment and capital funding cannot pay for nurses, doctors or the day-to-day delivery of care. What the sector needs is sustainable revenue funding. As a former head of fundraising, I know that capital fundraising is often the easiest, because people want to buy a new building or a piece of equipment, and paying the wages is never as, dare I say, sexy.
As many hon. Members have said, children’s palliative care also faces challenges. Children with life-limiting conditions and their families require specialist care that supports them from diagnosis through to the end of life and beyond. I remember one parent saying to me that if he got up eight times in the night to his daughter, he would consider that he had had a good night’s sleep— I cannot imagine what that must be like. I also saw siblings having a different life from those of their school friends because their brother or sister needed extra, additional care. Children’s hospices offer wonderful bereavement support to families, which is another issue that many hon. Members have mentioned.
Access to that care remains inconsistent across the country. As my right hon. Friend the Member for New Forest East (Sir Julian Lewis) said, evidence suggests that fewer than one in five integrated care boards formally commission specialist children’s palliative care services that meet national standards. There are also serious workforce shortages. England has just over 1,000 community children’s nurses, when safe staffing estimates suggest that nearly 5,000 are required. Across the UK, there are only around 24 specialist paediatric palliative care consultants, when experts estimate between 40 and 60 are needed. For many families that means they cannot access the support they need at home, even when that is their preference.
The Government have indicated that they will publish a modern service framework for palliative and end-of-life care later this year, which I absolutely welcome and I commend the Government for that. That framework presents a really important opportunity to address the challenges facing the sector.
I would like to ask the Minister a couple of questions. I will not repeat the ones that my right hon. Friend the Member for New Forest East mentioned because we all had that briefing. What steps will be taken to address the workforce shortages facing palliative services, particularly community children’s nurses and specialist consultants? What plans do the Department have to ensure that hospices have the sustainable funding required to continue delivering these vital services and protect their independence? I get the call for us not to have so much reliance on fundraising, but there is a real danger that hospices lose that independence if they take that statutory funding. The thing I always noticed was how they were more able to respond very quickly to the needs of individual families than the NHS. It is really important that we safeguard that independence.
How will the Government ensure that this opportunity with the new plan seizes the chance to stop that postcode lottery? Will it see where we should firm up some of the guidance to ICBs around the country? Will Ministers look at the innovation that charities are doing in this work around palliative care? I think particularly of Sue Ryder, which is investing in add-on wards at the Airedale general hospital in Yorkshire. It is also focusing more on home services, rather than services in the building, and on getting to more and more patients. It is important that we engage with and learn from it so that we can see it evolving into best practice.
There is also a really important issue around transition, which is important for young adults. When I worked at Martin House, we had just opened the teenage unit, which enabled us to have a setting that was a bit more grown up but not old ladyish or old mannish, if I can put it that way; it was an environment suited to the needs of those young people. Thankfully, we now see that these young people are living longer. When I was working at Martin House, young boys with Duchenne muscular dystrophy would probably come to the end of their life at the age of 18. They are now living into their late 20s, 30s and sometimes even 40s.
There needs to be an appropriate environment for those people to have support, because palliative care is one of the most compassionate parts of our health system. The professionals, volunteers and charities that deliver that care do extraordinary work every day, and they deserve a system that supports them and ensures that every patient and family can access the care that they need at the end of life. I hope the Minister can tell us how the Government intend to achieve that.
The Minister for Secondary Care (Karin Smyth)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for securing this important debate. We entered Parliament at the same time; we were immediately on opposite sides of the assisted dying debate, and we remain so. Although the Government are neutral, we have always articulated our concern around palliative and end-of-life care in many debates in this House. My hon. Friend has done a marvellous job of that today by bringing forward this debate.
I also thank all my hon. Friend’s colleagues on the commission on palliative and end-of-life care for the vital work they do as they continue to develop their third report. We are really grateful to all those who work or volunteer in the palliative care and end-of-life sector for the care and support that they provide to patients, families and loved ones at a time when they need it the most. As my hon. Friend the Member for Cannock Chase (Josh Newbury) said, everyone deserves a good death.
I commend the shadow Secretary of State for his contribution regarding his excellent experience in the sector; he made some really valuable comments. I have talked about this before, but I too come to this debate with experience. In 2008, I worked with clinicians around end of life and how to live and die with chronic obstructive pulmonary disease—a really unpleasant disease, if there is such a thing as a pleasant disease. I was made aware that people were talking about how to live with it, but no one was really responsible for working with patients and families on how to die with COPD.
I learned a lot about how we talk about death and dying in the health service and the care service, as well as the great work that our trainers and people do to support our clinicians about how best to die. That was really valuable for me when my own father died at home in 2010, supported by Macmillan and a fantastic community care team, which happened partly due to the training that I had and how I was able to articulate on behalf of my family. Things should not have to be like they are. That was 16 years ago, and it is really concerning that across the country people are still experiencing such poor care.
I see lots of that good care in my own local hospital, St Peter’s, which is doing some of the innovation that the shadow Secretary of State mentioned.
I want to reassure colleagues that the Government and my hon. Friend the Minister for Care, who leads on this work, are absolutely committed to creating a society in which everyone receives high-quality, compassionate care from diagnosis through to the end of life.
We have heard a lot about the role of hospices today, from my hon. Friends the Members for York Central, for St Helens South and Whiston (Ms Rimmer), for Birmingham Erdington (Paulette Hamilton), for Beckenham and Penge (Liam Conlon), for Cannock Chase, for West Dunbartonshire (Douglas McAllister) and for Bury St Edmunds and Stowmarket (Peter Prinsley), and from shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew). Although we recognise that the majority of palliative and end-of-life care is provided by NHS staff and services, we absolutely recognise that many hospitals do fantastic work in this area, and they face a challenging financial situation due to a range of pressures.
That is why last year we announced that we would support the sector with a record £125 million capital funding boost for those hospitals in England, to help them to provide the best physical environment for the people they care for. That money can be spent on fixing a roof, paying for double glazing or buying a new boiler. Although I take the shadow Secretary of State’s point that sometimes people are more willing to contribute to those sorts of things, I know too that finding the money to fund such repairs is what keeps those running the system awake at night, and this work also saves money in the long run, particularly on energy bills. The full £125 million has now been allocated to 158 eligible hospices by Hospice UK. My hon. Friend the Minister for Care has been touring the country to visit many of those hospices to see at first hand some of the good that the money is doing.
On top of that, we are providing around £80 million in revenue funding for children and young people’s hospitals over the next three years, as been said, giving them the stability they need to plan ahead—that was welcomed by the right hon. Member for New Forest East (Sir Julian Lewis). To reassure him, we absolutely recognise the different needs of children and their families in this work. A long-term commitment was a key demand from the sector, which faces a cliff edge in funding cycles every year. Children and young people’s hospices and integrated care boards have been informed of their allocations for the next financial year, and we intend to let hospices know about funding for future years once the process is complete.
We absolutely recognise that this money will not be a silver bullet, and many hospices still face pressing challenges. The need for palliative care and end-of-life care is also projected to rise in coming years with our ageing population, as we have heard. However, although around 75% to 90% of those at end of life would benefit from palliative care and end-of-life care support, only about 55% are identified as such in primary care. That is why NHS England recently wrote to all ICBs requesting an immediate update on the financial stability of hospices in their footprint and the steps needed to mitigate those risks. That will give us a clear national picture of any hospitals at risk of closure or significant service reductions and the potential impact on patients’ families and the wider urgent care system.
With regard to the wider system, neighbourhood health services and their development sit at the heart of our 10-year plan. We are building a service that will deliver more personalised care closer to where people live, empower people to lead healthier, independent lives where they can, and give them a genuine choice about how to access support. I want to reassure hon. Members that the NHS medium-term planning guidance identifies those at the end of life as a high-priority cohort in the implementation of neighbourhood health. I also say to my hon. Friend the Member for Newcastle upon Tyne East and Wallsend (Mary Glindon) that the workforce plan, when it comes forward, will reflect the move into neighbourhood services.
We have to move away from disjointed pathways, as my hon. Friend the Member for Worcester (Tom Collins) articulated so well in speaking about his terrible experience with his mother, and ensure a paradigm shift that looks at people holistically throughout the pathway, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said.
I am the Minister responsible for reforms to the system architecture, and we are asking ICBs to do more. NHS England’s strategic commissioning framework makes it clear that we expect them to commission services in line with the current and future needs of the people they serve. We are moving away from ringfenced incentive budgets, and streamlining the incentives to focus more on the outcomes that we should all expect from our systems. Via the model ICB blueprint, we have made it clear that it is the mission of ICBs to reduce inequalities through a careful assessment of the quality, performance and productivity of existing provision. As we heard in today’s debate, we have to ensure that there are high standards and focused objectives. Next month, ICBs and NHS providers will create a new plan to more effectively manage the needs of high-priority people. NHS England is supporting commissioners to understand those needs, with a dashboard that brings together all relevant local data in one place.
There is currently a contracting mix in the sector, as we have heard today. When we support ICBs to commission more strategically, we have to start moving away from the grant and block contract models. That is why the Government are developing a landmark palliative care and end-of-life modern service framework, or MSF, for England. Palliative and end-of-life care has been variable across the country for far too long, but the modern service framework will put a floor under the kind of care that patients can expect, as we heard from my hon. Friend the Member for City of Durham (Mary Kelly Foy). Although it would not be right to pre-empt exactly what will be in the final MSF at this time, we are working closely with all stakeholders to ensure that everyone has access to the care they need in the right place and at the right time. As part of the MSF, we have invited colleagues from a number of organisations to engage with us.
Ben Coleman
Can the Minister confirm that the MSF will include targeted support for children who require palliative care?
Karin Smyth
My hon. Friend pre-empts my next paragraph; I thank him for his contribution.
As part of the development of the MSF, we will be looking at some of the important aspects of care that my hon. Friend the Member for York Central mentioned, such as early identification of need, care delivered closer to home by integrated generalist and specialist teams, and strengthened out-of-hours community health support, including a dedicated phone line. I assure the right hon. Member for New Forest East that children, parents and carers will be included in that endeavour. As my hon. Friend the Member for Chelsea and Fulham (Ben Coleman) said, the experiences of people like Amy inform such work. Let me say to my hon. Friend the Member for Alloa and Grangemouth (Brian Leishman) that the experience of Calum and the Turner family must not be repeated.
Hospices do an amazing job for people at the end of life, those with life-limiting conditions, and the whole community of family and friends who support their loved ones on that journey, including through bereavement support, as we have talked about today. The quality of care, the compassion and the love that hospices provide are second to none. We absolutely recognise that the sector faces challenges, and we are determined to work with all our partners to understand those challenges. We are not talking about spending more; we are talking about focusing on the money we have at the moment and spending it better. We are developing a values-based, outcome-focused financial model to reflect people’s experience of care throughout their lifetime. While there are no easy answers, we are supporting them with record funding and reform.
Rachael Maskell
I am grateful to the Minister for her speech, but we have heard throughout the debate that 100,000 people are not getting the care they need. One in three people needs additional support. By maintaining the financial cap, how are we going to build enough capacity to ensure that everybody has access to excellent care at the end of life?
Karin Smyth
I thank my hon. Friend for her contribution. This issue warrants a longer debate, so that we can understand how to move the resources that exist. As we have heard this afternoon, when people are unnecessarily admitted to hospital, which is terribly distressing for them and their families, the resources follow them. It is about moving those resources towards neighbourhood health services, in which this cohort of people will be absolutely central, as I have said. That is what we need to be doing, and we will continue to discuss this with people as we move the service towards being community-based.
Colleagues are right to champion their cause in the House today, and we will continue to work on this issue to make sure that people have good-quality care across the country. Given the measures I have outlined this afternoon, I hope Members will agree that we are listening. We look forward to working with colleagues to make sure that we develop these services for the future.
Madam Deputy Speaker (Ms Nusrat Ghani)
The Minister has finished speaking, but the hon. Member does get to wind up the debate.
Rachael Maskell
I thank all hon. Members for their contributions. We have had 20 contributions to the debate, with 12 excellent speeches from Back Benchers; I have to say that it has been a debate of the highest calibre. I heard so clearly such praise for the staff working in palliative medicine right across the country—in Scotland and in England—and I thank them myself, too.
I particularly acknowledge the speeches made by my hon. Friends the Members for Worcester (Tom Collins) and for St Helens South and Whiston (Ms Rimmer), who talked about the loss of their mothers, with very contrasting experiences. That demonstrates the inequity across palliative medicine, and it cannot be right that people are not getting the care that they absolutely must get.
I wanted to ask the Minister a follow-up question about how the transition takes place. If we do not frontload the funding, we will never see the development of community provision, because we will not be able to pull people out without the resourcing in the community. The challenge really arises from the whole model, which was the emphasis of my speech. I trust we will look very carefully at enabling the flow of patients into the community and getting care in the right place, but also at the sufficiency of funding, as so many hon. Members said, to ensure the excellence of the care itself.
We also heard about the challenges that all hon. Members have had, whether for child or adult services, and we need to ensure that we train the workforce and have a sufficient workforce in the future. We need to get the commissioning right, and address those very pertinent issues. Above all, we must invest in the time and the compassion that is needed to give families and patients excellence in palliative care. As a clinician, I have witnessed working with people at the end of life. In such special moments, the whole workforce crowds around the patients, and supports them and their families. It is so moving, and today I also heard my hon. Friends’ moving reflections, which is what the debate is all about. It is about ensuring that we have those really special moments at the end of life, and we should really invest in that time so people can have those memories and cherish everything they possibly can.
We have debated assisted dying so much in this place over the last year or so. I have heard so many examples of poor care, where I know that specialist palliative medicine could have made such a difference to the individuals. That is why today’s debate is not only timely, but necessary. We must really invest so that everyone has the opportunity to receive that amazing care, love and support at the end of life, and so they do not have to even contemplate assisted dying. I think we have a responsibility to put this front and centre. Let us move on from the debate on assisted dying to make sure we get care right for everyone.
I want to close by saying a huge thank you to everyone here; I really do appreciate it. I should put on record that I am the co-chair, with Baroness Finlay, of the all-party parliamentary group on dying well. I invite all hon. Members to join us as we really try to advance this debate.
Question put and agreed to.
Resolved,
That this House notes the findings of the Independent Palliative Care Commission; calls on the Government to implement its recommendations in full, including to establish a comprehensive and specialist palliative care service that is equally accessible to everyone and properly funded, as well as a new commissioning framework that secures a service across all settings and is available from the point of a terminal diagnosis, the advancement of a life-limiting illness or latter stages of a chronic condition; and further calls on the Government to have a focus on workforce planning and training, to provide a comprehensive palliative care service, and to ensure that patients are empowered through future care plans to articulate what they want to happen towards the end of their life, while also establishing bereavement services for all.