Commons Chamber

Thursday 5th March 2026

(began 3 weeks, 1 day ago)

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13:44
Nusrat Ghani Portrait Ms Nusrat Ghani MP (Sussex Weald, Conservative)
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I thank the Member for giving notice of that point of order, and I can confirm that I have not been given notice of a further statement by the government. It is a case that major policy announcements should be made to the House first. And this is something that Mr. Speaker has frequently reiterated. There has been a written ministerial statement today, but I am sure the Treasury frontbenchers will have heard the feedback about members having a chance to scrutinise the table, or general officers may be able to advise on opportunities for that in respect of the Statutory Instruments mentioned in that statement, I can see the frontbenchers nodding affirmatively.

I let the Ministers affirmatively. I let the Ministers shuffle over. Edition of Bill

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Darren Jones. Ministerial Salaries (Amendment) Bill Second Reading. What day? Monday the 9th of March.

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Monday the 9th of March.

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Monday the 9th of March. The clerk will now proceed to read the orders of the day. Supply and appropriation,

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Supply and appropriation, anticipation and adjustments. Number two, Bill Second Reading. Now.

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Now. Minister, to move formally. Formally. The question is that the bill be now read a second time has made that opinion say I. I Of the contrary, no. the ayes have it. The ayes have it. The question is that the bill be. Now read a third time as meaning that opinion say I. I of the contrary, no. I think the ayes have it, the ayes have it. Our frontbenchers shuffling again. Mr. Steinbach, if you're ready, we will continue.

Lovely. We now come to the backbench debate on the contributions of Commonwealth contributions of Commonwealth troops in the First World War. I call Jas Athwal, who will speak for up to 15 minutes. Jas Athwal.
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14:06
Rebecca Smith Portrait Rebecca Smith MP (South West Devon, Conservative)
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Lemoore and subsequently buried in the Methodist graveyard there? It's a tiny village up around the China Clay works. It's pretty bleak, but that is where he was born and raised and where he was ultimately buried. Now he joined the Australian Munitions Workers. Having gone out to Australia as a British man in his early 20s. But then he came back towards the end of the war, serving in munitions to ensure that we had enough equipment to fight the war. And he only came in the beginning of 1918, but sadly by the end of the year had died of pneumonia.

But because he was already here in the UK doing that work, he was able to be buried close to home with what would be called a private memorial. So he doesn't have a headstone. His family put their own headstone in place for him, but ultimately those munitions workers came because they were offered a freebie. Effectively, they came over here to work to provide that service. But are a key part of those at the commission commemorate both here in the UK and abroad. Now, James Wilson, from an equally small part of my constituency, Yelverton on Dartmoor, and anybody who is watching this speech will know the Devon Towers Hotel, which is a key landmark on a big roundabout in Yelverton.

And that was what his father ran as a boarding house. He too went to Australia. Madam Deputy Speaker, and was a single farmer in 1915 when he enlisted, and he served with the Australian Imperial Forces, and he came over here, served in France, but sadly died just after the war, again of influenza and pneumonia, and was buried in a tiny village of Meavy on Dartmoor. Now he links very briefly to my favourite grave. Not something I ever thought I would say, but when you work for the commission, that becomes what you talk about with a man called Charles Allen, who was also Australian.

And he is unique because I believe he is the only grave that is in the UK with his photograph on it now. He was killed in 1917. He was a very handsome man and his granite stone cross in Efford Cemetery has a little enamel plate with his photograph on it. We're doing tours of that cemetery serves to show you just quite who these young men were that lost their lives. Now again, he came to the UK to do his basic training as a as an Australian, but sadly died of illness before he'd even started.

Furthermore, we have an a South African Labour Corps buried in Wembley, probably the most picturesque location for a headstone overlooking the south Devon coast. And then finally, Madam Deputy Speaker, I just want to speak of one family, the Tuckers of Yealmpton three brothers, all killed between the 12th of March 1917 and the 10th of August 1918, commemorated in Tyne Cot and in two French cemeteries as well, one missing. We do not know where he is buried. His brothers have graves, but all are then commemorated by the family back home in Devon.

A further Tucker not related, born in South Africa but also commemorated in my constituency in Plymouth, who died at the age of 33. He is buried in Plympton. Now. Why is this important? We keep their stories alive. It's more pertinent now more than ever. And just to flag, we've got war graves week from the 16th to the 24th of May, so there's plenty of opportunity for members to show their appreciation for the work of the commission.
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Yasmin Qureshi Portrait Yasmin Qureshi MP (Bolton South and Walkden, Labour)
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Yes. Thank you, Madam Deputy >> Yes. Thank you, Madam Deputy Speaker. And can I congratulate the hon. Gentleman for Ilford South for hon. Gentleman for Ilford South for getting this important debate? I think it's important that we recognise the contribution of the recognise the contribution of the Commonwealth troops in the first and the Second World War. When we remember the World Wars, we rightly honour the bravery of British servicemen and women. But Britain did not fight these wars alone.

Millions of men and women across the Commonwealth stood alongside British forces and played a decisive role in defending freedom in Europe and beyond. More than 1.3 million soldiers from the Indian subcontinent served in the First World War. They fought in some of the most brutal theatres of conflict, including the Western Front, Gallipoli and the Middle East. It is important to remember that what was known then as British India included regions that today form India, Pakistan and Bangladesh. Many of these soldiers who fought for Britain came from areas that are now part of Pakistan.

Among those who served a vast number of Muslim soldiers. In fact, historians estimate that millions of Muslim soldiers and labourers fought for the Allied forces during the two. During the second the two World Wars, at least 2.5 million Muslim contributed in the First World War, an estimated to 5.5 million during the Second World War. Across both conflicts, nearly 1.5 million Muslims are believed to have been killed in action. These men travelled thousands of miles from their homes to fight in conflicts that were not of their making, and Muslim soldiers fought in the trenches of northern France and Belgium, endured the freezing conditions of European winters, and served across battlefields stretching from Europe to North Africa and the Middle East.

Many fought alongside soldiers of other faiths, sharing food, hardship and danger. There are records of Muslim, Christian and Jewish soldiers learning each other's burial rites so that the fallen could be laid to rest with dignity on the battlefield. One lady, who often people forget about a woman called Noah Law Naz Shah Inayat Khan, who was a British Muslim woman who was the first wireless operator sent into occupied France. She was betrayed, but then arrested and tortured for months and then executed at the concentration camp.

She was given a George Cross posthumously as well. And yet, despite such enormous sacrifices, the contribution of Muslim soldiers remain largely absent from our national memory. At a time when we think increasing divisions in our society and in particular the demonising of Muslims in part of our political discourse and media, and some very senior politicians who should be absolutely ashamed of themselves. Too often, Muslims in Britain are portrayed as outsiders or as somehow disconnected from the history of this country.

But the truth is different. Muslims were in the trenches of the First World War. They were they in the forces that fought fascism during the Second World War. They served in the merchant navy, in Labour corps and across battlefield around the world. Many of them never returned home. we all benefit from. Today in my constituency Bolton South and Walkden many families trace their heritage to the Indian subcontinent, including Pakistan. For many of them, the history of Commonwealth soldiers is not a distant history.

It's part of their own family stories. For example, my paternal grandfather fought in the war and my maternal uncle had a king's commission when at the time, most people from the Indian subcontinent had the Viceroy's commission. And that's why we have a sense of belonging to this country. And
14:25
Martin Rhodes Portrait Martin Rhodes MP (Glasgow North, Labour)
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engage with this history. More recently, Colourful Heritage with partners has been granted planning permission to establish Scotland's first permanent memorial to the British Indian Army in the grounds of Kelvingrove. The design was agreed upon after consultation with community and faith groups, as well as pupils across a number of schools in Scotland. It reflects the diversity of those who served Hindus, Muslims, Sikhs, Christians and those of no religious faith faith. Thus far they have raised over £100,000, with the aim of raising a total of £270,000 to complete the memorial.

I am sure that members across the House will wish them well in achieving this important goal. As we reflect today on the contribution of Commonwealth soldiers to the First World War, our understanding of this deepens over time as new stories come to light and previously overlooked service is properly recognised. I will give way.

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I thank the hon. Member for giving way and he is making a very powerful speech. Would he agree with me that this is where the role with me that this is where the role of the Commonwealth War Graves Commission, and particularly their public engagement co-ordinators, is so important to go out and tell so important to go out and tell those stories because actually we have graves right around the country of Indian and Muslim, Hindu, Sikhs, service personnel, but Sikhs, service personnel, but actually ensuring that communities understand that they are in our midst is very important.

As is midst is very important. As is highlighting the Neuve-chapelle Memorial to the Indians on the Western Front as well. Martin Rhodes.

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Thank the hon. Member for that intervention. I do very much recognise the important work of the Commonwealth War Graves Commission Commonwealth War Graves Commission and also their outreach work, their public engagement work and also recognise the huge contribution of recognise the huge contribution of volunteers and in service of actually promoting that work, how we commemorate and who we we commemorate and who we commemorate must reflect the full breadth of those who served and sacrificed. I hope that the first permanent memorials of British permanent memorials of British Indian Army, on the grounds of Kelvingrove, will be a testament to that.

Madam Deputy Speaker, we must remember our shared past if we are

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to help build our shared future. I come to the Liberal Democrat spokesperson Monica Harding.

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Thank you, Madam Deputy Speaker, and I want to thank the hon. Member for Ilford South for securing this very important debate. And I, like very important debate. And I, like him, want to start by sharing the story of Khudadad Khan for his extraordinary courage, holding off wave after wave of German infantry. In 1914, he became the first soldier of Indian origin to receive the Victoria Cross. Yet what makes his story even more remarkable is the moment in which it occurred.

In
14:27
Monica Harding Portrait Monica Harding MP (Esher and Walton, Liberal Democrat)
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late 1914, the British Expeditionary Force had lost around 70% of its original strength. 70% of its original strength. Germany's armies were pushing through the channel ports. Had they broken through, the war could very broken through, the war could very well have been lost in its first month, and the mainland Europe would have likely fallen under the would have likely fallen under the domination of Imperial Germany. But the line held and the line held, in the line held and the line held, in part because 45,000 soldiers from India arrived on the Western Front just in time.

They had travelled thousands of miles from the subcontinent. Many arrived still wearing cotton uniforms designed for the heat of the Indian frontier, when they were suddenly thrown into the freezing mud of Flanders. They had never seen trench warfare before. They faced artillery barrages, barbed wire, machine guns and the bitter and unfamiliar cold of a Belgian winter. Yet they stood firm. And that moment tells us something fundamental about the First World War, because the story of that war is not simply a British story, it is a Commonwealth story.

Over 3 million soldiers and labourers from across the Empire fought alongside Britain in the First World War. The war memorials in my own constituency of Esher and Walton bear testament to a generation who fought not alone, but soldiers shoulder to shoulder with men and women from across the Commonwealth. And the numbers alone are staggering. More than 1.4 million came from India, nearly 630,000 from Canada, over 400,000 from Australia, almost 130,000 from New Zealand, and many thousands from the West Indies, Africa, Fiji and beyond.

And over a half a million Commonwealth soldiers lost their lives. This was not a marginal contribution. It was decisive and it altered the course of the war. Because Britain entered the war in 1914 with a relatively small professional army, around 700,000 trained soldiers in total, including reservists and territorials, and set against the vast conscript armies of the Central Powers, particularly Germany and Austria-Hungary. This force was tiny. Without reinforcements from across the Empire, Britain could not have sustained the war effort, and the wartime Prime Minister, David Lloyd George, put it clearly.

He said had they stayed at home, the issue of the war would have been very different and the history of the war would have taken a different course. We often hear that the arrival of the United States in 1917 tipped the balance of the war, and there is truth in that claim. But there is also a powerful argument that without the Commonwealth's contribution, the war might not have lasted long enough for the Americans to arrive at all. I will give way.

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I thank the hon. Member for giving way, and I was just wondering whether she would also agree with me that there was a significant contribution made by the 140,000 Chinese Labour Corps, ironically enough, who came over from 1916 to also bolster well, to from 1916 to also bolster well, to actually do a lot of the work on the front that then freed up the

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soldiers to be doing the fighting. Monica Harding member is entirely right, and it's something. I'll come back to you later. The I'll come back to you later. The forgotten stories of this war. So from the mud of Flanders to the deserts of the Middle East, from the jungles of East Africa to the mountains of the Balkans, Commonwealth soldiers were present in almost every theatre of the conflict, and the bravery and resilience too often forgotten. Overlooked was one of the most notable features of the conflict.

Canadian troops face chlorine gas for the first time at the Second Battle of Ypres in 1915, holding the line at Vimy Ridge. In 1917, four Canadian divisions fought together as one for the first time, and in just four days they achieved what the French and British had spent years and over 100,000 lives bravely failing to do, and this courage was not confined to the trenches in the skies above Europe. Canadian airmen distinguished themselves with equal daring. Fighter aces such as Billy Bishop, awarded the Victoria Cross, played a crucial role in securing Allied control of the air.

Australian troops bravely fought for eight months on the steep cliffs of Gallipoli, before playing a decisive role in the final offensives of 1918 and New Zealand, with a population of nearly 1 million people at that time, spent more than 120,000 soldiers overseas, and nearly 1 in 5 of them never returned. And here I want to turn to my own constituency of Esher and Walton, and it has a profound historical connection to New Zealand, dating back to the First World War. During the conflict, Walton served as a major centre for treating injured soldiers from the New Zealand Expeditionary Force, particularly those wounded in the Gallipoli Campaign, and the Mount Felix Mansion was converted into the first New Zealand hospital in the UK.

27,000 New Zealand soldiers were treated there. 21 New Zealand soldiers are buried in Saint Mary's churchyard in Walton, and we remember that in our roads, New Zealand Avenue runs through the middle of Walton and Adelaide Avenue is there too. And since 1920 an annual Anzac Day service is held at Saint Mary's Church. The Mount Felix Tapestry features the soldiers at the hospital and a tree donated by the New Zealand government in 1970 stands at the former site of the hospital.

So my brilliant constituents Esher and Walton ensure that the sacrifice of those from New Zealand who served in the Great War is remembered. If I could come back to soldiers from the Caribbean that served in the British West Indies Regiment operating across Europe, Africa and the Middle East, many of these were denied the chance by the British government to fight as equals. Instead, they were often assigned labour duties digging trenches, unloading ships, carrying supplies, and despite that discrimination, they served with courage and dignity, and African soldiers and porters were indispensable to the campaigns across the continent, carrying ammunition and supplies through terrain that would have stopped any conventional army.

They suffered catastrophic losses, but they were the logistical backbone of the campaign, and one of their story remains one of the least known chapters of the war. Women across the Commonwealth, as well, were also vital to the British war effort, serving as nurses, driving ambulances, working in munition factories, and keeping farms and industries running. And in many schools. Our students still learn about the Somme, about Passchendaele, about the Western Front, but hear very little about the role played by Indian and African, Caribbean, Australian, Canadian and Chinese forces.

And as Baroness Warsi actually powerfully put it, she said our boys weren't just Tommies, they were tariffs and genders too. So when we speak of those who served in the First World War, we're speaking about people from every corner of what was then the British Empire, people who crossed oceans to fight for a country they had never seen, people who fought in climates and conditions utterly alien to them. People who believe that they were fighting for principles, freedom, justice, and the defence of small nations.

And yet the response of the British government in the immediate aftermath often fell far short of the ideals which these men believed they had fought for. West Indian soldiers were excluded from the London victory parade in India. Promises of reform were made in return for wartime loyalty were followed by the brutality of the Amritsar massacre. The First World War did not just reshape Europe, it reshaped the political map of the world and the modern Commonwealth and the family of nations it represents today has its roots in the sacrifices made during that war.

Which brings us to the present. We must honour the shared history that binds us to the Commonwealth. So let us ensure that their contributions are fully recognised. Their services must be fully integrated into our national commemorations, their stories taught in schools so that young people understand that the First World War was not fought by Britain alone. We must hold the vital work of organisations such as the Commonwealth War Graves Commission and their volunteers, whose quiet dedication ensures that the name of the fallen, regardless of their nationality, faith or background, are remembered with dignity and that we fought alongside a brave coalition of nations and peoples of millions of individuals whose courage, labour and sacrifice made victory possible, who fought in the mud of Belgium, the deserts of Palestine, the mountains of Greece and the jungles of East Africa, and many of them, tragically, who never came home.

They were asked to fight and sometimes to die for a country they had never seen. Let us, a century later remember why they came and the bravery with which they fought, not as a footnote to history, but as an essential part of the story of how that tragic war was fought and won.
14:36
Mark Francois Portrait Rt Hon Mark Francois MP (Rayleigh and Wickford, Conservative)
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I call the shadow Minister, Mark Francois.

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Much, Madam Deputy Speaker. As the son of a man who fought in the the son of a man who fought in the Second World War, I'm privileged to be able to sum up on behalf of Her Majesty's loyal opposition in this debate about those who fell in the first, and in particularly the first, and in particularly the vital contribution that was made by Commonwealth troops during that Commonwealth troops during that epic conflict. It turned out to be a manpower intensive conflict in which the contribution of Commonwealth troops was invaluable.

The National Army Museum at Chelsea estimates that over 3 million soldiers and labourers from across what was then the British Empire, and today the Commonwealth, served alongside the British Army in multiple theatres of operations during the First World War. We've heard a number of erudite and touching tributes from hon. Members to that effect this afternoon, and perhaps I could just refer to a few of them. But before I do, there is one other important point I want to one other important point I want to make.

Where are reform? Where when we debate the contribution of people from all nations, of all colours, of all cultures, made a hundred years or more ago to defending the freedom of what was then the Empire, and is now the Commonwealth. Why is that bench yet again empty? When we debate defence related matters, if these plastic patriots who love to wrap themselves in the flag aspire to be a party of government, let them at least come to this House and behave like it.

Turning to the speeches, may I commend the hon. Member for Ilford South for securing this debate. And then, if I may say so, for introducing it so brilliantly, he spoke memorably about the extraordinary contribution of the Indian army, Hindu, Muslim and Sikh all joined together as one army fighting for freedom against tyranny, he said. Honour transcends borders. He was right. He was followed by my hon. Friend from South West Devon, who spoke very knowledgeable about the vital work of the Commonwealth War Graves Commission, not least because she worked for it and she highlighted their marvellous endeavours to commemorate the sacrifice that were made in defence of freedom.

On behalf of my party this afternoon, I would like to commend the Commonwealth War Graves Commission for everything that they do. The Member for Bolton South and Walkden also spoke powerfully about the contribution of the Indian Army, especially its Muslim regiments. The Member for Leicester South followed her in a similar vein and spoke in particular about the Sikh regiments who have a proud martial tradition in British service, not least in the First World War. The Member for Alloa and Grangemouth made a a very socialist contribution, if I might say so, and but he also paid tribute to those who served.

The Member for Glasgow North also paid a fulsome tribute to Commonwealth troops and the Liberal Democrat spokesman on member for Esher and Walton reminded us that after the regular, the largely regular British Expeditionary Force was wiped out holding the line in 1914, it was eventually citizens armies, including from the Commonwealth, who replaced them to win the war. As there were multiple contributions from across the Empire and the Commonwealth during the First World War, it would be invidious to attempt to highlight any one in particular as more important than the others.

Perhaps a better way of doing it is for me to attempt to summarise very briefly, in the few minutes I have, to cover a war that lasted four years, some of the particular national contributions to the wider war effort. So to begin with, the Canadians. Following the outbreak of the war, Canada established the Canadian Expeditionary Force, the CEF, principally for service on the Western Front. The Canadians fought in many of the major battles in that theatre, including second EP, The Somme, Vimy Ridge and Passchendaele.

In so doing, they were also supported by troops from Newfoundland, although that did not formally become part of Canada until after the Second World War. But the Newfoundland Regiment also fought at Gallipoli and then on the Western Front, including in the so-called Last Hundred Days when the Allied armies, the British Army in particular, but also with Commonwealth support, broke the back of the German Army in the field. This victory, fully utilising the principle of combined operations including infantry, artillery, tanks and aircraft working in concert, is one that should not be underestimated and is often highlighted by military historians as a significant feat of arms, completely contrary to what might be called the Blackadder version of the history of the First World War.

I see the Minister is nodding in a sense, then the Australians, who also made a major contribution to the First World War, in which over 400,000 Australians served in what was known as the Australian Imperial Force, the AIF. Over half of them became casualties, either killed or wounded. Perhaps the most famous Australian contribution, combined with their comrades from New Zealand, was in the ill fated campaign at Gallipoli in 1915, when the Australian and New Zealand troops, now forever known as the Anzacs, suffered heavy, very heavy casualties attempting to overcome the extremely well dug in Turkish defences on the peninsula.

Nevertheless, it is also important to record that Anzac troops also served bravely in other theatres of war, not least in the Middle East and also on the Western Front. India, to whom many members have already referred. This afternoon, may the largest contribution from the Commonwealth, particularly if we include those from what is now modern day Bangladesh and Pakistan, who in total contributed, I think, over a million troops over the total course of the First World War. I should declare an interest here.

Madam Deputy Speaker as my great grandfather in law, Colonel William Saunders, served as part of the Indian Army and at one time commanded a battery of artillery towed by elephants. Before he did, before transferring to the Royal Garrison Artillery on the Western Front, and, if I may say so, winning a DSO at the battle of Saint-Quentin, something about which the family obviously very proud. But the Indian army of today, and indeed its Bangladeshi and Pakistani counterparts, still maintain proud regimental histories that date back to their actions in the First World War.

South African regiments also made an important contribution to the Allied war effort, including the first South African Brigade, who famously fought at Delville Wood, which the troops abbreviated to the Devil's Wood on the Somme and given what they went through, that was probably appropriate. Although the South Africans did not just fight on the Western Front, but also against German troops on the African continent itself, including in both East and South West Africa. It's also important to record the contribution of some 600,000 60,000 black South Africans who served mainly in support and logistical roles, rather than as front line infantry, but who nevertheless made a very important contribution to the Allied war effort, as indeed

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was recognised by General Jan Smuts. Briefly, yes, yes. Just on that point around the South African regiments, does he South African regiments, does he agree with me that it's vital that the Commonwealth War Graves Commission continues its work to honour those labourers, which it honour those labourers, which it has done with the opening of a memorial recently in Cape Town, one soon in Kenya and Sierra Leone, and a commitment to do whatever it a commitment to do whatever it takes to ensure that those African labourers that have not yet been commemorated are in the future.



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commemorated are in the future. My hon. Friend is clearly a subject matter expert on this matter, but I entirely agree with her sentiment, both about the contribution of those South African labourers, but also about the vital work of the Commonwealth War Graves Commission. But it's also important to commemorate the contribution of Caribbean troops to the Allied war effort, most of whom served in the West Indies Regiment, as we've heard, which saw combat in France, Italy, Africa and the Middle East, and as indeed particularly pointed out by the hon.

Member for Esher and Walton, I believe, albeit from a different conflict. Madam Deputy company of HMS Victory at Trafalgar recalled the presence of a seaman whose name was John Francois. He was on victory, but I do not believe he was a direct relative, as he was recruited from the Caribbean. Nonetheless, I can assure the House that there was at least one Francois at Trafalgar, who served on the British side. In summary, in the very limited time available this afternoon, Madam Deputy Speaker, I've only been able to refer in the briefest outline to the contribution of troops from across the British Empire and the Commonwealth to what was believed at that time, at least, to be the war to end all wars.

Unfortunately, that proved not to be the case, and the world was involved in a second major conflagration barely two decades later. Let us passionately hope that in our lifetimes, and indeed those of our children and grandchildren, we never see a third. Although I would say humbly to the hon. Member for Alloa and Grangemouth, as the Roman military theorist Vegetius taught us civis pacem, para bellum, he who desires peace should prepare for war in order to deter it. In thinking how to conclude, I came upon some lines from Rupert Brooke in his eternal poem, The Soldier.

He wrote, if I should die, think only this of me, that there's some corner of a foreign field that is forever England. Well, if that be so, and I believe it to be so, then there's also a part of a neighbouring field. Which is forever Canadian, Australian, New Zealander, South African, Indian, Bangladeshi, Pakistani, African and Caribbean. Two without the contribution of all those nations from right across what was then the Empire and is now the Commonwealth, we would never have defeated the militarism of the Kaiser's.

Germany and Europe undoubtedly would never have been free. We thank them all and their nations for their service, lest we forget.
14:48
Al Carns Portrait Al Carns MP, Parliamentary Under-Secretary (Ministry of Defence) (Minister for Veterans) (Birmingham Selly Oak, Labour)
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Wow, father, that Minister Al >> Wow, father, that Minister Al Carns. Hey! >> Well, deputy Madam Speaker, I'm

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Well, deputy Madam Speaker, I'm grateful to my hon. Friend the Member for Ilford South for securing what is a very, very important debate at a very important debate at a very important time. And to all the honourable and right hon. Members for their cultural contributions and importantly, the spirit of the House in taking this debate forward. The role played by Commonwealth forces in the First World War is pivotal. Indeed, it's legendary and all too often overlooked chapter of our nation's history, and I am grateful to my hon.

Friend, that this debate will help us tell that story to this generation. It is a contribution, etched in stone in the heart of London, on the memorial gates on Constitution Hill, inscribed in memory of the 5 million volunteers from the Indian subcontinent, Africa and the Caribbean who fought with Britain in two world wars, it is a fitting fought in World War One, from the Indian subcontinent, from Canada, Australia, New Zealand, from Africa and as far as the Caribbean.

I mentioned.

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Commemorating those in London as well, and I've had the pleasure of well, and I've had the pleasure of in my part of south east London in Beckenham and Penge going to see going with the Commonwealth War going with the Commonwealth War Graves Commission to look at graves that they maintain. Does he agree with me? They play a vital role not only in maintaining and

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only in maintaining and commemorating those who have fallen, but also educating children and young people today about the contributions they made. OK.

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OK. I completely agree with the hon. Friend, the maintain and look after thousands of memorials all over the world, which helps us to continue to communicate and educate this important lesson. It is a memorial in London that commemorates the campaigns they fought campaigns in the Western Front in Gallipoli, Russia, the Middle East and Africa. Indeed, every major theatre of the conflict. And it's a memorial that rightly immortalises Commonwealth recipients of the Victoria Crosses during the Great War, including brave men like Khudadad Khan, mentioned earlier, a courageous soldier in the British Indian Army who single handedly held back the enemy to enable reinforcements to arrive.

The first non-British recipient of our highest military honour during the First World War. Of the 1 million people under British command killed during the First World War, nearly a quarter a colleagues and friends, I have some ideas of the sacrifice they loyally made, but not in any way, shape or form. At the scale, over 74,000 people came from India, 65,000 from Canada, more than 62,000 from Australia, 18,000 from New Zealand and nearly 12,000 from South Africa. Their names are recorded by the Commonwealth War Graves Commission across the cemeteries and memorials on every continent, with dedicated memorials inaugurated or under construction in Cape Town, in Nairobi and Freetown in Sierra Leone, Commonwealth forces are honoured prominently during remembrance, with Commonwealth High Commissioners playing a high profile role in commemorations at the cenotaph.

But we must do more. Indeed, today we remember their service and their sacrifice and I am delighted their legacy lives on in our armed forces. Turning to some of the comments made in the House, Madam Deputy Speaker, the hon. Friend from Ilford South made some really poignant remarks. Different languages, different cultures and different faiths came together to fight for a common good, demonstrating incredible honour, unbelievable duty and outstanding courage. And I think the key lesson from that was that it doesn't matter where you come from, your religion, your race, they were united in a common cause.

The hon. Member from South West Devon was right to point out the outstanding work that the Commonwealth, Commonwealth War Graves Commission does, and I commend her for her support to it in the past. And on going. It commemorates 1.7 million casualties across the globe, and even right now we have 5000 Commonwealth personnel serving in the British military. Our hon. Friend from Bolton, South, Walton, the story about a wireless operator deployed behind enemy lines covertly inserted into France, is truly remarkable, is describing how Commonwealth forces, or forces from individuals from further afield, did every part of the operational tapestry, both in the First and Second World War, and the hon.

Friend from Leicester South highlighted our histories are entwined, but in some cases we fail to educate and communicate that in particular to the youth of the nation, and highlights the requirement. If we are to push in the same direction, we must understand our shared history and that common cause which is one of democracy, the rule of law, the right to self-determination and equal rights. The hon. Friend from Alloa and Grangemouth highlighted some interesting comments, and he mentioned war as easy to talk about.

I will tell you now that war if you've been engaged, it is not easy to talk about. And I would say that the best way to avoid conflict is to deter it. And I support the hon. Member from Rayleigh and Wickford comments that you do not deter it by not preparing for it. I try to keep politics out of this debate, but this is not about the lack of realism. This is about remembrance. The hon. Friend from Glasgow North again mentioned education, communication to bind us together to build bridges and remove the division that people are sowing within the country, to deal in unity, to deal in hope and ambition, to drive the country forward.

And I commend that narrative. The hon. Member from Esher, Walton, pointed to the staggering contributions from across the Commonwealth that I think we have heard from so many people and such a poignant thing to dwell on. And then finally, the hon. Member from Raleigh in Wickford highlighted the lack of individuals from certain parties in this House today. I'll tell you where they are. They're probably out on social media, painting the sky grey and then selling the country umbrellas.

Yeah, and I think it is an absolute travesty that they're not here today to hear about the joint history that every member has mentioned, talks about the shared sacrifice, and talks that we are seeing in Ukraine with the use of uncrewed systems, which is changing how we fight. And unfortunately, conflict tends to be the mother of invention. I think my final point would be that when individuals from the Commonwealth came to fight us from other countries, it was a huge unifying factor because bombs, bullets and battlefields do not discriminate.

They serve together, they died together. And now we must focus on how we tell the story to ensure that we live together. I'd like to close by again, expressing my gratitude to my hon. Friend for securing this debate. I am pleased we have had the chance to mark the loyalty, the courage, and indeed the sacrifice of Commonwealth soldiers during the First World War. More than a century later, their legacy still inspires many young men and women. We must do more to honour their sacrifice and indeed increase our ability to collectively recruit people into the British armed forces from all walks of life.

Indeed, as our debate has shown, their legacy continues to inspire us all. Thank you.
14:56
Jas Athwal Portrait Jas Athwal MP (Ilford South, Labour)
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Jas Athwal to wind up. and can I thank all my colleagues, friends, hon. Friends, right hon. Friends who have contributed to this debate. It's really appreciated. And certainly as I close the debate, I'd just like to make a declaration that my paternal great grandfather served in the First World War. My maternal grandfather served in the Second World War. And I just want to quote the words of General Sir Ian Hamilton, because I often remember this quote and it reminds me and I, I never met my great grandfather.

He passed away before I was born. But if I want to remember him, I want you to remember him like this. So, writing to the Commander in Chief shortly afterwards, General Sir Ian Hamilton paid noble tribute to the heroism of all ranks of the Firozpur Sikhs in the highest sense of the word. Extreme gallantry has been shown by this fine battalion. In spite of these tremendous losses, there was not a sign of wavering all day. Not an inch of ground gained was given up, and not a single straggler came back.

The ends of the enemy's trenches leading into the ravine were found to be blocked by the bodies of Sikhs, and of the enemy, who died fighting at close quarters, and the glacier slopes is thickly dotted with the bodies of these fine soldiers, all lying on their faces as they fell in their steady advance on the enemy going forward.

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Thank you. The question is, as on the Order

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The question is, as on the Order Paper, As many as of that opinion say aye. of the contrary. No, I say aye. of the contrary. No, I think the ayes have it. The ayes have it. I will allow a couple of have it. I will allow a couple of moments for the frontbenchers to
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14:59
Rachael Maskell Portrait Rachael Maskell MP (York Central, Labour )
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live on to what she called palliative total pain the physical, psychological, emotional, spiritual psychological, emotional, spiritual and social pain that palliative medicine can transform the way we medicine can transform the way we not only approach death but embrace life. Her legacy has driven palliative medicine since we have dedicated teams to deliver care, as was described to me in York, as not was described to me in York, as not knowing that such outstanding care was even possible. Every complexity embraced and addressed in 2024, 320,000 people died in England.

Two weeks ago, evidence published by Marie Curie showed 1 in 3 people fail to get the interventions. They need over 100,000 people, despite requiring specialist palliative rising and will grow by 42% in a decade. Where you die, what day or what time determines the care you receive? 42% of all deaths occur in hospital, 28% at home, 21% in care homes, 5% in hospices, and 4% in other settings like prisons. According to Sue Ryder, just 50% die at a place of their choosing.

I've had the privilege of working with leading academics and clinicians, health leaders, international experts, charities and people with lived experience in establishing the Independent Commission on Palliative and End of Life Care with Baroness Finlay, chaired by Professor Sir Mike Richards, we sought solutions to establish equitable access to high quality palliative and specialist palliative care, and I am beyond grateful. I have been inspired and I have learned much. I'm also indebted to Professor Phyllis Murtagh from the Wolfson Palliative Care Research Centre at the University of Hull, and want to pass particular mention to Professor Katherine Sleeman.

Irene Higginson of King's College London, Oxford consultant professor Be We Hospice, UK, Marie Curie, Sue Ryder, the Association of Palliative Medicine, together for Shorter Lives and my own local hospice, Saint Leonards and so many more. We held ten evidence sessions and eight roundtables. We received 506 written submissions from experts and spoke to 129 witnesses. Then presenting our report to the Minister. Now, government has progressed to the modern service framework. It must be commissioned in a single pathway across all settings focussed on excellence and crisis prevention and investing in the community.

We found early identification to access high quality specialist interventions transformative for patients at the point of terminal diagnosis or point of terminal diagnosis or increasing frailty. A serious illness conversation. As Professor Sir Chris Witty recommended, undertaken by well-trained clinicians, inject 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 and personal planning, co-produced and personal optimal care is supported with palliative medicine in York.

The Frailty Hub brings all sectors together clinicians and services when intersected with palliative when intersected with palliative care, crisis and missions are avoided. Emergency services do not escalate without cause and rather medicine integrates with the hospice at home. Team, one team, one set of records and one plan. Avoiding crisis management avoids distress in the last three months of life. However, almost half visited their emergency department and 1 in 8 spent more than 30 days in hospital placing palliative care professionals in emergency departments furthers the model to triage patients to the right service.

Clinicians at the back door discharge into the community care community palliative care teams on the wards. In hospitals, specialists connect with patients, introduce palliative care where appropriate, and seek to discharge the community to hospice or a specialist unit in the hospice. In the hospital, reducing hospital deaths and improving disease management as our bodies fail, high stakes interventions and little to the quality or quantity of life yet carry risk, as do hospital stays with infection, deconditioning and disorientation. Far from this being the Liverpool Care Pathway, palliative care focuses on enhancing life and not hastening death.

GPS have a significant role to, and I would just ask the Minister to review the retiring of the palliative care register. This focuses on identifying patients for palliation early so interventions can be considered. So can she set out how she will still achieve these 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, with conditions like dementia rarely ever referred.

While there has been a move away from prognostication on life expectancy due to its unreliability and often significant inaccuracy, recognition of palliative needs early is key. Mary Creagh 2020 for Better End of Life 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. Their report, Measuring Unmet Need for Palliative Care, highlighted how 1 in 3 people do not receive specialist care.

Their post bereavement survey in 2024 showed a doubling of unmet need compared to 2015 when the ONS survey, which
15:46
Paulette Hamilton Portrait Paulette Hamilton MP (Birmingham Erdington, Labour)
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>> Think of what. I said. Thank you, Madam Speaker. Can I take my hon. Friend up the M6 from Birmingham to Newcastle-under-Lyme and through her paid tribute to the wonderful Dougie Mac Hospice. For many years they've served people in Newcastle and Stoke on Trent and across North Staffordshire. They committed their caring, their compassionate and they deserve a shout out in this

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debate today. Can I thank my hon. Member? I am

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Can I thank my hon. Member? I am sure that every member in this room has a local hospice who they really has a local hospice who they really appreciate and they cannot do without. So thank you for giving your local hospice a shout out and your local hospice a shout out and I'm sure they'll appreciate it. Hear, hear. But, Madam Deputy Hear, hear. But, Madam Deputy Speaker, 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 of of gap filling and cake and bake sales. It cannot be sustained by charity alone. It 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 to 47%. We are heading towards a cliff edge. Yet we are funding these services as as as if they're an optional optional extra.

We must ensure that hospices receive proper reoccurring 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. Madam Deputy Speaker, we must also talk about access, just as we have seen with GP appointments, accessing hospice care is becoming harder. It if we cut beds and staff, we close the door on dignity.

This brings me to the assisted dying bill. Madam Deputy Speaker, I am concerned that it is not clear where the funding for this 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 auspices embedded not as a charity extras, but as a core partner in the NHS, funded for the long term and resourced to be there for everyone because the people of Birmingham, Erdington and across

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this country deserve to live and die with dignity. Yeah yeah yeah yeah yeah. Tom Collins.

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Tom Collins. Thank you very much, Madam Deputy Speaker. And I'd like to add. My thanks to. My hon.
15:49
Tom Collins Portrait Tom Collins MP (Worcester, Labour)
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>> My hon. >> Friend the Member for. >> York Central for leading on this topic. >> I have seen palliative.

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I have seen palliative. Care fail. My mum, Alison, had ovarian

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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 turns out, the waiting time was longer than she had. In my constituency of Worcester, we have hospices with superb facilities, both Acorns Children's Hospice and Saint Richard's Hospice are loved institutions in our city.

They're struggling and it's vital that we support them and clearly we need more hospice capacity. But our deficiencies in palliative care are vast, and my lurking, uneasy suspicion is that many of them aren't hospice shaped but reflect

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deeper deficits across our NHS. I will. Julie Minns very grateful to my

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Julie Minns very grateful to my friend for giving way. He raises a very important point about the NHS very important point about the NHS in my limited experience but painful experience. One of the things that doesn't happen enough things that doesn't happen enough is that even when there's a hospice bed available, the NHS staff do not bed available, the NHS staff do not refer end of life patients to hospice because the palliative team is 9 to 5, Monday to Friday.

Does he agree with me that we have to get to a point where palliative support in our NHS is available 24 over seven, so that those referrals can take place? Tom Collins.

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I thank my hon. Friend for that point and she's entirely right. We need far better integration across need far better integration across those services, and I was heartbroken to see that that the heartbroken to see that that the palliative care that my mother was receiving seemed to have been outsourced to charities and wasn't outsourced to charities and wasn't being provided by the NHS at all. And that specialist care ought to be something that's native to our be something that's native to our NHS.

I was recently talking to a couple of GPS in Worcester. Speaking with them is a refreshing change. Well, 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 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 in pain, inconvenience and indignity start to change.

Medics dealing with palliative care understand that our bodies are intermingled, complex systems, and that our bodies 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 doesn't cut it as an approach. You treat the whole person or you 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 specialities. Patients become units of flow, 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 and different areas under different trusts.

All 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 long, cold night in A&E corridors that inevitably follows. This has to change. Addressing our gaps in palliative care demands a fundamental shift in the way our NHS thinks and works. There will be a place for the cut and shut quick surgical procedure here and there, a course of antibiotics or a cast 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 and 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.

Madam Deputy Speaker, I'd like to touch on the topic of assisted dying. I've found that a difficult debate to navigate, largely for the reasons I've discussed. The overwhelming message I've heard from medics and 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 this available to all. As we do this, treatments that shorten but enhance life will undoubtedly play a role.

But they must sit at the apex of well-developed practice in end of life care that we don't 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, dealing 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.
15:54
Mary Glindon Portrait Mary Glindon MP (Newcastle upon Tyne East and Wallsend, Labour)
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Mary Glindon. >> Thank you. >> Madam Deputy Speaker, and I'm very sorry to hear about my hon. Friend's mother. And I think that this is a demonstrate that this is a topic of deep personal importance to me and to many of us here in the chamber as well as 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. And whilst I'm relieved it's now getting more attention it deserves.

This has been needed for far too long, and I want to take this opportunity to commend in the strongest possible terms, my hon. Friend, the Member for York Central. She rose to that necessity and convened the brightest minds in their respective fields to think about how palliative care could be different. Thank you.

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Yes. It's a necessity. That is not

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It's a necessity. That is not that. It's a necessity isn't an overstatement. And as my hon. overstatement. And as my hon. Friend said, the new new research commissioned by Marie Curie shows that almost 1 in 3 dying people that almost 1 in 3 dying people have unaddressed symptoms and concerns and limited or no access concerns and limited or no access to GP services. This is a system in crisis where demand for specialist palliative care is set to increase significantly.

People in the UK are living longer lives with complex needs, and this is a mounting pressure on services which are already patchy and under strain, according to a widely cited, widely cited study published in BMC medicine. By 2040, the demand for specialist palliative care care services could increase by 42% for those who access specialist palliative care, a referral can be an incredibly daunting experience. People are forced to stay there, stay there 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 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 this strategy, I hope the Minister will look closely at the practical support provided to patients and families as they navigate 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 which 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 and specialist specialist palliative care professionals. I would be grateful if the Minister could set out whether palliative care service services will be a key component of the workforce plan, the palliative and End of Life Care Commission underlines the hard yards we need to do on training.

It highlights that lack of training available to clinicians, clinicians and 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 that 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 our earlier identification.

Not only would this improve outcome for patients, but it was also. But it would also 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 programs from September this year? Will she also commit to ongoing and special specialist level training for those already part of our NHS workforce? Madam Deputy Speaker, we must thank all those who currently work in the palliative care world because their work is nothing short of awesome.

And in conclusion, Madam Deputy Speaker, I wish to end my speech with a reflection on what must be our overarching focus. A person is no more vulnerable than when they are told their life will come to an end. For occasions when nature makes that choice, we must enable people to maximise the precious time they have left. Today, too many people are not afforded that opportunity, and I urge the government to be bold as it sets a new direction for palliative and end of life care.
15:59
Liam Conlon Portrait Liam Conlon MP (Beckenham and Penge, Labour)
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Yes. >> Liam Conlon. >> Mr. Speaker, and can I start by thanking my hon. Friend the Member for York Central for bringing this debate to the chamber today. Discussions around assisted dying have divided this House. Yet one impact we can all agree on is the prominence given to palliative care. And that is incredibly welcome. Whilst I'll come on to discuss policy and funding in a minute, in the words of Dame Cicely Saunders, the founder of the modern hospice movement, palliative care is about more than just bricks and mortar.

And it is this. I'd like to begin with many of the benefits of proper palliative care and hospice support are not easily quantified, and certainly can't be captured on a balance sheet at Saint 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 for allowing time for spiritual reflection and reconciliation at the end of life. Saint Christopher's was the first modern hospice in the world to combine medical care, research and teaching for end of life patients.

Every family in Beckenham and Penge has been touched by Saint Christopher's Hospice and speaking to them about the care their loved ones have received, you truly begin to understand the meaning of holistic care. In one example, patients are given access to a specialist adapted gym and physiotherapists, where the focus is on retaining practical movements to maximise quality of life. In another, Saint Christopher's invites outpatients into hospice for art classes and therapies, providing them with community and enjoyment, but also ensuring that the hospice is a familiar and safe place, meaning a more comfortable experience should they become an in-patient at the hospice at some point in the future.

And this care extends beyond patients and to the families themselves. Saint Christopher's offers bereavement support for families after a death, as well as encouraging conversations towards the end of life which facilitate reconciliation, honesty and peace. And you see it in the impact and enthusiasm of our community in supporting Saint Christopher's Hospice through various fundraising events throughout the year. It is so important that these 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 already squeezed by 2048. Marie Curie estimates that the number of people with palliative care needs will be 25% higher than what it was 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 to provide even access.

Where a person lives should never determine the dignity of their death or access to the support I laid out earlier. Even in one place, significant disparities exist between groups, to 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 they are entitled to.

We need providers and the government to begin to address this, and I am glad the government have begun to relieve some of these problems. For example, through last year's announcement of record funding, a £100 million boost for adult and children's hospices, including £1.6 million for Saint Christopher's, the biggest investment into end of life care in a generation. It is enabled and supported the construction of Nuffield ward at Saint Christopher's, which is the first of three wards to be refurbished, and I was incredibly proud to visit the hospice in December, along with the Health Secretary, to officially open the ward.

Going forward, I would like to ask the government to continue in the spirit of this recent success, as Steve Smith, the chief executive of Saint Christopher, said following the latest funding announcement. Whilst 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 is developing a palliative care and end of life care service framework for England and unbelievably, this will be the first national plan for this vital care to be delivered since 2008.

Speaking to friends at Saint Christopher's and Hospice UK, I know there is a real desire to engage with Ministers to shape this vision to meet the government's own ambitions in the ten year health plan of shifting care out of hospitals and into the community. This framework must commit to a fairer, long term funding model. I will do.
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Josh Newbury Portrait Josh Newbury MP (Cannock Chase, Labour)
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they have to keep up with them or they'll lose many of their staff and they want to recognise the outstanding care that their highly skilled workforce provide. But the reality is the payments they get from the NHS often don't keep pace with increasing costs, squeezing them tighter and tighter year on year. I know this is the same story for many other hospices that serve my constituency, like acorns and the Dougie Mac. A stark example of this pressure can be seen at Saint Giles, where a third of their beds are currently closed due to funding constraints, most definitely not because of a lack of demand or need in previous years.

This spare capacity has been given over to the NHS to help with winter pressures. Any hon. Members who've worked in the NHS will know that extra capacity is essential in the cold winter months. However, the amount paid for relatively lower level care than Saint Giles typically offer meant that the hospice made a loss on those beds, so donations were effectively subsidising NHS care. So sadly that arrangement had to be stopped. And I think on this side of the house, we have to be honest that chief among the cost pressures faced by hospices in the last year has been the increase of employers National insurance contributions, which has cost Saint Giles £400,000.

I continue to believe that, given the vital role they play for people at a critical time in life and the pressures they take off, the NHS hospices should be exempted from this increase. To continue. Not to do so will continue to restrict the availability of end of life care and cost the NHS more in the long run. Like many in the chamber today, I devoted lots of time to the assisted dying debate, pouring over heart wrenching letters, speaking with constituents and professionals on both sides of the argument.

That debate showed me, whatever your view, that we need far more focussed discussion and funding for care at the end of life, when hospices have to cut their services, the people who need them don't just disappear. Instead, they go to the NHS, or they become one of 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 cost of specialist services. Hospices can not only maintain their services but also expand their role in meeting growing demand and the various challenges ahead of us.

We all deserve a good death, but many of us don't get that. That must change. It can change. And I look forward to working with everyone in this chamber and the incredible people providing palliative care to ensure that it does change. Thank you Douglas McAllister.
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Douglas McAllister Portrait Douglas McAllister MP (West Dunbartonshire, Labour)
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Thank you, Madam Deputy Speaker. >> Thank you, Madam Deputy Speaker. The hospice sector in Scotland is under severe and growing financial pressure, with two thirds of pressure, with two thirds of hospices making cuts or planning to do so in the near future. This is due to underfunding that has left due to underfunding that has left hospices stretched to breaking point, with many being forced to cut services at a time when they are needed more than ever. Nowhere is this reality clearer than in my constituency of West Dunbartonshire.

My constituency is home to Scotland's oldest and largest hospice, Saint Margaret of Scotland Hospice and Chaz 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, 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.

Saint Margaret's has served generations of families in West Dunbartonshire and beyond, and I want to thank the formidable and irreplaceable stewardship of Sister Rita Dawson and her team of wonderful staff and volunteers. Saint Margaret's is currently undertaking a £6 million refurbishment project and this 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 patients receive care in dignified therapeutic surroundings fit for the 21st century.

Yet the hospice continues to face a funding gap. At the same time, Robin House provides extraordinary children's palliative care to families facing the unimaginable. IT services embody precisely what the commission describes holistic speciality speciality care that extends beyond the patient to the whole family, including bereavement support. But like adult hospices, it relies heavily on charitable income alongside statutory funding, and that does not always reflect the true cost of delivery. I understand that the findings of the commission are related to England, specifically as part of the government's ten year NHS plan.

I welcome the fact that the UK government has committed significant investment in 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. But having spoken to representatives from hospices in West Dunbartonshire, it is clear that there has been very little indication of help. Help, which 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 is 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 compete to complete essential building works, while additional public funding sits elsewhere, somewhere in devolved budgets. So I ask the Minister, given the capital and revenue investment announced for palliative care in England, has she held discussions with her Scottish counterpart to ensure that 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? Hospice building improvement works announced by the UK government, and 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

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of it? Thank you, Madam Deputy Speaker. Scott Arthur Peter Prinsley.

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Scott Arthur Peter Prinsley. Thank you, Madam Deputy Speaker, and I'd like to thank my hon. Friend, the Member for York Central for having this important debate. And I'd like to pay tribute to her And I'd like to pay tribute to her political expertise in this area and for everything that she has and for everything that she has done. Now, Dame Cicely Saunders, a much quoted in this debate, understood that medicine. Dame Cicely was the founder of the movement of the hospice movement in this country.

She understood that medicine is not only about curing illnesses, it's about the dignity
16:17
Peter Prinsley Portrait Peter Prinsley MP (Bury St Edmunds and Stowmarket, Labour)
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and ensuring that people are supported compassionately at the most vulnerable moment of their most vulnerable moment of their lives. And 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. And in in my continue that legacy. And in in my own work as an ear, nose and throat surgeon dealing with patients with surgeon dealing with patients with advanced cancers in the head and neck, I am well aware of the importance of hospices.

I'd like also at this moment to pay tribute to Doctor Eric Wilkes, who was a brilliant general practitioner and a founder of the hospice movement in Sheffield. He was the 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 Saint Luke's Hospital. Now, the term palliative care was actually only invented in 1990, some 2020 years or so after I first met Doctor Wilkes.

And and it was the Sheffield model that was completely crucial to this development. Now, I'd just like to say something about the palliative care in my own constituency of Bury St Edmunds and Stowmarket, and in particular the remarkable work of Saint Nicholas Hospices, the wonderful chief executive, Linda Mcenhill, and all of her staff. Now the hospice provides essential support for those approaching the end of life, for their families and for their loved ones. Now, what makes this hospice a little bit unusual is that it sits right on the campus of the West Suffolk Hospital and arrangement, which facilitates help for the patients in the hospice from all the services within the hospital.

So, for example, if a patient falls and fractures a leg or needs an ear surgeon, then support is available rapidly and nearby. Most hospices simply don't have access to that level of clinical support, and that is a real advantage for the berries and hospice. Now, Saint Nicholas Hospice also illustrates a wider challenge which faces palliative care across the whole country. As we know, demand for hospice services is increasing. Saint Nicholas lately increased its capacity by about 33%, and that was to meet the needs of the patients and families in the local community.

But in order to do this, we have to recruit more staff. And so we must do something about increasing training capacity across the hospice service, and in particular, because we need to make sure 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 2/7 more people. So palliative care is a crucial part of a healthcare system. The problem, as as we have heard on many occasions, is that the hospices are relying on charity and legacies.

Now that is obviously admirable, but it raises an important question, which is, I think first asked by the Baroness Finlay in the other place. Now, 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 that up. Yet for some reason, if we need a hospice, we expect a charity to raise the funds to do that and run it. Yet being born and coming to the end of your life are just an inevitable part 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. Now, if we genuinely believe that dignity at the end of life matters,

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then let's do that. Let's make palliative care core. Thank you. Yeah.

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Yeah. Which brings us to the front bench contributions. Alison Bennett. bench contributions. Alison Bennett. Thank you, Madam Deputy Speaker. And I'd like to begin by thanking all the hon. Members for their all the hon. Members for their thoughtful and moving contributions this afternoon, in particular, the
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Alison Bennett Portrait Alison Bennett MP (Mid Sussex, Liberal Democrat)
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this afternoon, in particular, the hon. Members for Worcester and St Helens South and Whiston, who spoke so movingly about their own very personal loss. But of course, we wouldn't be here holding this debate were it not for the hon. Member for York Central, who set out the frame of this debate so brilliantly, and has done so much work outside this 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 want to begin, because last week I was out in Burgess Hill and I saw an elderly gentleman holding on to a walking frame standing by the edge of the pavement, and I got talking to him, and it turned out that he was waiting for a lift to Saint Peter and Saint James Hospice, where he was going to a bereavement cafe, and 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, but for the last six months he's been going back to Saint Peter and Saint James for this bereavement cafe, and he's beginning to feel a little better with that support each week. So my thanks go to Saint Peter and Saint James, and for all the hospices that support our constituents for what they are doing. We are at a point where our palliative care system is at a tipping point. With a funding cliff edge approaching, 75% of hospices are running a deficit.

2 in 5 are planning reductions in clinical services in the year ahead. And across England, 380 hospice beds lie empty, not because there is no need for them, as many hon. Members have said, but because there is not the funding to staff them. Around 300,000 people a year are cared for by hospices, yet around 100,000 more. 1 in 3 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 us that nearly 1 in 3 dying people had 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 to 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 though. 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 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, and around 69% of people are admitted as inpatients in the final six months, with a median stay of 13 days. 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 pharmacy and paramedic services might have experienced a calmer, more dignified end of life and they might have spared the NHS considerable cost.

Yet the very sector that relieves this pressure is itself under extraordinary strain between 2022 and 2024. As the hon. Member for Cannock Chase noted, sorry. Between 2022 and 2024, there was a £47 million real terms cut in hospital hospice funding and as the hon. Member for Cannock Chase 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. The 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 hon. Member for New Forest East 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 the strength of an area's ability to raise funds, or whether you are an adult or a child. Hospices, of course, welcome the capital funding from the government, but this quite simply does not pay.

Nurses salaries and 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, Madam Deputy Speaker, but it is also a very real one for all our areas across the country, and particularly for my area in Sussex, where the Southern Hospice Group are at the moment, consulting on how to cut their costs. Marie Curie and others have warmly welcomed the government's commitment to develop other palliative care and end of life modern care.

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. This is, of course, good news. The government has rightly identified five core challenges delays in early identification, inconsistent commissioning, workforce shortages, gaps in 24 over seven provision and limited uptake of personalised and advanced care planning. But these are not new problems that need solving.

Madam Deputy Speaker, we have known this 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. And we would improve support for children who have lost a parent by appointing a Cabinet member for children and young children, and extending pupil premium plus funding to children in kinship care.

The government must provide stronger national leadership and oversight. It must place palliative and end of life care at the heart of plans for a neighbourhood health service. Looking beyond hospices, and it must deliver a new funding and commissioning model that ends the postcode lottery. It must invest properly in the workforce, and it must scale up proven models of care that shift support from hospital to community, improving patient experience and delivering better value for taxpayers. The government seems happy to talk about moving care from hospitals to the community, but we need to see the material change.

We Liberal Democrats believe the government has a choice. It can allow hospices to drift from crisis to crisis, beds closed, staff lost, unmet need rising year after year, all the while struggling, struggling, struggling to plug gaps left by the struggling NHS. Or it 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 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.

Thank you.
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Stuart Andrew Portrait Rt Hon Stuart Andrew MP (Daventry, Conservative)
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Yes. State Stuart Andrew. >> Yes. >> Thank you very much indeed, Madam Deputy Speaker. And may I Madam Deputy Speaker. And may I also begin by congratulating the hon. Member for York Central for securing this really important debate and for all the work of the Independent Commission on Palliative and End of Life care for the amazing work that they have undertaken. Their report certainly provides an important contribution to the discussion about how we ensure people receive compassionate and high quality care at the end of life.

This debate is really important. There is a saying that there is nothing certain in life than death and taxes. Well, it seems we spend an awful lot of time in this place talking about taxes, but until recently we have not really talked about death. And I agree with the hon. Lady from Newcastle when she talked about the fact that we'd gone into assisted dying and rather we had missed, I think, a leapfrog, the important debate around palliative care. And I also want to say pay tribute to the other member for the other part, the other Newcastle, sorry, and for the tribute that he made to Dougie Mac and to all colleagues who were making representations and congratulations for the amazing work that hospices do around the country, and to the moving contributions that we heard from the hon.

Lady from Saint Helens South and the hon. Gentleman from Worcester. These debates are even more powerful when we talk about those personal experiences we've been through, and I thank them for sharing those, because for me, palliative care is about dignity. It's about 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 the manner that they choose before coming to this House.

I had the privilege of working for 16 years in the hospice movement, in both children and adult hospices, and with organisations who were supporting families whose loved ones were edging towards the end of their life, and many of those who were supporting the families of children who had life limiting conditions. And that experience, I have to say, has stayed with me. It has informed how seriously I take this debate today, and it's because I saw first hand the extraordinary compassion and professionalism of the people who provide this care, and the profound difference it makes to families facing unimaginable circumstances.

And when it comes to children particularly, I think no parent expects to outlive their child. And often those parents would say to me when they realised that their child was living with a life limiting condition, it meant that their dreams and aspirations changed. Suddenly. They weren't thinking about their first day at school, their first day at university, their wedding day. They were changing their whole aspect and the plan for that child's life. And that is why hospices and palliative care services are so important when they support those more than 300,000 people every year.

And 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. And they are all, I think, a vital part of our health system because there was a wonderful saying in the children's hospices that I always used to relay, which is they can't add days to their lives, but they can add life to their days. And, and I think that that really does show how important they are to so many families.

And they also the, as I say, a vital part of our health system because they're relieving pressure on hospitals and providing specialist care in communities right across the country. Hospices are not an optional extra within our health system. They are a core part of how our compassionate and health care should work. Seeing adults and children get the care they need at the end of their life, as I did at Hope House Children's Hospice, East Lancs Adult Hospice and Martin House Children's Hospice was phenomenal to see and it is no wonder that our hospice movement has been world leading.

Yet the sector is under increasing strain. Hospice leaders report rising costs, workforce shortages and growing demand for services at the very moment they are struggling and across the country we are seeing reductions in services, bed closures and significant financial pressures. And as many other members have mentioned today, hospice UK has warned that 2 in 5 hospices are now cutting or reducing services that that I know does, but should concern every member of this House. Now, the government will point to recent capital funding, announcements 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. It cannot pay for doctors or the day to day delivery of care. What the sector needs is sustainable revenue funding. I know as the head of fundraising, previous head of fundraising myself, that actually the capital fundraising was often the easiest thing to raise money for. People want to buy a new building, a piece of equipment. The paying the wages was never as, dare I say, sexy. And as many of us as the 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 right through to the end of life and beyond. I remember listening to one parent saying to me that if he got up eight times in the night to his daughter, he would consider that he'd had a good night's sleep. I can't really imagine what that must be like. And seeing siblings having a different life to perhaps their friends at school have because their their brother or sister needed extra additional care.

And then the wonderful support that they offered families through bereavement. And another issue that many have mentioned today. But as we've heard, access to that care remains inconsistent across the country. And as my hon. Friend the Member for New Forest East said evidence suggests that fewer than 1 in 5 integrated care boards formally commissioned specialist children's palliative care services that meet national standards. There are also serious workforce shortages. England has just over 1000 community children's nurses. When safe staffing estimates suggest nearly 5000 are required, and across the UK there are only around 24 specialist paediatric palliative care consultants.

When experts estimate between 40 and 60 are needed. And for many families, this means they cannot access the support they need at home, even when that is their preference. Now, the government has indicated that it will publish a modern service framework for palliative and end of care, end of life care later this year, and I absolutely welcome that and I commend them for it. That framework presents a real important opportunity, I think, to address the challenges facing the sector.

So I would like to ask the Minister a couple of questions. I won't repeat the ones that my hon. Friend mentioned, because I think we all had that briefing, but I would like to ask that what steps will be taken to address that workforce shortages facing palliative care services, particularly when it comes to community children's nurses and specialist consultants? And what plans does the department have to ensure that hospices have the sustainable funding that is required to continue delivering these vital services, but also, may I say, protects their independence? I think there is a real danger.

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 are taking that statutory funding. And the thing that I always noticed was how they were able to respond much, very, very quickly to individual families needs than perhaps the NHS could. So it's really important that we safeguard that, that independence. May I also ask how the government will also ensure that this opportunity, with this new plan, seizes the chance to stop that postcode lottery and where we should perhaps firm up some of the not instructions, but certainly guidance to ICBs around the country.

I think also, it'd be interesting to know whether the Ministers will look at the innovation that charities are doing in this work around palliative care, particularly, I think, of Sue Ryder, because they are now investing in add on wards at the Airedale Hospital up in Yorkshire. They're also focusing more on home services rather than in a building and actually getting to more and more patients. I think it's important that we engage with them and learn from them, and also so that we can make sure we can see what is evolving into best practice, practice, and also that really important issue around transition.

It is particularly 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 just a bit more grown up, but wasn't Old lady and old man ish, if I may put it that way, it it was, you know, it was suited. It was the environment that was suited to those young people's needs. But now we are seeing thankfully, we are seeing these young people are living longer.

So young boys, particularly with Duchenne muscular dystrophy, when I was working there, would probably come to the end of their life for 18. They're now living to their late 20s, 30, sometimes even 40s. There needs to be an appropriate environment for them to have that support, because palliative care is one of the most compassionate parts of our health system. The professionals, the volunteers and the charities who 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.

And I

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hope that the Minister can now tell us how the government intends to achieve that. Thank you.

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Thank you. I call the Minister, Karen Smith. Thank you, Madam Deputy Speaker. And can I also thank the hon. Member for York Central for securing this important debate? We entered Parliament at the same time. Madam Deputy Speaker were immediately on opposite sides on the assisted dying debate and remain so obviously the remain so obviously the government's neutral. But we have always then articulated our concern around palliative and end of life care in many debates in this House over the time, and I think she's done a marvellous job in doing that today, bringing forward this debate.

And to all her colleagues on the Commission on Palliative and End of Life care for the vital work that they are doing as they continue to develop that third report. And we are really grateful to all of those who work or volunteer in the palliative care and end of life sector for the care and support they provide to patients, families and loved ones at a time when they need it most. And as my friend from Cannock Chase said, everyone does deserve that good death.

And can I also really commend the contribution from the shadow Secretary of State, from his excellent experience in this sector? And I think he made some really valuable comments around that. And I, too, come to this from my experience, which I've talked about before, from 2008 when I worked with clinicians around end of life,
16:43
Karin Smyth Portrait Karin Smyth MP, Minister of State (Department of Health and Social Care) (Bristol South, Labour)
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how to live and die with COPD, a really unpleasant disease if there is such thing as a pleasant disease. is such thing as a pleasant disease. When I was made aware that people were talking about how to live with it, but no one really was responsible for working with patients and family about how to die with COPD. And I learned a lot die with COPD. And I learned a lot about how we how we talk about death and dying in the health service and care service and the great work that our trainers and great work that our trainers and people do about supporting our clinicians, about how best to die.

And that was really valuable for me when my own father died at home, supported by Macmillan and Fantastic Community Care Team in 2010, which is now 16 years ago, when we as a family, partly due to the training that I'd had and the articulation that I was able to make on behalf of my family, it shouldn't have to be like what it is. That's 16 years ago, and it is really concerning that still, across the country, people are experiencing such poor care.

And also I see lots of that really good care in my own local hospital at Saint Peter's, which are doing some of the innovation that the shadow Secretary of State said. I want to do reassurance to my colleagues that this government and my hon. Friend, Minister of State for care, who is leading on this work, are absolutely committed to creating a society in which everyone does receive that high quality, compassionate care from diagnosis through to the end of life. Madam Deputy Speaker, we've heard a lot about the role of hospices here today from the Member for York Central, from Saint Helen's and Will Stone, from Birmingham Erdington, from Beckenham and Penge, from Cannock Chase, from West Dunbartonshire, and from my friend the Member for Stowmarket and Bury St Edmunds, and indeed from the opposition spokesperson.

While we recognise that the majority of palliative and end of life care is provided by NHS staff and services, we of course absolutely recognise that many hospitals do this fantastic work in this area and they do face a challenging financial situation due to a range of pressures. And that's why last year we did announce that we would support this sector with a record £125 million capital funding boost for those hospitals in England to help them provide the best physical environment for the people they care for.

And that money can be spent on fixing a roof, paying for double glazing or buying buying a new boiler. And I know, although I take the point by the shadow Secretary of State, sometimes people are more willing to contribute to those. I know. Those are the sorts of things that keep people who are running the system awake at night, making it happen. How you find the money to fund those repairs. It saves money, particularly on energy bills in the long run, too.

And the full 125 million has now been allocated to 158 eligible hospitals. Hospices by hospice UK. And I know my hon. Friend, the Minister of State for care, has been touring the country, visiting many of these hospices to see first hand some of the good the money is doing. On top of that, we are has been providing around £80 million revenue funding for children and young people's hospitals over the next three years, giving them some of the stability that they need to plan ahead.

And I know that was welcomed by the Member for New Forest East, and we do absolutely recognise to assure him the different needs of children and their families in this work. The long term commitment was a key term demand from this sector, who faced cliff edge of funding cycles every single year, and children and young people's hospices and integrated care boards have been informed of the allocations for the next financial year, and we intend to let hospices know about funding for future years once this process is complete.

But Madam Deputy Speaker, we absolutely recognise that this money won't be a silver bullet and many hospitals still face pressing challenges. And the need for palliative care and end of life care is projected, as we've heard, to rise in the coming years with our ageing population. But while around 75 to 90% of those end of life would benefit from palliative care and end of life care support, only about 55% of people are identified as such in primary care. And that's why NHS England recently wrote to all ICBs requesting an immediate update on the financial stability of hospices within their footprint and the steps taken needed to be taken to mitigate those risks.

And 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. Now, with regard to the wider system, Madam Deputy Speaker, Neighbourhood Health Services and their development sits at the very heart of our ten year plan and we are building a service that will deliver more personalised care closer to where people live, empowers people to lead healthier, independent lives where they can, and have that genuine choice about how to access support.

And the NHS medium term planning guidance identifies those at the end of life as a high priority cohort in the implementation of neighbourhood health. So I do want to assure people about that. I can also say to my friend, the Member for Newcastle East and Wallsend, of course, the workforce plan as it comes forward will also reflect that move into neighbourhood services. We have to move away from the disjointed pathways so that, as so well articulated by my friend, from his terrible experience with his mother, my friend from Worcester and my friend from Bury St Edmunds, we have to move away from disjointed.

Sorry, we have to move away from disjointed pathways. And as my friend from Bury St Edmunds said, absolutely have that paradigm shift that looks at people holistically throughout that pathway. Now I am the Minister responsible for reforms to the system architecture, and we are asking people ICBs to do more. The NHS England Strategic Commissioning Framework makes clear we expect them to commission services in line with the current and future needs of the people they serve. We are moving away from those ring fenced incentive budgets, and we are streamlining those incentives to focus more on the outcomes that we all expect from our systems.

And we've made also clear that via the model ICB blueprint, that it's their mission to reduce inequalities through a careful assessment of the quality, performance and productivity of existing provision. We have to, as we heard from the debate today, ensure those high standards and focussed objectives. Now, next month, ICBs NHS providers will create a new plan to more effectively manage the needs of high priority people, and NHS England is supporting commissioners to understand these needs with a dashboard which brings together all relevant local data in one place.

Now on the on the modern service framework, there is currently, as we've heard today, a contracting mix in this sector. But when we support the ICBs to commission more strategically, we have to start moving away from the grant and contract models. And that is why the government is developing the landmark palliative care and end of life modern service framework, or MSF, for England, because for far too long as we've heard, palliative and end of life care has been variable across the country.

But the modern service framework will put a floor under that kind of care that patients can expect. As we heard from my friend the Member for Durham, whilst it would not be right to pre-empt exactly what will be in that final MSF at this time, we are working closely together with all stakeholders to ensure that everyone has access to the care they need in the right place, at the right time. And as part of the MSF, we've invited colleagues from a number of organisations to engage with us as part of its development.



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Script to the Minister for giving way. Just on that point, can I just clarify that MSF would include targeted support for

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children who require palliative care? Just come to. My next paragraph. Thank you for that. As part of the development, we'll be looking at some of the important aspects of care that the hon. Member for York Central has mentioned, including the early identification of need care delivered closer to home by integrated generalist and integrated generalist and specialist teams, and strengthened out-of-hours community health support, including dedicated phone line. And can, I assure the Member for New Forest East that does include particularly for children and parents and carers.

And as my friend from Chelsea and Fulham said, the experiences of people like Amy make that much better. As he said in his speech and to my friend from Alloa and Grangemouth, the experience of Callum and the Turner family mustn't be allowed to continue. Madam Deputy Speaker, Hospices do an amazing job for people at the end of life and for people with life limiting conditions and the whole community of family and friends supporting their loved ones through that journey, including, as we've talked about today, bereavement support, the quality of care, the compassion, the love they provide is second to none.

We absolutely recognise that this sector faces challenges. We are determined to work with all our partners in the sector to understand those, understand those challenges. We are not talking about spending more. We are talking about focusing on what we have at the moment, spending that better, being on a values based, outcome focussed model, moving the financial model to reflect the the experience of people's care throughout their lifetime. And while there are no easy answers, we are supporting them with record

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funding and reform. I'm grateful to the Minister's speech, but we have heard speech, but we have heard throughout the debate that 100,000 people are not getting the care they need. 1 in 3 people need that additional support. So by maintaining the financial cap, how are we going to build such capacity to ensure that everybody has access to excellence in the end of life?

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to excellence in the end of life? Mr. Smith. I thank her for that contribution. I think it warrants a debate of longer term to understand how we need to move the the resources that exist, as we've heard this afternoon as well, the the use of resources that follow people unnecessarily into hospital, which are terribly distressing for them and their families, and moving that resource as part of our move to the neighbourhood Health Services, of which this cohort of people will absolutely be central.

As as I've said, to move that resource with people throughout the pathway as part of that movement over time, that's what that's that's what we need to be doing. And that's what we'll continue to discuss with people as we move. Move the service to be a community based service. Colleagues are right to champion their cause in the House today, and I hope that they will agree with me that we will continue to work on this issue to make sure that people do have that good quality care across the country, as we've heard from this afternoon and from the measures that I've outlined this afternoon, that we are listening, we look forward to working with colleagues to make sure we develop these services for the future.
16:54
Rachael Maskell Portrait Rachael Maskell MP (York Central, Labour )
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She hasn't the Minister hasn't given away. But Rachael Maskell, you do get to wind up Rachael you do get to wind up Rachael Maskell to wind up. >> Thank you, Madam Deputy Speaker. I did want to first of all, thank I did want to first of all, thank all hon. Members for their contributions today. We've had 20 contributions in today's debate, 12 excellent speeches from backbenchers. And I have to say, it was a debate of the highest calibre. And also I heard so clearly in the debate such praise for the staff working across palliative medicine right across the country, in Scotland and England.

So I really do thank them for myself as well. I further want to just pay particular recognition of the speeches made by my hon. Friends for Worcester and Saint Helen's, as they talked about the loss of their mothers and the very contrasted experiences that they had that demonstrated the inequity we see across palliative medicine. And it cannot be right that people are not getting the care that they absolutely must. Today, I did want to go on to raise a point with the Minister as a follow up question about how the transition takes place, because if we're not front loading the funding, we will never see the development of the community provision because we won't be able to pull people out without resourcing in the community.

And that's where the challenge really comes from. The whole model and the emphasis on the contribution I made today. So I trust that we will look very carefully to ensure that we enable that flow of patients into the community to get the care in the right place, but also the sufficiency of funding, which we heard from so many hon. Members today, to to have the excellence in care itself. And I think we've also heard the challenges, which I think all hon.

Members have had, whether for children or adult services, that we need to ensure that we train the workforce and have the sufficiency in workforce into the future, that we get the commissioning right, and we address those very pertinent issues, and above all, that, we really invest in the time that is needed, the compassion to give families and patients to give that excellence in palliative care. I, as a clinician, would only say that I have witnessed working with people at the end of life, such special moments as the whole workforce, crowds around the patients and supports them and the families.

It is so moving. And I think today I've also heard the moving reflections from my hon. Friends, because this is what the debate is all about. It's about ensuring we have that really special moment at the end of life where we can really invest in that time, take those memories and cherish everything we possibly can. And when we've been debating so much in this place about assisted dying over the last year or so, I've heard so many examples of poor care where I know that a specialist palliative medicine could have made such a difference to those individuals.

And that's why today's debate is not only timely, but necessary. So we really do invest. So everyone has the opportunity for that amazing care, love and support at the end of life and don't have to even contemplate this matter of assisted dying. I think we've got a responsibility to put this front and centre, and let's move on from that debate on assisted dying to make sure we get care right for everyone. So I just want to close by just saying a huge thank you to everyone.

I really do appreciate it. I should put on the record. Madam Deputy Speaker, I am the chair co-chair with Baroness Finlay of the APPG on dying. Well, and I do invite all hon. Members to come and

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join us as we really do try and advance this debate. Thank you. The question is, as on the Order

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The question is, as on the Order Paper, as many of that opinion say, I God, you know, I think the ayes I God, you know, I think the ayes have it. The ayes have it. I'll let the front benches shuffle over. If they are planning to leave the

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chamber, not. I beg to move that this House.
16:59
16:59
Abena Oppong-Asare Portrait Adjournment: Endometriosis, fibroids and the Women's Health Strategy Ms Abena Oppong-Asare MP (Erith and Thamesmead, Labour)
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Deputy speaker. >> Endometriosis. >> Fibroids and related gynaecological conditions ruin lives of millions of women. Yet these conditions remain undiagnosed, misdiagnosed, dismissed or mistreated within the health system, women are told to shut up and stop complaining. We are fobbed off. We experience shameful delays. We are left in pain. So my argument today is simple. We need the forthcoming women's Health strategy to address head on these conditions, listen to women, tackle the taboos and create a timely and effective treatment.

1 in 10 women suffer from endometriosis. It is a painful and debilitating condition in every community, in every workplace, in every family. 1 in 10 means at least 20 members. Women members in current parliament, despite being widespread, it is remains misunderstood and dismissed. Yet it ruins women's ability to learn, to earn, to have sex, to have children and live a normal, healthy life. It literally destroys mental mental health. There has been greater awareness in recent recent years, and a wider discussion about the impact of these conditions, led by public figures such as BBC's Emma Barnett and this year's BAFTA winning short film This Is Endometriosis, which I hope to be hosting a screening of Here in Parliament soon.

And in this House. I also commend the great work of the chair of the APPG, the Member for Bathgate and Linlithgow, as well as the chair of the Women and Equalities Select Committee. The Member for Luton North. Yet millions of women are still being failed by the NHS and wider society. There's literally still a lack of appreciation of the true nature of the disease. Suitable supports throughout the worlds of education and work, and stigma associated with the symptoms, such as heavy bleeding and intense blinding pain.

The average wait for diagnosis is nine years and four months, according to the latest report launched this week by the charity endometriosis UK. Yet the report highlights that diagnosis times are not getting better. They're actually getting worse. This March is Endometriosis Action Month. It is therefore vital that we use this opportunity to act now for the benefit of those suffering today and long into the future, and in a moment and sadly, with, with even with this diagnosis, there is no

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cure, just pain management. I'll give way. I thank the hon. Member for giving way and for giving, taking giving way and for giving, taking some time out of her very passionate speech about the huge numbers of women who suffer from endometriosis. Given the challenges with diagnosis she's outlined and the enormous pain and suffering, the enormous pain and suffering, does she agree that far more money and government support needs to go into research so that we can better into research so that we can better understand this condition and how to diagnose and treat it?

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I'd like to thank the hon. Member for raising this, and it's nice to have a male ally in the chamber raising this. In fact, a chamber raising this. In fact, a few male allies here. I think it goes wider than that because obviously the government is looking obviously the government is looking to publish the women's Health strategy quite soon. And I'm going to talk about this in detail. The to talk about this in detail. The data is already out there in terms of what why it's what the delays are.

In fact, it's about recognising the signs and actually making sure that people get the adequate help that they need. And I will talk about this in detail about some of the stuff that I've done, particularly in my constituency, that also highlights this. It's often been said, but worth repeating, that if these conditions were suffered by 1 in 10 men, there would be research into cure, fast diagnosis, effective treatment, time off work, and a sympathetic understanding reaction from all the other men.

If only women got the same reaction at work within the health system. Andrew Mitchell Endometriosis UK found that 39% of the respondents had to visit their GP ten or more times before endometriosis was suspected, and 46% were sent home from hospital without treatment. This is simply outrageous, and this leads to, in response to the point that you, the hon. Member opposite, raise in terms of the fact that people are visiting GPS on repeatedly before even being recognised that they have that condition.

So when I surveyed my constituents, one told me I had to go to my GP three times and leave an utterly desperate comment begging for help until they took me seriously. Another said it was a condition I'd never, ever heard of until it started to affect me. And another said the pain was so excruciating that it felt worse than birth pain. This is just so common and this is the experience of millions of women down the decades. And I also want to say that women of colour suffer the double whammy of facing misogyny within the NHS, as well as racism that tells you we have a higher threshold threshold to pain, or that black women can handle it.

The recent interim report on maternity services by Baroness Amos last week highlighted the structural racism within the NHS, which essentially leads to worse health outcomes for women of colour. The endometriosis UK report says that women of colour, the average wait for diagnosis is now 11 years, 11 years. That is grave injustice. So it's not just a question of equitable health provision, it's also a question of social justice for women. Madam Deputy Speaker, it of course makes no sense that within the NHS, with stretched resources and overworked staff to the millions of women repeatedly presenting with their symptoms being sent away, returning in pain, making complaints for years on end, getting it right the first time matters.

So I do welcome the new NHS online, a virtual hospital in England which is due to launch next year in 2027, menstrual health conditions, including endometriosis, will be one of the priority areas. NHS Online Hospital will use the NHS app to triage patients and provide fast access to specialist clinicians online where needed. Specialists will be able to arrange local testing for women. I invite the Minister to comment further on how the NHS online will help women with these conditions.

The forthcoming Women's Health Strategy affords us a huge opportunity to move forward. I know the Minister will not be divulging the contents to this House today. I know we have to wait and to read the strategy in full, but I know that both the Minister and her Minister colleague in the other place, who is responsible for women's health, get it. She knows that a range of conditions affecting so many millions, so many millions, must be front and centre in the strategy.

The strategy must address early diagnosis and faster and effective treatment. It must tackle the stigma and taboos. Most of all, it must address the way doctors are trained so that endometriosis and fibroids and similar conditions are identified fast. We have made a great progress on sepsis. For example, in early identification. We must also do the same for endometriosis and fibroids. Will the Minister give us assurance that training for doctors will be will form a key part of the strategy? Will she work with the Royal College of GPS and the NHS training providers to ensure that these conditions are central to the syllabus that every newly qualified doctor has knowledge to identify endometriosis? When a woman presents with these symptoms, earlier diagnosis means early treatment and that saves a huge amount of pain, dismay and taxpayers cash down the down the line.

It really is a common sense approach given the huge number of women involved. I long for the day when we have a cure with proper medical research, as the hon. Member opposite has also alluded to, and I'm sure that this day will come. In the meantime, will the Minister agree with me that women should not be waiting years in unnecessary pain and that the women's Health Strategy can and must offer women a woman in pain, a real sense of home hope.

Thank you, Madam Deputy Speaker.
09:35
Karin Smyth Portrait Karin Smyth MP, Minister of State (Department of Health and Social Care) (Bristol South, Labour)
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I call the Minister again. Minister. Madam Deputy. Minister. Madam Deputy. >> Speaker, and can I congratulate my hon. Friend, on securing this important debate? And I am grateful important debate? And I am grateful to her, as I know my friend, the Baroness Merryn, who leads on this work for the department, is really grateful for the conversations that she has been leading on this and putting the spotlight on this, this, this particular particular endometriosis, but also the renewed women's health strategy and giving me the opportunity to set out what the government is doing in this Endometriosis Action month.

Because, as she has said for far too long, women with gynaecological conditions, including endometriosis and fibroids have been failed and we acknowledge the impact it has on all aspects of their lives. And this message, this government's message to women, is clear. You do not have to put up with this anymore, and I am pleased to hear that she will be hosting a screening of the short film This Is Endometriosis, about the harrowing experience of a woman seeking care for her endometriosis symptoms. I hope to be able to get along to that when she does that, and I encourage everyone to to do that.

Madam Deputy Speaker, we inherited a broken NHS where many women are still the subject to a system that doesn't understand our needs and wasn't designed with women in mind, and we are committed to changing this. Ensuring that women are listened to and get the healthcare that they need when they need it, and improving awareness of endometriosis, fibroids and other women's health conditions is a vital first step in our commitment to end this neglect of women's health and reduce the stigma that is attached to it.

And the hon. Lady is doing her part through the debate this evening. The General Medical Council has begun work to improve women's health representation in the curricula, and used to train healthcare professionals. For example, since last year, students graduated from UK medical schools are required to pass the medical licensing assessment, which encourages a better understanding of common women's health problems among all doctors as they start their careers in the UK. And this assessment includes topics on women's health, including endometriosis and fibroids.

Women's health is included in the Royal College of General Practitioners curriculum for trainee GPS and Women's Health Library, which brings together educational resources and guidelines on women's health. In November 2024, the National Institute for Health and Care Excellence updated its guidelines on endometriosis to make recommendations for healthcare professionals on referral and investigations for women with suspected diagnosis and taking together. I do think these actions will improve the standard of care that women receive, and I think it's encouraging to see not just the NHS taking action to raise awareness and improve training for all our partners in arms length bodies too.

And this work has to be ongoing across government. It is shocking, perhaps, that that's fairly recent starting, but I pay tribute to many as I know she would many, many hon. Members across all sides of this House Madam Deputy Speaker who have led an awful lot of work to raise awareness of this in the last few parliaments, and I think it is starting to bear fruit. In July last year, the Department of Education published revised statutory guidance, which sets out in black and white how secondary schools should cover menstrual and gynaecological health, covering things like heavy breathing, heavy bleeding and when to seek help from professionals.

We know that women often spend years being dismissed, misdiagnosed or simply not being listened to, and this has also been reflected in Endometriosis UK recent report, which my hon. Friend has made reference to, and we are clear this is unacceptable and women should not have to put up with it anymore. We've introduced Jess's rule that requires GPS to rethink diagnosis for their patients. We're rolling out Martha's rule, which will give in-patients in acute hospitals in England the ability to initiate a rapid review of their case from someone outside of their immediate care, and these will help make sure women are listened to by their doctors and their concerns aren't dismissed.

Now, early diagnosis is also key, and that's why we continue to roll out community diagnostic centres across the country for women on gynaecological pathways. As of last month, 106 community diagnostic centres across the country now offer an out of our service 12 hours a day, seven days a week, meaning patients can access vital diagnostic tests around busy working lives. And in September, we have announced the new online hospital called NHS online to give women on certain pathways the choice of getting the specialist care they need from their home.

And what this means is that wherever women live in the country, they can have access to the very best gynaecological care. And earlier this year, we announced that menstrual problems, which may be a sign of endometriosis and fibroids, fibroids will be among the first nine conditions available for referral from 2027, and the detail is being worked through ahead of the launch next year. Our revolutionary online hospital will help reduce patient waiting times, deliver the equivalent of up to 8.5 million appointments and assessments in its first three years, four times more than an average trust, while giving women choice and control over their care.

And finally, this government are committed to encouraging ICBs to further expand women's health care and women's health hubs at a neighbourhood level, and support ICBs to learn from women's health hub pilots to improve the services for women, as well as the rest of the population. Now, Madam Deputy Speaker, we know that women can be impacted by a range of different health conditions at the same time, including those that not only affect women, those that affect women differently or more severely to men and those that affect different groups.

We know this is the case for fibroids, as she has outlined, particularly where black women are disproportionately affected and often face barriers to timely, compassionate care. And as my friend has raised, this is also the case for ethnically diverse women with endometriosis, as highlighted in the Endometriosis UK report. We're not complacent about these inequalities. We are committed to building a fairer Britain to ensure people can live well for longer and spend less time in in, in ill health. And the ten year plan will shift how we will focus that care from hospitals into communities, and how neighbourhood delivery can help adapt the gaps in provision and those long waiting times specifically for those with deprived areas like constituencies like mine, and women from ethnic minority backgrounds.

And can I just add, Madam Deputy Speaker, to the hon. Gentleman who raised about research, we should also add that the Department, through the NHS higher, has commissioned several studies focussed on endometriosis diagnosis, treatment and patient experience and at present they are funding seven active research awards totalling an investment of £7.8 million. This includes a new £2.3 million award on the effectiveness of pain management for endometriosis, starting in March 2026. So, as my hon. Friend has raised this important debate, we know that services are not serving women as they need to right now.

I think there are some some really helpful starting signs that that is starting to change. Training awareness is a key part of that. We need to keep keep we keep need to keep highlighting the differences as women present for for care. We will listen to women, and I look forward to working with her and others on developing and implementing the renewed Women's Health Strategy over the coming

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months. The question is in this House, do now adjourn, as many say I. The do now adjourn, as many say I. The ayes have it. The ayes have it. Order. We start with questions to the Minister of the Cabinet Office, Laurence Turner.
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