Palliative and End-of-life Care: Funding

Baroness Merron Excerpts

Wednesday 4th September 2024 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the adequacy of funding arrangements for accessible and equitable palliative and end of life care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we want a society where every person receives high-quality, compassionate care, including at the end of their life. Integrated care boards are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. This is to promote a more consistent national approach and supports commissioners in prioritising palliative and end-of-life care. We will be considering the next steps, including funding, more widely in the coming months.

[The Lord Bishop of London]

I thank the Minister for her reply. We know that the hospice sector depends on charitable giving because of the low level of statutory funding at present. This means that the wealth and resilience of a community define the level of hospice services. This entrenches inequalities of place and means that access to hospice services is extremely unequal. Can the Minister outline what the Government are doing to look at the funding settlement, and particularly the wider hospice funding model, to ensure that this is not just another service that has poorer access for those in more deprived areas?

[Baroness Merron (Lab)]

I certainly take on board the point that the right reverend Prelate makes. It is the case that the amount of funding that charitable hospices receive varies by ICB area. That, in part, is dependent on the breadth of a range of palliative and end-of-life care provision within the ICB area. I can assure your Lordships’ House that my colleague, Minister Kinnock, the Minister of State for Care, has recently met with NHS England, and discussions have started on how to reduce inequalities and variation in access to services and their quality.

[Baroness Pitkeathley (Lab)]

My Lords, does my noble friend agree that when end-of-life or palliative care is delivered at home, the principal deliverers are usually the family—the unpaid carers—of the patient? Does she agree, therefore, that they must be considered in this equation to get them as much support as possible, and that they ought to be given as much information as possible about the patient’s prognosis and the treatment plan, bearing in mind the sensitivities associated with such information?

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[Baroness Merron (Lab)]

My noble friend is absolutely right, and I certainly agree with the points she has made. Those who care for their loved ones are absolutely crucial to ensuring that the right care is provided in the right place and the right way for that person. Everybody is individual, and we want a society where everybody receives the right kind of care at the end of their life. That should be a time of dignity, and we want to provide that.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, people with neurological conditions face many barriers to accessing palliative care, even though it could do them a huge amount of good. The answers to this are better identification of individual needs and better collaboration between palliative and neurological services. Can the Minister assure me that she will look at this? There is a great inequity in access to palliative care. I declare my interest as a chair of the Scottish Government’s neurological advisory committee.

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise this, and I can give her that assurance. She raises the point about identification of people with specific needs. I am interested to see that there are some very good examples of local good practice—for example, in Dorset, where they have proactively gone out to identify who needs palliative and end-of-life care. By so doing, they have raised the percentage of the local population who should be receiving it. That is a model we will want to look at. With regard to those who have particular needs, as the noble Baroness describes, I think that model will be helpful too.

[Baroness Hollins (CB)]

My Lords, the Minister has rightly pointed to the growing need for excellent palliative care close to home, and I am glad of that, but I wonder whether she is aware of the Hospice UK report pointing to the number of redundancies occurring across the sector. In the context of the 2022 Act, which required the NHS to commission adequate NHS care, this seems to be rather urgent, not just to provide good care for people but to reduce the impact on the acute hospital sector of not providing palliative care.

[Baroness Merron (Lab)]

The noble Baroness is right in her observations, and we certainly recognise that times are difficult, particularly for many voluntary and charitable organisations including hospices, for example, due to the increased cost of living. We are working alongside key partners and NHS England to proactively engage with stakeholders, including the voluntary sector and independent hospices, because we want to understand the issues they face and to seek solutions to them.

[Baroness Brinton (LD)]

My Lords, the charity Together for Short Lives has found that the NHS local funding for children’s hospices has dropped by 31% in the last three years. Worse, the previous Government’s £25 million children’s hospices grant has been given to local integrated care boards, many of which have delayed distributing it. As a result, the children’s hospice movement is in real crisis. Please will the Government urgently review the funding that government has in the past put aside for children’s hospices, to make sure that they receive it?

[Baroness Merron (Lab)]

As the noble Baroness said, in 2024-25 the £25 million in funding from NHS England was distributed, for the first time, via integrated care boards. As I understand it from the previous Government, that was in line with NHS devolution. We will carefully consider the next steps on palliative and end-of-life care funding much more widely in the coming months and will take on board the comments of the noble Baroness and other noble Lords.

[Lord Evans of Rainow (Con)]

My Lords, everyone should be able to access quality palliative and end-of-life care and patient care in their local area. Under the Conservatives, we made integrated care boards legally responsible for commissioning palliative care services to meet the needs of the local population. What assessment has the Minister made of access to palliative and end-of-life care across the country? What steps will the Government take to ensure that everyone, especially those living in rural areas, can access quality end-of-life care?

[Baroness Merron (Lab)]

As the noble Lord will be aware, statutory guidance and service specifications are provided to support commissioners in ICBs to meet their duty. As I am sure the noble Lord is also aware, NHS England has developed a palliative and end-of-life care dashboard that brings all the relevant local data together and helps commissioners to understand the situation so that they can provide for their local populations. This is part of ongoing work for this new Government to see how we meet requirements to provide dignity, compassion and service at the end of life and just prior to the end of life.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, although I pay enormous tribute to the hospice movement, there will be some people for whom end-of-life care means assisted dying. We will have the Second Reading of the Bill in November. I hope that my noble friend will be able to give strong government time, if not government support, to enable that Bill to make good progress.

[Baroness Merron (Lab)]

The Prime Minister has already reiterated his commitment to allow time for a Private Member’s Bill and a free vote. I recognise that this is an extremely sensitive issue with deeply held views on the various sides of the debate. Our commitment is to ensure that any debate on assisted dying in Parliament will take place in a broader context of access to high-quality palliative and end-of-life care and that we will have robust safeguards to protect vulnerable groups, if the will of Parliament is that the law should change.

[Lord Patel (CB)]

My Lords, the Minister mentioned funding—I am glad that the Government will look at funding—as well as the NHS England dashboard. Both are processes that do not deliver care, particularly for children who require hospice and end-of-life care. I will give an example that the noble Baroness, Lady Brinton, briefly referred to. Because NHS England has devolved funding to ICBs, average funding for ICBs supporting hospices for children is £149, with a range from £18 to £376 per case. ICBs are legally bound to deliver hospice care, but the accountability to do so is not there—and that is what NHS England needs to focus on.

[Baroness Merron (Lab)]

I am grateful to the noble Lord. I will ensure that my colleague, the Minister of State for Care, is fully aware of the comments that he and other noble Lords have made today. They will form part of our looking at the situation to make sure that services—not just processes—are provided.