Social Care Funding

Derek Thomas Excerpts

Tuesday 1st October 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I started the year encouraged by the 10-year plan and now by this weekend’s infrastructure investment. They are both welcome. Certainly, in Cornwall and on the Isles of Scilly, there is an ambition and enthusiasm for how they can use such opportunities to put right the challenges that we have. We all recognise, as has already been said this afternoon, that everything hinges on how we effectively and appropriately care for people in old age and people who need social care during their working lives.

The Minister might be interested to know something that I heard recently: care homes, including charitable care homes in Cornwall, have beds. Our urgent care centre closed its doors to new admissions not long ago because it had people in beds who needed to be elsewhere at a time when beds were available. However long we need to wait for the Green Paper—I really hope it comes soon because it is getting embarrassing now—I hope the Minister will ask searching questions of areas such as Cornwall, where beds are available in one place and individuals who should be in those beds. The system is under enormous pressure.

When it comes to the Green Paper—we have heard this already—there needs to be clarity and fairness. For example, why do we think that dementia is an issue for social care and not use NHS funds to properly care for people? As has already been said, it would lead to far better care and support for families and also reduce the burden in the cost of such care. Also, who pays? Why is it that someone who is funded by the state costs a certain amount of money, but if for some reason circumstances change and their family needs to fund their care, the cost of their care leaps by enormous amounts in just a weekend. Why, if it is state-funded, is it a matter of hundreds of pounds, but if it is privately funded, is it a matter of thousands for the same care?

Will the Minister look at some of the solutions that we are trying to bring forward in Cornwall? We have a health and care academy. There is an enthusiasm to train people in Cornwall to work in nursing and domiciliary care. Part of the challenge is that the cost of doing that, even using the apprenticeship levy, makes it not possible for everyone who wants to do it, but in Cornwall we need people to train locally so that they stay local.

Finally, I was on Scilly on Friday where urgent healthcare, GPs and social care have been brought together. A business case has been put to bring everything together in one place so that people do not need to leave the Isles of Scilly to get the care that can easily be provided at home. Again, it would reduce the cost and the pressure on the workforce, who at the moment are stretched all over the place. Will the Minister look at that plan to see how we can find some funding to make that integration become a reality on the Isles of Scilly?

Health Infrastructure Plan

Derek Thomas Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

I am grateful to the hon. Gentleman for that question and for the tone in which he asks it; it is an extremely important point and he makes it well. The investment in CT scanners and X-ray machines is an important start. It means that none of them will be over 10 years old, which is hugely important. He is absolutely right to talk about treatment, the workforce and the many parts of the system that provide effective cancer care. Although it is a specialist hospital, I recently visited the Royal Marsden Hospital in London to see the amazing research and work being done there. He is absolutely right that we must continue to promote that specialism and expertise right across the country to ensure that everyone gets the diagnosis, treatment and cancer care that they deserve. I would be happy to meet him subsequently to discuss the manifesto he highlighted.

[Derek Thomas (St Ives) (Con)]

I welcome this fantastic announcement. Our fantastic NHS staff are expected to deliver modern NHS services in buildings that were designed for a completely different era. Therefore, when considering the proposals that will come forward from Cornwall, will he pay particular attention to those that involve modern technology, so that people do not have to travel to the centre to receive diagnosis and treatment?

[Edward Argar]

My hon. Friend makes a good point. Local NHS trusts will be developing their plans and proposals on how they wish to see services modernised, but he is absolutely right and I am sure that they will have heard him, just as I have.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Stephen Hammond]

I met the hon. Lady about this disposal last December, and I have followed the matter carefully. The local health system has not wanted to continue using the site, but I am happy to assure her that I will look at bids from all comers. It is not my decision; it is a decision for local healthcare bodies and NHS Property Services.

[Derek Thomas (St Ives) (Con)]

The Minister will be aware that our general district hospital was closed to new admissions in recent weeks, and the reason given was delayed transfers of care. Ever since I was elected, many others have joined me in looking at how we can provide a step-down, step-up facility—a community healthcare hub—with beds in the St Ives constituency. I wonder what funding is available to achieve that aim.

[Stephen Hammond]

My hon. Friend is right. He will have heard me say in response to my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton) that we are already making available £3.9 billion extra to provide these facilities. We should not be complacent, however, and it is important to recognise that we want world-class facilities for world-class care. One of the benefits of the long-term plan is that we can create a stable environment for capital investment, and we can make the case for more capital investment at the spending review.

NHS Workforce: England

Derek Thomas Excerpts

Wednesday 17th July 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate the hon. Member for Wolverhampton South West (Eleanor Smith) on securing this debate on an issue that she and I have discussed—her office is near mine in Norman Shaw North—and both care deeply about.

I am glad to see the Minister in his place. He knows my constituency well and understands the challenge of getting to it. In fact, he was the first MP ever to visit me in the heady days before 2010, when I stood as a parliamentary candidate because I thought that coming to Parliament would be a great way of changing the world. I have since learned that that is probably not the case.

The credit should really sit with the people who work in the NHS. In particular, I pay tribute and send my thanks to those who work in West Cornwall Hospital in Penzance, Helston Community Hospital—or cottage hospital, for those of us who grew up there—and other places where NHS staff and others do a fantastic job in really difficult situations, as we have heard. They make sure that people who arrive for whatever reason get the best possible care.

I was keen to take part in the debate because I recognise that things need to be done. We must take responsibility for the way things are at the moment, and although I understand what the legal responsibility is and the reason for the debate, I want to understand a bit more about the solutions, too. I have never thought that all the solutions can be created, thought up or delivered here in Westminster or in any Government Department. Although real progress in integration and improving services on the ground needs to be enabled through legislation, support and encouragement, people in health and social care in Cornwall have got together and worked extremely hard for many years to deliver a system in which pathways and integration are much better than when I welcomed the Minister off the train.

One problem of many is the workforce, which is undoubtedly a challenge. There is also no doubt that the NHS 10-year plan is a fantastic document, but it depends heavily on workforce. I know that the Minister will agree and will want to ensure that we have people in place. We may not participate in this Chamber, but across Parliament, the bunfight, debate and arguments about the NHS go on, and have been taken up by people in local campaigns and the media. That has created an environment in which people choose not to nurse or do anything else in the NHS because they are misinformed. I know of lots of people who would have gone into or considered going into nursing or social care, but will not do so because the NHS is a political hot potato.

[Karen Lee (Lincoln) (Lab)]

On the hon. Gentleman’s point about people not joining the NHS to nurse, the lack of bursary is a significant issue. If someone wants to train, the bursary is really important.

[Derek Thomas]

I am addressing the point the hon. Member for Wolverhampton South West made about the importance of working cross-party, as we will in this Chamber. I will come to the bursary later.

Actually, I will come to that part of my speech now as the hon. Member for Lincoln (Karen Lee) has mentioned it. I was one of the MPs who signed a cross-party letter requesting a royal commission for the 70th year of the NHS, because I believe that although we do not have all the solutions, we should set the tone. That would help to open the door of opportunity for those who work in the NHS. I will come to the bursary, which I have already raised with the Minister; I asked him to look in particular at the impact on mature students. Podiatry in Plymouth, for example, will not be taught from September onwards. In the south west, where the incidences of diabetes and other vascular problems are significant, we need podiatrists, so that is a major problem. The reason given is that most people who go into podiatry do it later on in their careers, and one of the challenges arising from the removal of the bursary and introduction of student loans—I voted for that and regret doing so—is that those who take out the loan immediately lose all welfare and can no longer get housing benefit.

For someone with a young family who wants to study, the student loan, or the grant available for mature students, is just not enough. The Minister is aware of my view because I have raised it before, and there is work to do on that. It is not about financial incentives; it is about making it affordable for people to go and do a fantastic job. As the hon. Member for Wolverhampton South West rightly said, some people bring so much to health and social care and we need to ensure that we take away every possible barrier without creating unintended consequences. I am sure that the Minister will be pleased to address that point later.

I will talk briefly about how Cornwall is responding. I have been very keen to see what we can do in Cornwall to make sure that people can turn up, get training and work and train on the job. For people in Cornwall, most opportunities for training are outside the area, but as we know, people who go into some professions, including in the NHS, tend to stay where they train. That has always been a problem for Cornwall, which has struggled to recruit the people we need. We have set up a health and care academy using the apprenticeship levy. The academy can offer people training and jobs as healthcare assistants. There, they can do 12 hours per week working and studying through the Open University, and will become qualified nurses after four years. As they are already settled in the area and have family there, they are very likely to work for the NHS for the rest of their careers.

That is really positive, but there are some challenges and I have met the Minister to talk about them. One of the challenges is that for hospitals—in this case Royal Cornwall Hospital—to provide that kind of support, they need extra cash. It is not just about the apprenticeship levy, which they want to use and not repay, but about staffing 100 nurses and 100 healthcare assistants at a time, and providing pastoral support and other elements that come with training up staff on a ward or in a hospital. An added pressure is that for a hospital without the staff that it needs, really excellent healthcare assistants are no substitute for fully qualified nurses with a wealth of experience.

There is a problem in this place. I am a skilled craftsman in the building trade but I have put my tools away, despite the desperate need for skilled craftsmen in Cornwall. In this Chamber and across the House, we have lots of GPs and talented nurses. For some reason, we decided to pitch up here instead of continuing in our valuable jobs. I think that we are part of the problem. I am not suggesting that we should all pack up and go home, although we might get more done if we did, so we should consider it.

[Eleanor Smith]

I get what the hon. Gentleman is saying, but I worked for 40 years in the health service and it was because I saw its deterioration that I came to Parliament to say, “This is what’s happening.”

[Derek Thomas]

I said that in humour, which is why I talked about my own skill—or lack of. It is a curious thing, though, to hear people talking about the crisis in staffing when so many of them are in this place.

On a more important note, we are in a tricky situation with the challenges around the apprenticeship levy. In Cornwall, we hope to train 200 nurses using the apprenticeship levy over the next two years—that would address the shortage—but we have to recognise that funding is needed and I know that the Minister is looking at that now.

[Paul Girvan (South Antrim) (DUP)]

Will the hon. Gentleman give way?

[Derek Thomas]

I will when I have finished this point. Whatever the solution, we must recognise the added pressure on existing staff.

[Paul Girvan]

On that point, it is all very well getting nurses into and through training, but in Northern Ireland the NHS is haemorrhaging nurses who are not leaving the profession, but going into agency work, getting paid two and a half times more than they were and working the hours that they want. Not only is workforce planning impossible when people can just work when they want, but we lose continuity of care in wards.

[Derek Thomas]

I appreciate that valuable intervention. I had a conversation with the former Secretary of State for Health about how, when the student loan was introduced, there might have been a way in which students had all their loan written off if they gave seven years’ service to the NHS. The advantage of that, to be honest, is that people who had done seven years after qualifying would probably have settled down by then, entered into a home purchase and perhaps had family, so they would have been, first, less likely to clear off to another country and, secondly, kind of tied into the NHS where they were.

In part, that addresses the problem the hon. Gentleman raises. Yesterday, I met a newly qualified nurse from the south-west who found that on Christmas day she was the leading NHS nurse, supported only by agency staff. That must stick in the back of NHS staff’s throat, when they know that extra pay is available to agency staff. Efforts have been made to address that, and there must be ways to do so, but that is what we are getting at today—the workforce challenge.

If we have a workforce challenge, other things will happen, such as agencies springing up and the demand for them. We have to get to a place where working for the NHS as a nurse employed by the local trust is the best and most rewarding place to be, and appreciated by all. We simply do not say often enough how great such people are. We can do so many things locally and nationally to rebuild value, trust and appreciation in those people. The challenge for Health Education England is to look at how we fund local innovative ideas, ensuring there is enough money, as well as flexible support, to find solutions. I discussed that with Simon Stevens, and he seemed alert to the challenge.

As I said, I met nurses from the south-west yesterday, and they were concerned about safety on wards and retention of nurses. We have this bizarre circle spiralling downhill: if nurses do not feel safe, they go to do something that might not be nursing. Unfortunately, in places of low unemployment, lots of other work and employment opportunities are available, often paying more.

Solutions are possible. In Cornwall, I have found that people often do not know what is available. The Royal Cornwall Hospitals NHS Trust and other trusts in Cornwall, my local college and I got together to work on an event in the college called “Work for the NHS+”, which included 15 or more different parts of the NHS, as well as some from social care. They came along to tell students and the general public what the employment opportunities were, the pay and training that could be expected, and what kind of career paths were available. In Cornwall, as in many other parts of the country, there are some fantastic members of staff and people in the NHS and social care who can inspire others. This might sound ridiculous in a debate on shortages on a ward, but when we have such individuals, we must find opportunities to get them in front of people who are thinking about which career they should choose.

I do not know much about the other challenging problem raised by the nurses yesterday, but it is right to mention it. They said that although more nurses are training, training placement opportunities are fewer. They suggested that part of nurse training now is off the ward—obviously that has happened before, but they were concerned about whether that virtual training or simulators were the same. I know that the Minister will take seriously all opportunities to get nurses trained in the best possible way, so I will not dwell on a subject that I do not know much about.

I mentioned the issue to do with podiatry, which is a real problem in the south-west. We must find ways to help professionals, whatever they do, whether therapy, physio or all the things that people to do to ensure that we stay well and do not end up in hospital. Podiatry is one of those. We must ensure that people get the training, that they can afford to do so, and that they can have a great career in the NHS or with local authorities. We need to talk to universities about exactly why they are not attracting the kind of numbers they need to justify the courses.

I should have declared an interest at the beginning: I chair the vascular and venous disease all-party parliamentary group. One thing I am being told loud and clear—I have done a lot on this—is that because we have taken the nursing bursary away from older students, they find it difficult to go on the courses that I am describing. That will have a real impact on the numbers of nurses available to do those important jobs. If we do not address that issue, in a place such as Cornwall, where diabetes is a significant problem, the pressure on urgent care will be enormous—if it is not already.

Last week, our general district hospital—the only one in Cornwall—closed to the public, because a spate or outbreak of vomiting and diarrhoea put a lot of people from nursing homes and others into hospital. In that situation, the system rallied and did some amazing work to cope, ensuring that no one who needed care was failed, but it was also an example of why we need to work equally hard, if not harder, to ensure that at the best of times and the worst of times people get the best healthcare available.

The NHS in Great Britain is the envy of the world. We need to be careful always to remember how fantastic our system is. Last week, my brother and his wife came back from Cambodia with stories of trying to get healthcare there—they have two young children—and that reminded me of how fantastic our health service is, as are all those who work in it.

Health

Derek Thomas Excerpts

Tuesday 14th May 2019 Commons Chamber

[Derek Thomas (St Ives) (Con)]

We are talking about preventive health care, and I want to focus on podiatry and its workforce. This place has supported changes to the nursing bursary, and I continue to support those changes for students, but they are having an impact on mature students that I do not think was intended. We all have feet, which we need to look after, and if professionals help to take good care of our feet, it can avoid problems in the future. We all need the podiatrists and others who work to care for our feet.

Plymouth University has recently announced that because of changes in applications for its podiatry undergraduate programme, it will be unable to run the course from September, so in the south-west, especially Cornwall and Devon, no one will train in podiatry. We all know that when people train in an area, they tend to stay there.

[Rebecca Pow]

The diabetes foot pathway relied on opening eight podiatry clinics across Somerset. Does my hon. Friend agree that it is the podiatrists who are helping to solve the diabetes problem?

[Derek Thomas]

I completely agree with my hon. Friend, and I attended a conference 18 months ago at which the podiatrists and Plymouth University mentioned the risk of this happening. We are now seeing that prophecy being fulfilled. I appreciate what my hon. Friend says about what has been done to improve the pathway and reduce lower limb amputations. We must not see that good work reversed.

When it comes to caring for our feet, we are heading for a perfect storm. Fewer people are going into training because of financial barriers, and in 10 years we will see an enormous amount of podiatrists retiring from the profession. That adds up to a real challenge that we need to address quickly. I ask the Minister to look at what has happened since the nursing bursary was removed for mature students and whether we can address that.

The impact on patients is severe. Type 2 diabetes is the fastest growing health threat facing our nation, and 3 million people are living with it. That figure is set to reach 4 million by 2030. Diabetic foot care costs the NHS in England between £1.1 billion and £1.3 billion a year—£5.7 million per clinical commissioning group. It accounts for £1 in every £100 spent, more than the combined cost of three of the four most common cancers. Some 80% of the 135 lower extremity amputations each week in England are preventable through good foot care, and the Government have made a commitment in legislation and policy to provide safe care. That is just one example of how, if we do not get this right, we will fail to avoid the impact on patients of more lower limb amputations and lower life expectancy. The facts show that after a lower limb amputation, life expectancy is reduced to about five years.

There is also an impact on the NHS. I have mentioned the sheer cost of caring for lower limb problems, and it will have an impact on multidisciplinary teams if we do not keep people with the skills coming through. It will also have an impact on budgets. As well as the impact on social care and on the budgets for those delivering support in people’s homes, making changes around a home because someone has had a lower limb amputation is a costly affair that is easily avoided if we get it right and get enough podiatrists on the ground.

There is an urgent need for action. I ask the Government to look at why mature students are uniquely impacted when going to study these important professions. If a mature student is on any sort of benefit—housing benefit or other financial support—the minute they take out a student loan to study to be a podiatrist, they lose all that support. Perhaps the Department of Health and Social Care and the Department for Work and Pensions need to look at that, because that is a significant barrier to people coming into a skill we so badly need.

I ask the Minister to look at solutions to reverse the reduction of mature students going into important parts of the NHS such as podiatry so that we can save money for the future, to be used where needed, and provide a real opportunity to improve people’s lives.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

No. The NHS long-term plan has a whole swathe of policy to reduce health inequalities. The best thing we can do to reduce health inequalities is ensure that more people are in work, and the record number of jobs that have been delivered is a vital part of that agenda.

[Derek Thomas (St Ives) (Con)]

2. What steps his Department is taking to ensure that the NHS has the workforce that it needs to meet the objectives of its 10-year plan.

[The Minister for Health (Stephen Hammond)]

The long-term plan sets out how we will make the NHS a world-class employer and ensure that the NHS has the people that it needs. The NHS, led by Baroness Harding, is engaging with people across the sector to develop a people plan. That plan will set out how the challenges of supply and demand reform can be met, and it will be published in the spring.

[Derek Thomas]

I thank the Minister for that response. In Cornwall, we have set up the Health and Social Care Academy, and we use the apprenticeship levy to enable local people to train within the NHS service or social care wherever they want to. However, there are many restrictions around the levy, and I wonder if the Minister will meet me and others to discuss how the levy can actually be about training and supporting people into the NHS, rather than just restrictions about paying fees.

Health Inequalities

Derek Thomas Excerpts

Wednesday 20th March 2019 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I congratulate my hon. Friend the Member for Telford (Lucy Allan) on securing the debate. This is such an important subject. A Cornish MP absolutely understands health inequalities and the lack of funding to target them. In Cornwall, there is no shortage of examples of health inequalities. I will mention just a few issues: vascular disease, including diabetes, kidney disease, dental health problems, skin cancer, diagnosis times for people with severe conditions, including ankylosing spondylitis—I chair the relevant all-party parliamentary group for that—and mental health services. It is clear that in Cornwall there are inequalities in all those areas.

My hon. Friend was right to address the need to allow funds to be targeted towards health inequalities. As a Member for Cornwall, which has long been underfunded compared with the rest of England, or at least the English average, I fully support that. However, in the short time that I have this afternoon, I would like to address a different aspect of health inequality—dementia. Dementia is a disease, but it is not primarily treated by the NHS. It is a Government commitment to provide NHS services free at the point of use. If someone has a stroke, heart problems, cancer or flu, the NHS will treat them free of charge. If someone has dementia, a recognised disease, it can cost tens of thousands of pounds—I learned today that it can cost up to £100,000—to get the care that they need.

I am suggesting that it would be in the interest of the Government, the Department of Health and Social Care and certainly those who are concerned about social care budgets to make dementia an NHS problem, rather than a problem for social care. According to the Alzheimer’s Society, which is about to launch a call for a fund for dementia, 50,000 avoidable hospital admissions happen simply because we do not adequately care for those with dementia or for those who care for them. Failing dementia care services could be avoided. According to independent reports, 23% of all services for dementia are failing. That sounds quite dramatic, and it is dramatic when one sits with a person who has cared for a loved one and who has also been in hospital because she cannot cope with being awake every night and trying to ensure that her husband does not turn on the stove, fall out of bed or fall down the stairs. Where we have failing services, because the issue is not properly dealt with within the NHS family, we really have problems and we cannot fully understand how severe the problems are.

People who treat dementia patients would be adequately trained if this disease were brought within the NHS window, the NHS envelope. We would be able to ensure that everyone who cared for someone with dementia was adequately trained. Independent reports say that 38% of carers who care for people with dementia have not been trained in the disease or all the things associated with Alzheimer’s or dementia.

I have welcomed and am so pleased with the commitment to the 10-year plan for the NHS. It is time, and this is an opportunity, to address health inequalities and to treat dementia as a disease within the NHS and one to be treated by the NHS. I would therefore like us, as we develop the plan, to create a recognised pathway of care for those with dementia and to ensure that all those providing care are adequately trained in dementia care and all that goes with it. Clearly, that will have a cost, but I believe that it is the right way to care for people, many of whom have served this nation for such a long time during their lives.

My father-in-law suffered full frontal dementia for many years—for 10 years—and it was such a battle to get the support that he needed. Even when he was completely dependent and could not do anything for himself, he was still cared for within social care and not the NHS. That was the case right up to the day he died, even though he died of pneumonia. That was a few years ago, but it is one example of how we do not fully understand dementia. Stories are hidden at the moment, but by dealing with dementia within the NHS as a disease, we could really help people to reduce so much of the harm and the inequality that we have talked about. We could do something fantastic and make better use of the money that is available to care for those we all care about.

--- Later in debate ---

[Jackie Doyle-Price]

I have been in close consultation about that issue with the recently departed Minister of State for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton). She has really challenged the DWP to look after people who are vulnerable, and put in place safeguarding policies for them, so I confirm to the hon. Member for Central Ayrshire that that discussion is taking place.

My hon. Friend the Member for St Ives (Derek Thomas) raised the issue of dementia. Clearly, dementia has a big impact on the number of years in which people can enjoy a healthy life, and we must get that right. For that reason, we have introduced the ageing society grand challenge, which is focused on narrowing those inequalities. My hon. Friend is right that we must have better integration with social care; there have been a lot of moves towards better integration between local authorities and the NHS, and that must continue.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) referred to public health cuts. We have tackled those through the NHS forward plan, and have said that this is an area in which we expect the NHS to focus and work collaboratively with local government, specifically highlighting health visitors and the wider public health agenda. My answer to the hon. Lady’s point is “watch this space”, but we recognise that we spend less if we spend wisely, which has to be about getting the system to work better.

[Derek Thomas]

rose—

[Dr Whitford]

rose—

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 19th February 2019 Commons Chamber

[Mr Speaker]

Order. Mr Luke Graham, calm yourself. You aspire to statesmanship, and I wish to cultivate and hone that legitimate aspiration—calm, Zen, statesmanship!

[Derek Thomas (St Ives) (Con)]

On Friday, I was privileged to take part in the launch of the health and social care academy in Cornwall. Cornwall NHS and social care providers have come together to train local students, including mature students, within the local health and social care provision without student tuition fees so that they can secure a job in Cornwall. May I invite the Minister to come and see the work we are doing and welcome this local innovation that is helping to address the NHS workforce challenge?

[Stephen Hammond]

My hon. Friend rightly points out that there are several routes into healthcare professions, and I am delighted by what is happening in Cornwall. I understand that my right hon. Friend the Secretary of State will be visiting him in the very near future.

Hospice Funding and the NHS Pay Award

Derek Thomas Excerpts

Wednesday 31st October 2018 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I thank the hon. Member for Heywood and Middleton (Liz McInnes) for securing the debate. “Fantastic” is probably the wrong word to use, but this is an important opportunity for us to speak about the great work that hospices do, the part that they play in all our local communities and how they help people and their families at the most difficult times of their lives. It is an honour to take part in the debate. I want to talk about the role of hospices, how they contribute to the desire to integrate health and social care and, as a result, how they must be funded to deliver the great work that they do.

This may seem a strange thing to say, but I have spent my most special moments at the bedside of someone in a hospice. Over the years and even as an MP, I have taken the opportunity to sit alongside people and their families in our local hospice, St Julia’s, which is just on the edge of my constituency, and I always leave with an incredible sense of gratitude for the work that the hospice does and how it helps people at that difficult time. It helps people to live and die well, which is what I am sure we would all love to be able to do when the time comes.

Let me explain what I have learned in recent years. Even now, the word “hospice” assumes that that is where we will die if we have—dare I say it—the right kind of illness to justify that, but I am learning that hospices are actually far from just places to die. People can go into one when they are very sick and come out a week or two later, having had various things done to help them, to get their body working again and to identify the right medicine. Hospices can give people time to work out what medicine or drug is really the right one for them. My mum was ill for a very long time. She was given a few weeks to live, but actually lived for more than a year. She spent 10 days in a hospice when we really thought it was the end and then she went on for a good six or seven months after that, simply because the hospice was able to correct her medication and—well, “flush her out” is probably the way to put it. It was lovely to come together as a family and sit alongside her, and to give my dad a break; he had about 10 days of really important respite. The hospice movement across the country, in my constituency and across Cornwall is fantastic. When I go there, it is a different experience from when I go to sit beside the bed of someone in an urgent care setting who is also reaching the end of their life.

In Cornwall, we are learning that hospices are not just about taking people in the closing days or months of their lives, but about alleviating pressure on urgent care by taking people out of a ward where it is not really appropriate for them to be in their last few days, and on community care. In response to trying to get the money it needs, our hospice has done a great bit of work by going out to homes and supporting people there in their last few days and weeks.

The point is that, by properly funding hospices and all the work they do, I am convinced that we would create a saving for the wider NHS as well as the beds that are needed for other people. That is important in my constituency, because our main hospital is in special measures—“requires improvement” is where we are at the moment—and one area of that is about palliative care. The frustration is that there is a desperate need for beds in the hospital, but in the hospice, beds are available all the time. It is simply about a lack of commissioning joined-up thinking and working together, and not having enough money in the hospice system.

Hon. Members have given various quotes about how much NHS funding hospices receive. Some time ago, my first question in Prime Minister’s questions, when the then Chancellor was replying, was about how little Cornish hospice care was funded. At that time, about 11% of the money came from the NHS. That is in a part of the world where there is a lot of deprivation and average earnings are low, so the rest of that money was being found by people who were not awash with cash. I do not know that it has improved much since; we are still one of the areas that receives the least money for our hospice care.

That is frustrating, because people are dying in the urgent care centre who should be in a hospice. Three weeks ago, I spent time with a family who were desperate to get their mum out of my local hospital, which is part of the urgent care set-up. I do not want to be unfair to the hospital team, but unfortunately, they were so keen to get the lady home that they waited for care packages that did not arrive, and she died in the hospital when she could have been in the hospice.

[Melanie Onn]

I thank the hon. Gentleman for making that important point, which raises an issue that I have had with a constituent. His wife was sent home supposedly well after going into hospital for urgent treatment but sadly she died two days later. Going to the local hospice, St Andrews, would probably have been a much better option for her, but it had not been thought of in that process.

[Derek Thomas]

The hon. Lady is absolutely right, and I have heard several stories where that has been the case. Separate to the debate, there is an obsession—I use that word because it might get the Minister’s attention, although it may be the wrong one—with getting people home at every possible opportunity. When I sit with those people, some of whom are desperately lonely, I ask whether that is right for them or whether hospices, community hospitals and other settings would be more appropriate. I want us, as leaders and politicians, to be careful not to create an assumption that home is always the best place, because I do not believe that. It certainly was not for my mum in the last days and weeks of her life.

Addressing some of the challenges requires an uplift in the funding available to hospices across the board, and we must pass on pay increases to nursing staff. I say again that when I go into my hospice, the working environment is very different from that in the urgent care centre, but I have already said that Cornwall is a low-wage area with a high cost of living due to the beautiful environment that we live in, which attracts people and pushes up the cost of housing. It is expensive to live in my part of the world, so nurses are not choosing to leave the hospice setting because they prefer urgent care—obviously, we need them there as well, so I am not trying to discourage that—but because they need the money to live. We should not be saying, at any stage, “It is okay, because hospices are a different environment to work in and they might prefer it there, so they will settle for lower wages.” I hope that we would never assume or expect that.

I met the chief executive of Cornwall Hospice Care soon after the pay award, and he expressed concern that the money being offered to NHS nurses and staff would have a negative impact on hospices and other parts of the system where people are not directly employed by the NHS. I agreed to raise that in the House at the first opportunity, which I have done, and I am grateful for this opportunity to do so as well.

I know that I am among friends when I say that the value of hospice care is not underestimated. The work that hospices do for children and adults is fantastic. They are an essential part of bringing health and social care together and ensuring that people are cared for in the right setting and as close to home as possible. We all know that it is better to be near our families, whatever our health situation, and certainly during the last moments of our life.

As I have said, people are dying in my urgent care centre, which has already been judged as poor for palliative care, when there are beds in the hospice not far away. That must be addressed, and I want the Minister to intervene to put pressure on the system—or systems, at the moment—on the question of why we cannot do more. There has been progress in the last three years towards working better together, but making the right decision is painfully slow for somebody who does not actually have the time for that decision to be made. There have been improvements in working together, and the managers in all the systems in Cornwall, including the hospices, have healthy relationships, but things seem to be getting stuck at ward level, so patients are potentially not getting the best care.

As I have said, hospices now do fantastic work in the community, which has been a response partly to funding but also to need. They are going out into people’s homes to help families and individuals to manage their care properly. I have made fairly clear the two things that are needed to help hospices to deliver that vital role. In the discussions around the NHS pay award, what engagement opportunities have the Minister and the Department had with hospices? Have they been included in discussions about how that can be addressed and passed on? I would love the Minister to look closely at the situation in Cornwall, which will be true elsewhere too, where the money available for hospices is not enough. That is a choice made at a local level by commissioners, not the Department.

We should also assess whether we are making full use of what is available in hospices. If there are 12 beds with people in who are being cared for in the right place, that care is far more cost-effective than if there are eight beds, as is the case in my local hospice. It is not just about throwing more money at hospices, but about making better use of resources. That will reduce the cost of care while ensuring that those people, who have such a challenge ahead of them in the days and weeks to come, are given the care, love and attention that they absolutely deserve and that we would expect in the great nation in which we live.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Caroline Dinenage]

I am really pleased that the hon. Gentleman has raised this issue. Plymouth is indeed leading the way in creating hubs and showing how incredibly valuable they are in bringing together all the relevant services in one place, not only to tackle people’s current healthcare needs but to play a vital role in prevention.

[Derek Thomas (St Ives) (Con)]

Health and social care hubs provide a real opportunity to ensure that patients are cared for in the right place, and it is vital for that to be extended to those who need palliative care. Can the Minister confirm that the NHS 10-year plan will adequately address the need for equal and appropriate access to palliative care across the country?

[Caroline Dinenage]

My hon. Friend is absolutely right to mention this. Palliative care is crucial to the experience not only of patients but of their families and carers. He will be interested to know that we have a new indicator from 2018-19 to measure the proportion of people who have had three or more emergency admissions in their last 90 days of life, which will help us to assess how people can be better supported in the community, and to do that better.