Ageing and End-of-life Care

Anna Dixon Excerpts

Thursday 30th October 2025 Commons Chamber

[Anna Dixon (Shipley) (Lab)]

I thank the hon. Member for Strangford (Jim Shannon) for securing this debate, and I draw the House’s attention to my entry in the Register of Member’s Financial Interests. I am an officer of the all-party groups on carers, and on housing and care for older people, and I was formerly chief executive of the Centre for Ageing Better.

As ageing is a subject close to my heart, I decided to check out my latest personal life expectancy projection according to the Office for National Statistics life expectancy calculator, and it turned out that I have a one in four chance of living to 95. Many people would think, “Oh, how fantastic!” Yes, we all want to live longer, but not everybody will enjoy that same life expectancy. We know that there is a significant gap—about 19 years—in life expectancy between the most and the least deprived. That gap is reflected across the country, as well as in my own constituency, between Wharfedale and Windhill and Wrose.

Despite the tech bros trying to defy ageing and death through all sorts of techniques, in reality we are mortal and we will all face death at some point. More of us will die at older ages because of increased life expectancy. To be honest with hon. Members, death is a boom industry, and if they have not already invested in a funeral director, that might be something to look at. The post-war baby boomers are now in their 60s, 70s and heading into their 80s, so more of us will be dying in the coming decades.

Society needs to change in a number of ways to respond to our ageing society. Departments across Government are looking at related issues, including working for longer, which is a matter for the Department for Work and Pensions, and ensuring that we build new homes that are accessible. I will be speaking to the Minister for Housing and Planning, who summed up in the previous debate, about bringing in new regulations to make homes more accessible.

In addition, we need to reform end-of-life care. By 2050, it is projected that an additional 147,000 people will die per year, bringing the total to 745,000 per year. As the hon. Member for Strangford said, the people who miss out on end of life care are more likely to be older, from black and minority ethnic communities, from lower socioeconomic communities or to have a non-cancer diagnosis. There is a lot to do to close the gap in access to palliative and end-of-life care, particularly for older people.

An example of really good practice in Bradford is the REACT model—the Responsive Emergency Assessment and Community Team model. If you have not already visited, Madam Deputy Speaker, you may wish to do so. It is a partnership between the Marie Curie hospice and Bradford Royal infirmary. A palliative care doctor is embedded in A&E, so when people who are at the end of life are hitting the accident and emergency department, they get an intervention, assessment and referral back to a proactive multidisciplinary community-based team. The results are staggering in reducing the number of hospital bed days that people at end of life experience.

As we have heard, most people do not want to die in hospital. I commend the shift that this Government are looking to make from hospital to community, which I hope is as true around end-of-life care as around other services. However, there is a huge lack of consistency between integrated care boards in how and what they commission. There is much to do to support better care in the community, including providing better support to GPs, particularly those with a specialist interest in end-of-life care; having district nurses working more closely with primary care teams and embedded within the new neighbourhood health teams; more examples of hospice at home and multidisciplinary community teams; more training for care home managers and staff; and the innovative use of unused hospital wards to provide hospice services in hospital, where appropriate.

As has been mentioned, we must ensure that there is a 24/7 hotline for patients and, importantly, for their carers, so that when they find themselves in crisis at home, they can get access to the advice that they need. The National Institute for Health and Care Excellence has said they should have had access to such advice since 2011, but according to Marie Curie, only one in three areas has such a 24/7 hotline.

While there are examples of good practice, there is much to do. It is good news that more of us are living longer, but society has to adapt. I am pleased that we are doing things as a Government—we have a pensions commission and the Casey review looking at social care—but I say to the Minister: now is the time to have a national strategy for palliative and end-of-life care. We are an ageing society and we need that, along with reform of continuing healthcare. In his response, I hope he will set out how we ensure that everybody dies well in old age and has a good death.

--- Later in debate ---

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I yet again thank the hon. Member for Strangford (Jim Shannon). He should be proud of Mona Shannon, and she will be proud of him not just for raising this topic today, but for all the work he does across this House talking about health, because he is assiduous and dedicated to timely health interventions, and that should be applauded across the House and this nation. I am indebted to him for securing this debate.

In the hon. Member’s speech, he mentioned who he had spoken to. I, too, have met the organisations Sue Ryder and Marie Curie, including at party conference, and I have met many other organisations, including LOROS and Rainbows, that cover my area. When I saw the title “Ageing Community” for this debate, I must admit that I thought the hon. Member should have applied for a five-day debate, considering what we could cover. I also notice the expertise in this debate. We have a secondary care surgeon, someone with public health experience at the back and me as a GP. It is turning into a multidisciplinary team, and there is a lot to unpack, whether it is prevention, mitigation, healthy lifestyles or looking at the best examples across the world. I recently travelled to Japan and Korea and saw how they look after their elderly and their approach to the lifestyle of the elderly. There is a lot to be learned out there, as across the world we all grapple with an ageing population.

There are other topics that we could talk about, and some were touched on. On social care, it is a shame that there has been a change from cross-party talks to an independent commission. I note that Baroness Casey is being taken back to the Home Office, which means she is spread thinly. There is a wider debate to be had on social care, which is: what do the British public actually want? Often we look at the Scandinavian model, but say that we do not want to pay the taxes for it. We want the household or family approach, like the Bangladeshi or Pakistani model, but we certainly do not actually want grandma or grandpa coming to stay with us and we want to stay working. Therein lies the problem in British culture. We are not 100% sure what we want when we cross over from the NHS into social care, and we are not sure how to provide it.

Some hard evidence of policies on an ageing community has been talked about, and unfortunately I have to raise the issue of winter fuel. In the Government’s analysis when they took away winter fuel payments—despite all the warnings—they knew that it would put 50,000 people into absolute poverty and 100,000 people into relative poverty. We can contrast that with the Opposition and our recent announcement on stamp duty. Jackson-Stops estimates that in the first year alone, up to 500,000 people above the age of 55 would consider downsizing because of that policy. I do not call that downsizing, as we heard in the debate on stamp duty—it is right-sizing, because it gives a real chance not only for more families to go upwards, but for people to move into more appropriate accommodation as they age.

There is a lot to be said in the debate about an ageing population, as the hon. Member for Shipley (Anna Dixon) pointed out, but I will focus my comments on the three questions that I think I caught from the hon. Member for Strangford: the assessment of the need for a national strategy for palliative care; what the Government are doing to ensure that palliative care is included in neighbourhood health centres; and the progress being made on 24-hour support.

I will start with the national strategy and funding, and let us give credit to the Government where it is due. When it comes to children’s hospice funding, they have continued the payment and extended it, which is welcome, although it does not offer enough mitigation for national insurance contributions. The Government will say that when it comes to adult funding, they have given £100 million. That is capital funding, though, and as one hospice worker put it to me, there is no point in having new curtains and a lick of paint if there are no staff.

As the Liberal Democrats pointed out, the National Audit Office report on the hospice sector that came out only yesterday states:

“DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector”,

or what the real impact of Government funding is. It continues:

“In 2024-25, 11 independent adult hospices in England reported service reductions or staff redundancies, and other hospices announced plans to reduce services, in response to reduced income or increased costs. Cuts appear to be across all types of services offered by hospices. Most hospices reported the increase in the costs of service delivery within the palliative and end-of-life care sector as being the primary reason for service reductions…Six hospices have been designated by ICBs as ‘commissioner requested services’, a mechanism to forewarn ICBs of potential difficulties with services that, should they discontinue, would have significant impact on the local population”.

Hospice UK responded to that, saying:

“unfortunately the whole hospice sector is…struggling, just as demand for their services is rising. Surging costs mean 2 in 5 English hospices are planning cuts this year, and 20% ended last year with a deficit of over £1m.”

What does that actually look like in real life? In my area, LOROS is facing a deficit of £2 million. It has already had to reduce its in-patient capacity from 31 to 20 beds, and it is reducing its day therapy and cutting its physiotherapy, occupational therapy, social work, chaplaincy and complementary therapies, and closing the volunteer home-visiting service.

It is not just my region that is affected: a cursory look at Hansard will show that the Kirkwood hospice in Kirklees has made 19 redundancies; the Ashgate hospice in Derbyshire has 52 jobs at risk, with beds cut from 21 to 15; St Catherine’s hospice in West Sussex is looking at 40 job cuts, with half of its new rooms being mothballed; Weston Hospicecare—highlighted both here today by the hon. Member for Weston-super-Mare (Dan Aldridge), and by others, including my hon. Friend the Member for Bridgwater (Sir Ashley Fox) at other times—faces an increased national insurance bill of £139,000; the Arthur Rank hospice in Cambridgeshire is losing £829,000, which is forcing the closure of nine beds, 40% of its capacity; and Marie Curie has pointed out that its national insurance contribution costs have risen by £2.9 million.

Through all this, we have still never heard whether the Health team knew that this was going to happen and chose to push it through, or whether it was simply an oversight when it came to challenging the Treasury. Ever since the Budget, we have never heard an answer to that. At the time of the Budget, the CEO of Marie Curie, Matthew Reed, said:

“The Health Secretary himself has acknowledged that palliative and end of life care is not good enough, so we are shocked by the lack of measures in the budget to fix it. Palliative care needs are projected to rise by 25% over the next 25 years, around 147,000 more people each year, yet this government lacks a strategy to tackle the magnitude of this challenge.”

Have the Government made an assessment of how much the NICs increase has impacted the hospice sector? As has been mentioned, Together for Short Lives estimates that the average hospice is facing a bill of about £133,000.

I raised a lot of these questions in a debate in January, and the Minister for Care kindly wrote to me in response. It is not just about the financial side; we are looking at the structural aspect too. He wrote:

“As you are aware, integrated care boards…are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. In addition, the National Institute for Health and Care Excellence…has published quality standards and guidelines to support commissioners to carry out this duty. While the NICE guidelines are not legally binding, they act as a regulatory benchmark for best practice in palliative and end-of-life care…Whilst the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.”

So there is a grey area about where hospices are covered, and that fits in with the NAO report.

[Anna Dixon]

As the hon. Member rightly says, ICBs are under a legal duty to commission palliative care services. Does he not recognise that the problems we are having, not just with hospice care but with the lack of availability of palliative and end-of-life care, often come down to poor commissioning—ICBs failing to commission in line with that statutory guidance—and the confusion that arises between charitable donations and that which should be commissioned by the NHS?

[Dr Evans]

The hon. Lady is spot on; that is exactly the point that I was getting at. While there is a legal duty in terms of palliation, what that palliation looks like is important. Her question was also raised by the hon. Member for Strangford, who asked whether it is now time to have a strategy dedicated to palliative care, given the rise in demand.

The letter goes on to say:

“Charitable hospices are autonomous organisations that provide a range of services that go beyond that which statutory services are legally required to provide. Consequently, the funding arrangements reflect this.”

We are in a grey area, and a palliative care strategy could well be a way to unlock this problem. I will be interested to hear what the Government have to say on this issue.

However, it is not just about finances and commissioning; it is also about the workforce. That is partly addressed in the letter:

“As set out above, we have committed to develop a ten-year plan to deliver an NHS fit for the future. This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”

By my calculations, we are coming up to Halloween and even bonfire night, and we still have not seen a workforce plan. My question to the Government is: when are we likely to see that?

That leads me on to my next point: how do the Government intend to ensure that palliative care specialists are included in neighbourhood health centres? The 10-year plan is laudable, and I think there is agreement across the political spectrum on its contents, but the one thing it is missing is a delivery chapter. How are we going to do it? The shift is correct, but we do not know how we are going to get there, so I would be grateful if the Minister could address that. The 10-year plan explicitly talks about public-private partnerships, and there is concern on both sides of the House that we could see PFI mark 2. If Members need to have their memory jogged, private finance initiatives brought in £13 billion to build hospitals and services, but at a cost of £80 billion to taxpayers.

Why does this all matter? In my last few moments, I will turn to the final question that was posed by the hon. Member for Strangford, which was about access to 24-hour support. I will quickly read out a couple of comments from one of my constituents, whose husband Mat sadly passed away from a brain tumour. She highlights this issue:

“During the day, the support was outstanding because I could call the community nurses and the palliative nurses, and they would always call me straight back. They would visit Mat daily to administer the medications needed in his syringe drivers. They were kind, caring and so supportive to us and our family.

The night times were different and frightening. Often during the night when I was trying to get support, he could see how scared and stressed I was, which made him more scared, often telling me he was okay just to try and not make me worry. Every night I used to be thinking what might happen tonight—will Mat have another seizure? Will he be in so much pain again? Will they call me back if I need support? How long will it take to get help to arrive?”

Marie Curie points out that only seven of the 42 ICBs in England have a single point of access. I raised this issue with the Minister in a letter in August, and he kindly responded in September. He pointed out that integrated care boards must commission on this basis. There is NICE guidance on “End of life care for adults”, under quality standard 13, and on “End of life care for adults: service delivery”, under NICE guideline 142, which talks about the fact that there should be some form of 24-hour care, but at no point did the letter address the issue of the phoneline. When I asked the Department about data, I was told in a letter:

“Regarding data about palliative care helplines, such as average waiting/response times, the Department does not collect or hold this information.”

Will the Minister look at that and consider whether the Department should hold such information?

The letter went on to say:

“We recognise that more could be done to support the palliative and end-of-life care sector. I have tasked officials within the Department and at NHS England to look at how improving the access, quality and sustainability of all-age palliative and end-of-life care to ensure that their proposals are in line with the ten-year plan.”

I would be grateful if the Minister could ask the Minister responsible whether there is indeed an update and what that looks like. At the end of the day, we are concerned not necessarily about inputs, but much more about outputs.

We know that death is certain for us all; only our willingness to face it seems optional. This is very much a British mentality, and I believe we need to change that when it comes to talking about death and our mortality. We need to speak more openly and candidly about what an ageing population looks like, for that is what we are. That is why the hon. Member for Strangford brought forward this debate, and he reminds us that we chase the days ahead while never quite noticing how swiftly they turn into years behind us. That leads me to reflect on the fact that, as politicians and as a society, we build a world to live longer, yet we all too easily forget to ask: how do we want to grow old?