Hospice Funding

Bambos Charalambous Excerpts

Monday 22nd April 2024 Commons Chamber

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I thank the hon. Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this important debate.

Hospices do incredible work. In communities across the country, they hundreds of thousands of people every year with essential palliative and end of life care. The services that hospices deliver are absolutely crucial to improving the quality of life for people in their final weeks and days, helping to provide a dignified, comfortable and compassionate end of life. That support is vital not just to people at the end of their lives, but to their family and friends. End of life care impacts not just the patient but all their loved ones, and the specialist support that hospices provide patients in their final stages of life, and their families who are watching them pass away without suffering or pain, is immeasurable. It is why hospices are so important.

In my Enfield, Southgate constituency, we are lucky to have a facility of the incredible North London Hospice, which has been caring for people since 1984. Its health and wellbeing centre in Barrowell Green helps to enable the best of life at the end of life for people across the boroughs of Enfield, Haringey and Barnet, providing tailored care, including physical, emotional, spiritual, wellbeing and bereavement support for patients, friends, carers and loved ones. I must also mention those in the wonderful North London Hospice photography club, who support each other and take amazing pictures, which they sell to raise funds for the hospice.

I remember hearing from a constituent of mine, Joy Watkins, who was receiving care and support at the hospice. Joy has sadly now passed away, but her words about the importance of the hospice and the care that she received were incredibly moving. Joy spoke about going to something called a death café—an informal space for people to talk about end of life, share their concerns and listen of others express their thoughts, hopes and experiences of death. She said that going to the death café enabled her to make choices about the end of her life. She could make choices about who to spend time with and about the finances that she would make use of at the end of her life. It transformed the way in which she viewed and handled the end of her life.

The way in which we talk about and approach dying matters, and Joy’s words have really stuck with me. Indeed, they were one of the reasons I introduced my private Member’s Bill—the Terminal Illness (Provision of Palliative Care and Support for Carers) Bill—back in 2018. Next month, Hospice UK will be promoting its campaign for Dying Matters Awareness Week, and I look forward to supporting its efforts on that important initiative. Honest and timely conversations about death and dying are essential to good end of life care, but barriers including lack of confidence, taboos around discussing death, and confusion about who should be having these conversations all too often mean that patients, carers and families may not understand what is happening or get all the information and support that they need. That is where hospices and their brilliant staff come in. More recently, a close family member of mine received support from North London Hospice, and although Gabby sadly passed away, I am so grateful for the hospice’s specialist care.

Yesterday I and about a dozen hon. Members ran the London marathon. I was proud to do so to raise money for North London Hospice. When pounding the streets of London in such a wonderful festival of community yesterday, I was struck by how many runners were, like me, raising money for their local hospices. That demonstrates the sad reality of inadequate central funding for hospices. I have been trying to bang the drum for North London Hospice since I was first elected, and although it took me a few years to muster the courage to put on the running vest and put my knees on the line, as each year passes it feels as if the challenges facing hospices grow greater and more acute.

As we know, hospices are an integral part of our health and social care system. They work in partnership with local health and care systems, helping to reduce the pressure on our NHS by caring for patients who would otherwise be directly supported by NHS services. As a community, we are reliant on hospices—they are important parts of the communities that they serve—but they are also reliant on us for support, through fundraising and donations, because they are largely charitably funded. On average, around two thirds of adult hospice income is raised through fundraising such as charity shops and marathons, and the figure is higher for children’s hospices, which must raise around four fifths of their income.

[Munira Wilson]

On children’s hospices, Shooting Star in my constituency, which I have already mentioned, is very grateful that the Minister has committed to the children’s hospice grant for 2024-25, which comes centrally from NHS England. The problem is that that is a year-to-year commitment, which does not help hospices such as Shooting Star to plan for the long term. Does the hon. Gentleman agree that a ringfence should be placed around that funding and that it should be pegged to inflation year on year so that children’s hospices can plan properly?

[Bambos Charalambous]

The hon. Member makes an excellent point. Long-term funding is absolutely essential if hospices, particularly children’s hospices, are to be able to plan ahead.

North London Hospice is reliant on donations from the community each year to fill its £10 million funding gap, as only a small proportion of its costs are funded by the NHS. Of course, the cost of living crisis continues to eat away at people’s finances, which directly impacts on our communities’ ability to provide the vital charitable support that hospices rely on. The reality of the current state of funding is that hospices are struggling to keep up with inflation and rising costs, which is leading to services being cut. However, demand for palliative care continues to grow—for North London Hospice, it has grown at a rate of 5% year on year. The costs of running hospice services, including energy bills and the cost of paying staff a fair wage, also continue to rise rapidly.

Hospices recruit from a small pool of staff in the NHS and care sector, but they are not provided with the same Government funding to meet NHS pay levels, meaning that many hospice staff are doing the same job as their NHS colleagues but being paid less for it. As a result, Hospice UK’s figures suggest an 11% growth in payroll costs this year, which means around £130 million of additional spending that is not met by increased statutory funding. As I have mentioned, those costs are not met with additional uplifts from NHS funding or contracts, and despite a legal requirement for ICBs to commission palliative care services that meet the needs of the local population, the funding that hospices receive from ICBs varies significantly across the country and means that charitable donations make up much of their income.

[Gen Kitchen (Wellingborough) (Lab)]

As a former hospice fundraiser—it is what I did before I came here —I am grateful to the hon. Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing the debate. Part of the problem that I faced at first hand was that when I was going out to private companies, trusts and foundations in order to raise funds to increase pay with inflation, that was often the hardest thing to fundraise for. The ICB was never very forthcoming, particularly when we would enter into conversations with it in the year prior to the year being funded.

[Bambos Charalambous]

My hon. Friend makes an excellent point. Fundraising is hard enough; inflationary costs make it much harder for fundraisers to do their excellent job of bringing an enormous amount of money together to make sure that all our hospices are run adequately.

Many hospices, like North London Hospice, will continue to operate a deficit budget for 2024-25, with the shortfall being met from reserves. Indeed, Hospice UK estimates that the sector is on track for a £77 million collective deficit for financial year 2023-24, the worst end of year figures in around 20 years of tracking. This funding model is simply unsustainable, and will undoubtedly lead to hospices cutting back essential services for patients. The issue is becoming increasingly urgent. We need to look at how hospices are funded in this country. They provide essential support; they should not be a voluntary service that is topped up by whatever fundraising is available. An integral part of our healthcare system is reliant on charitable donations. No other services are funded in that way; it is unthinkable that it would be left up to charities to plug shortfalls in maternity services, for example, so why is end of life care reliant on the kindness of strangers? It is really worrying. We need a far more secure, long-term model of funding that protects our hospices and partners them with the wider health and care system. If we do not properly support our hospices, we are in danger of losing them.

[Martin Docherty-Hughes (West Dunbartonshire) (SNP)]

I appreciate that funding models are different across the UK, but the hon. Gentleman has raised a point that I have a bit of concern about. There are two hospices in my constituency, one of which, St Margaret of Scotland, is the largest and oldest in Scotland. The voluntary capacity on the board of management has allowed it to develop and increase its palliative care provision. Does the hon. Gentleman agree that we should maybe look at parity of esteem between the voluntary hospice sector and our different NHS structures, in order to have equity of approach and investment?

[Bambos Charalambous]

The hon. Member makes an excellent point. We need to look at what models work best for each region. I do not know about the model he talked about, but we need to look at the long-term funding of hospices, and what works best for each hospice and region.

I am pleased that today’s debate has shown the strength of feeling on this issue, and that Members have highlighted the need for greater support and funding for hospices in the UK. That point was made clearly in the excellent speech by the hon. Member for Hastings and Rye, as well as in interventions. I look forward to hearing from the Minister on the Government’s response to the challenges that have been outlined. Finally, I once again thank everyone at North London Hospice for all their amazing work in my community and beyond, and I also thank Hospice UK for all its advocacy on these issues and its excellent briefings ahead of today’s debate.