Woodlands Hospice, Aintree

Debate between Dan Carden and Conor McGinn

Wednesday 7th February 2018 Commons Chamber

[Dan Carden]

I absolutely agree. I hope that this debate will focus people’s eyes on the hospice sector across the UK and at Woodlands, where we need to ensure viable funding, and also funding that is longer term and better planned. Pressure needs to be taken off hospice managers as they plan the kind of care they provide for our constituents.

People who face progressive life-limiting illnesses require different levels of care. Apart from care and treatments specific to their conditions, they are likely to have what is often called palliative care, particularly as they approach the end of their lives. Death is a natural part of life. We will all die eventually, and most deaths—around three quarters—are expected, so the majority will require some form of palliative care, and everyone deserves to be able to end their life in comfort and dignity. That principle should be central to any civilised society.

There is, I am sure, agreement across the House on the importance of palliative care. It is not a bonus or extra, but an essential part of a good healthcare system. The hospice sector supports around 200,000 people with terminal and life-limiting conditions in the UK every year. This amounts to more than four in 10 of those estimated to need expert end-of-life care. Hospice care is free for everyone and provided for however long it is needed, be it days, weeks or even months. More than 40,000 people in the UK receive bereavement support from hospices each year.

Hospices support people with a wide range of conditions, including cancer, motor neurone disease, cardiovascular disease, dementia, multiple sclerosis and Parkinson’s disease—to name just a few—and they are increasingly supporting people with multiple life-limiting conditions. Most hospice care is provided while people are in their own home, but it can also be provided in a care home or at the hospice itself as an in-patient. It is a style of care rather than something that necessarily takes place just in one building. Hospices also aim to feel far more like a home than a hospital.

Outcomes are difficult to assess, and of course most patients do pass away, but it is worth remembering that many do not. A gentle, dignified, reflective and peaceful death with 24/7 expert care and surrounded by loved-ones is something that cannot be measured by traditional means, but we can measure the value in the appreciation and wellbeing of the patients and families helped through their bereavement. When I visited Woodlands, I was delighted to meet people who had long and happy associations with the hospice, had made friends there and still visited regularly for support with their health, but also to keep in touch with staff and friends.

It is also clear that NHS pressures mean increased pressures on hospices.

[Conor McGinn (St Helens North) (Lab)]

I thank my hon. Friend for giving way, and for outlining the work of the hospice movement. Does he agree that the values and ethos of the movement are deeply ingrained in communities throughout Merseyside? Willowbrook Hospice in St Helens, which is celebrating its 20th anniversary, is a good example. But hospices should not have to rely on the generosity of our constituents: they need statutory funding, because they are an integral part of social care.

[Dan Carden]

I welcome my hon. Friend’s intervention.

Britain’s older population is set to increase sharply in the next few decades. The number of people aged 85 or over is expected to double in the next 20 years, and the number of people aged 100 or over is set to increase by more than eight times by 2035, to more than 100,000. The number of adults with life-limiting conditions is also on the rise. Everyone deserves high-quality, compassionate care at the end of their lives.

In recent months we have again witnessed the impact of severe winter pressures on the NHS, which has left hospitals buckling under unprecedented demand. Most people in the United Kingdom—just over half—currently die in hospital. Hospitals are amazing, life-saving places, and I pay tribute to all the staff who keep our NHS running at such difficult times. It is our country’s greatest achievement.

The hospice sector plays a vital role in providing care for those who no longer respond to curative treatment, so that patients who have no clinical need to be in a hospital bed can receive specialised and personalised care provided by a hospice multi-professional team. That also frees up hospital beds for those with acute care needs. A good hospice is a perfect example of good health and social care integration. We need a joined-up approach by the NHS, social care, the community and the voluntary sector. I welcome the Government’s decision to bring social care under a departmental umbrella, and I hope that the Minister will reassure me that hospices too will be recognised as a crucial part of the care system as a whole.

On average, adult hospices in the UK receive a third of their income from the Government, although the amount received by individual hospices varies widely. The rest comes from community fundraising, grant applications, hospice charity shops, lotteries and investments. According to Hospice UK, collectively charitable hospices in the UK need to raise about £1 billion a year from their local communities, which amounts to about £2.7 million per day. In a period of stagnant wages, and with national income distributed unevenly, that is a constant challenge, and the fact that it affects different areas and regions differently must be taken into account. Hospices rely on NHS funding contributions, and need assurances that those will continue even in the challenging financial climate that the NHS currently faces.

Some hospices have agreements in place for multi-year funding, but many are reliant on year-by-year decisions on funding levels, and that requires constant planning by hospice managers. NHS funding needs to be on a more committed and sustainable basis to allow for planning and development, and to enable staff to devote more of their time and energy to doing what needs to be done in relation to patient care. Of course, in more deprived areas, such as the communities in north Liverpool, the need for statutory funding is even greater. The fundraising opportunities that are available in the catchment areas of individual hospices can be very limited. Deprivation also means more complex health needs among the population that hospices serve. All too regularly, I see people dying younger, people dying from addictions, and people dying from diseases that are linked directly to poverty.

The complexity of funding for hospices creates further organisational difficulties for management and staff. Commissioning and contracting arrangements are still causing issues: nationally, a third of hospices are now working with four or more commissioners. Woodlands, for instance, covers a number of clinical commissioning groups, and requires each CCG to maintain or increase funding each year just to stand still. When funding decisions are made on a year-by-year basis, simply maintaining funding can take up much time and effort that should ideally be focused on patients and care.

I am sure I speak for the entire House when I say that we are all very grateful for the care that hospices deliver to people and communities across the country. They need ongoing recognition of the value that they provide to the healthcare economy as a whole. Specialist palliative care and end-of-life services need to be proactively included in transformation plans and service developments. The Government’s intentions were set out in July 2016, when they said that

“every person nearing the end of their life should receive attentive, high quality, compassionate care, so that their pain is eased, their spirits lifted and their wishes for their closing weeks, days and hours are respected.”

In order to realise those aims for every person in the UK, we must look at the funding framework as a whole to make it easier for hospices to receive sustainable NHS funding.

Can the Minister address two specific points: what guarantees are there that as pressures increase on NHS budgets, statutory funding to hospices, especially those in more deprived areas with the specific health problems affecting poorer communities, will be protected, and what is the Minister doing to encourage longer term funding models—multi-year agreements—so that hospices can plan better and care better? The people-centred care that responds to complex and changing needs provided by hospices like Woodlands is invaluable, and I believe every Member will want to do all we can to support the work they do across our constituencies.

I want to finish by paying tribute to the wonderful staff and amazing volunteers who make Woodlands the wonderful life-affirming place that it is, as well as thanking all those who give up their time to volunteer in hospices across the UK.