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.