Hospice Funding
Joy Morrissey Excerpts(2 weeks, 6 days ago)
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Joy Morrissey (Beaconsfield) (Con)
May I start by wishing you a very happy Easter, Madam Deputy Speaker, and by thanking the Clerks, the Doorkeepers and the House staff who have drawn the short straw and have to be here for the Adjournment debate at the end of the day?
I am pleased to have secured this debate on hospice funding, a topic that I know is of concern to Members from across this House. Even on the last day of term, the subject still gives pause to so many. A hospice provides a beacon of hope to so many people in their darkest times. It provides the comfort and knowledge needed at a very difficult time, and without hospice support, many would be lost. That is why, across the country, we see volunteers giving up their time and their finances to support local hospices—because, primarily, many of them are charities, although they receive some funding from the NHS. Members from across this House, from every party, believe that hospices matter.
Jim Shannon (Strangford) (DUP)
First, I commend the hon. Lady for bringing this debate forward. She is absolutely right to highlight the work of hospices, but also all those groups that raise money for hospices, so that they can do their work. For instance, the Elim church, which has a cancer group that holds a dinner or breakfast every month, recently gave £5,000 from a coffee morning, as well as its monthly offering. Again we see charitable organisations, particularly when they are supported by churches, making the difference in this nation. Does she agree that while they are admirable, we cannot expect coffee mornings and fun runs to raise the funding that the Government have an obligation to provide? Rather than seeking to end life, the Government must seek to ensure that people’s last days in palliative care are dignified and pain-free. That will only come with fully funded end-of-life palliative care.
Joy Morrissey
I thank the hon. Member for that intervention, and I pay tribute to all the volunteers who organise the fun runs, and to volunteers in my constituency, such as Sharon Williams, who does the Thames hospice walk in Denham village every year. These are the people who support our local hospices, and we should all pay tribute to them.
Hospices matter because each year they support 310,000 people and 92,000 family members. Hospices matter because they are vital holistic care services for people and their loved ones at the end of life. Hospices matter because they provide crucial end-of-life and overall healthcare, relieving the pressure on the NHS. They provide both community specialist and acute care. However, I suspect that the Minister and the Government already know this, and I am sure that they agree that hospices matter, so let me turn to why this debate matters.
The hospice sector is under enormous pressure, and it faces an unprecedented challenge. The sector is caught in the triple squeeze of increased demand, increased cost and uncertain funding. Only the Government have the power to change that squeeze. Only the Government can eliminate the increased cost or create more certain funding. In this House, recent months have been consumed by a debate about assisted dying, while the real scandal of the lack of support for end-of-life care through hospices goes below the radar. It is estimated that the demand for palliative care in the UK will increase by 25% in the next 25 years, but as hospices face this increased demand, the Government have decided to saddle them with increased cost, and have failed to provide a long-term settlement.
Let me speak about the excellent Thames hospice that supports many families in my constituency and the constituencies of my neighbours. I would not be here today were it not for Baroness May of Maidenhead. As a long-term champion of Thames hospice, she asked me to have a word with the hospice, as it was so concerned about its funding, which I did, and that led to this debate. Again, Members of Parliament from both Houses continue to champion this important cause.
I recently met Dr Rachel de Caux, the chief executive officer of Thames Hospice. Like many other hospices, Thames hospice represents the very best of our communities: people who believe in providing quality of life at end of life, for everyone; passionate people who care, like the Thames hospice Denham support group, and the volunteers who make donations and support those who go into the hospice. Through their excellent work, they enable 80% of the people they support to receive dignified end-of-life care at home, and the rest to get specialised in-patient service. I visited the service recently, and when I visited the call centre, I was moved to see volunteers and staff working around the clock to help those who had just received a terminal diagnosis, or families who could not cope. They were going to people’s homes and working all hours of the day and night to ensure that people had the pain support and palliative care that they needed, at home or in the centre.
Thames hospice, like many hospices, faces a critical moment. Less than one third of its income comes from the NHS. Like many hospices, it raises the rest through its charity shops, fundraising efforts and the generosity of private donors. The Chancellor’s Budget was like a hammer blow to its finances, and it faces a deficit of up to £1 million, largely as a result of the Government’s choices. The national insurance tax raid, from which this Government recently voted not to spare hospices, will add £300,000 to its costs for the next financial year, while changes to the national minimum wage will add another £200,000, both through the direct impact and the need to maintain pay differentials. Meeting the NHS pay settlement, which the hospice needs to do to keep clinical staff—but which, again, it needs to do without Government support—will add a further £100,000. Finally, Thames hospice’s suppliers face the same cost pressures, and are passing those on to the hospice through higher prices.
I know the Minister will talk about the £1 million settlement of additional funding for hospices that was announced in December, but let us set out the detail of that money: it was for capital expenditure, and is welcomed, I am sure, by hospices, but it was not money for meeting operational cost pressures. It was also split across 170 hospices, so it became a drop in the ocean for individual hospices and their needs.
Warinder Juss (Wolverhampton West) (Lab)
Will the hon. Lady join me in commending Compton Care hospice in my constituency? The hospice, which I visited recently, does great work raising funds, and it really welcomed the £100 million support provided by this Government. However, the hospice emphasised to me that if it was not there to provide social care, therapy and respite care for patients and their families, the NHS would need an extra 100 beds. Hospices provide invaluable services to our communities, which makes it so important for us to continue to support them as much as we can.
Joy Morrissey
The hon. Gentleman makes an excellent point about the pressure that hospices take off the NHS. The wonderful work of the hospice the hon. Gentleman mentions is the reason the NHS can function in the way it does. The cost savings on palliative care—both in hospital and out-of-hospital care settings—are invaluable. The hospices in our constituencies are a model that already works, and they are trusted by the community. I think we should be funding that model, instead of allowing hospices to die on the vine because of a lack of funding and changes to the funding model. I thank the hon. Gentleman for that point.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
I congratulate my hon. Friend on securing this debate. We should not just complain about this terrible new tax that is being applied to hospices, but point out to the Minister that the return on taxpayers’ investment in what hospices spend on the dying is very great indeed. If a little bit of the big increase in funding that the NHS received was transferred to hospices, it would pay great dividends; it would save the need for much more costly care in the hospitals. The return is 300%, according to St Helena hospice, just outside my constituency, on whose behalf I am speaking this evening. I hope the Minister will address that point when he winds up.
Joy Morrissey
My hon. Friend makes an excellent point. That 300% cost benefit would be replicated across the country, in every hospice setting. A small amount of money given to hospices through the NHS funding model would be invaluable. We talk about palliative care and assisted dying, but why are we not having a debate about increasing hospice funding, and making that service part of the NHS? If hospice settings were part of the NHS, they would be exempt from the rise in national insurance contributions. That increase is devastating hospices right now. Many rely on volunteers or low-paid workers in charity shops. The money raised helps pay for the running of hospices. Although that is a wonderful model, hospices are not exempt from the NICs increase, as other NHS bodies are. Even changing the status of hospices to make them part of the NHS would go a very long way to making their financial model viable.
Rachael Maskell (York Central) (Lab/Co-op)
The hon. Member is making a powerful speech. I have steered the palliative care commission for the past six months, and the one thing that has become crystal clear in our minds is that the fundamental funding model is completely broken; it is not fit for purpose. Furthermore, we need more integration in the system. Hospices are involved in part of people’s care; they do not provide the entirety of their care. Does she believe that the findings of the commission need to steer the future funding of the hospice sector?
Joy Morrissey
That is an excellent point. We should be led by the evidence, and also by what the commission finds. I wish to highlight the hon. Lady’s long-term work championing out-of-hospital care provision—not just palliative care, but all adult social care. I can recall many a debate on this matter in which there were just one or two of us in the Chamber, and she was always one of them. She is a long-term champion of the vulnerable, of palliative care, and of those who desperately need better services. May I thank her for all that work? Madam Deputy Speaker, it is not often that you will see me reach across the House, but let us give credit where credit is due. There are Members from all parts of the House who have championed these causes over and over again, and it is only right and fair that I recognise them today.
There is a very real prospect of the hospice sector collapsing under the weight of the national insurance changes, and that would be unimaginable. These are institutions that are trusted in our communities and that we need to protect. They need additional funding from the NHS. The Government must act. I urge them to please reconsider the national insurance changes. Exempting hospices from the NICs increase, or helping to fund their operating costs, would make a material difference to their ability to survive. Our hospices matter, and I hope the Minister will hear that message loud and clear, and show us that the Government understand how vital they are.
Stephen Kinnock
My hon. Friend speaks with tremendous and deep knowledge of the sector. I welcome the work that she is doing on the commission on palliative and end-of-life care, and we very much look forward to seeing the outcomes and results of that.
My hon. Friend is right that if we are to make the three big shifts at the heart of our 10-year plan—the shifts from hospital to community, from sickness to prevention, and from analogue to digital—the delivery of that will require a left shift in terms of both funding and reform. It is absolutely right that we take a hard-headed look at funding across our NHS and ensure that funding is going to where it is needed. She will know that the share that hospitals get of overall NHS funding has gone up dramatically since the early 2000s, to the detriment of primary care, community care and palliative care—all the things that happen outside hospital. That is something that we must address and shift upstream, because we will never solve the considerable challenges that our NHS is facing until we make that left shift.
I note that the funding announcement was warmly welcomed by the sector. Toby Porter, chief executive of Hospice UK, said:
“Today’s announcement will be hugely welcomed by hospices, and those who rely on their services. Hospices not only provide vital care for patients and families, but also relieve pressure on the NHS. This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need, when and where they need it.”
I hope that the measures I have outlined in my response to the hon. Lady will go some way to reassuring all Members of this Government’s unwavering commitment to the sustainability of the hospice and wider palliative and end-of-life care sector.
Joy Morrissey
I thank the Minister for outlining what the Government are doing. Will he consider looking at the exemption to the national insurance increase for workers and at allocating more funding directly to hospices so that they can conduct the palliative care that is needed in the out-of-hospital care provision? Although the Government may want to give it to palliative care, there is no directive that does so at this time, aside from capital expenditure. Therefore, could more money be allocated to hospices for operational costs?
Stephen Kinnock
The definition of where employer national insurance will be levied is based on the Office for National Statistics’ definition of where it should be, and it is the same definition used by previous Governments. I do not think that point is up for debate.
Joy Morrissey
To clarify, the NHS and the staff within it are exempt from the changes. How is that part of the national statistical average, when everyone in healthcare who is under the NHS umbrella is exempt from the changes? All I am asking is for hospice care, which is out-of-hospital care provision and which technically falls within adult social care, to be incorporated into the exemptions already given to the NHS.
Stephen Kinnock
The exemption was given to 100% full-time workers within the NHS; in essence, hospitals. As regards GPs, dentists and care providers, ENICs are being levied on those other parts of the health and care sector. Every aspect of my portfolio is therefore seeing ENICs being levied.
Puberty-suppressing Hormones
Joy Morrissey Excerpts(4 months, 2 weeks ago)
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Wes Streeting
I am grateful to my hon. Friend for his question. This lies at the heart of the dilemma that has plagued clinical leaders and political leaders, particularly since the scandal at the Tavistock clinic was brought into the public eye. There are many people in our country—young people, and young and older adults—who will say, and some have certainly told me in my office, that having access to puberty-suppressing hormones has been completely life-changing and affirming, and has led to a positive outcome for them. Yet we know that the prescription of that medication to this particular group of patients for this particular medical need has not been supported by underpinning evidence in the way that the use of other drugs has been underpinned by effective trials and an evidence base.
That has been the challenge: people with a lived experience saying that this has been positive, while none the less—at the Tavistock clinic, in particular—not only puberty blockers but a whole range of medical interventions were delivered with the best of intentions, but in ways that were inappropriate and clinically unsound. That was the genesis of the Cass review, and it is why I think it is so important that we proceed in an evidence-based way. To do the contrary risks real harm to people and also a lack of trust in the medical profession that will be damaging for our entire country, and particularly for this group of patients.
Joy Morrissey (Beaconsfield) (Con)
May I thank the Secretary of State for a very nuanced, well thought out and genuinely moving statement? He will very rarely hear me praise those on the Labour Front Bench, so he should enjoy it. I thank him for taking what is a very difficult stance. What I saw is that the Secretary of State has put young people first and has protected young people today. I am very grateful for that, and I would like to offer him my thanks. I also thank him for his nuanced approach in helping trans people in their transition in adulthood, because this is complicated and it needs a nuanced approach. I thank him for understanding that, and for his boldness today.
Wes Streeting
I thank the hon. Member for her question. In case she worries that she is going soft on the Government—or, worse still, in case I worry that I agree with her—we should just remind each other that even a stopped clock is right twice a day. For those watching our proceedings this afternoon, it is true to say that politics in our country has been quite divided on a wide range of issues, certainly in the nine and a half years that I have been in this House. However, that is not to say that, on a wide range issues, we do not have consensus or work together to build it. I actually think that is a good thing in our politics. There are plenty of things we can disagree about in this House and contest elections on, but especially in an area such as this that involves vulnerable children and young people, the more we can try to build consensus and create an environment in our country where these children and young people and their families feel safe, the more we will be doing a really good job.
Far and away the hardest part in this process for me personally has been spending time with these children and young people and their parents, many of whom have spoken in genuinely heartfelt terms about the fear they feel living in our country. Some are looking to live in other countries, and doing so quite sincerely. It breaks my heart, actually, because I want this country to be one where everyone, whatever their background, feels safe, included and respected, and there is much we can do across this House to build that kind of country.
Access to Primary Healthcare
Joy Morrissey Excerpts(6 months, 1 week ago)
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Luke Taylor (Sutton and Cheam) (LD)
I am in general agreement with others about the state of the NHS. The NHS was a Liberal idea, delivered by the Labour party, then broken by the Conservatives. The attendance among Conservative Members at today’s debate shows just how much interest they have in trying to fix it. The Liberal Democrats will act as a responsible, constructive Opposition and work with the Government to fix the NHS’s many problems.
Luke Taylor
No, I will not.
Solving the crisis in access to primary care matters not just to patients facing traumatic situations, but to our GP surgeries, which are striving to do their best under the most difficult of circumstances. Our hard-working GPs dedicate years to training and work hard at what they do because they are passionate about being there for their patients. For too long they have been let down, and it is our job now to give them the means to continue doing their remarkable job.
We know the difficulties. Too often, appointments are not available, and patients and staff experience frustration and conflicting priorities when attempting to access services. For patients, that often means resorting to dialling 111, or even 999, and attending A&E when issues escalate. That puts further pressure on our already overstretched NHS emergency facilities, which too often have to deal with issues that could have been fixed by preventive primary care if patients could have accessed it in a timely way.
GPs in Sutton and Cheam tell me that requests for appointments are triaged because of the level of demand. Decisions have to be made to prioritise patients with increasingly complex needs, often with very little information available. Unsurprisingly, that is affecting GPs’ mental health and making it increasingly difficult to retain experienced staff, further eroding the ability of practices to keep up with demand.
The ask from GPs in my constituency is simple: the Minister must act quickly to increase their budgets, and offer certainty to allow them to plan ahead financially after a sustained period of real terms cuts in funding. That will allow them to hire and retain more staff at competitive wages during this cost of living crisis, lower the collective workload and treat more patients more effectively.
It is not enough to simply offer more training places, or incentives to train, if surgeries cannot employ the GPs who are already qualified and available. That is a particular problem in my constituency. If the NHS cannot compete with the private sector on pay, or with overseas Governments, who attract our doctors with improved conditions, a lower workload and possibly even better weather conditions—legend has it that there are places that have even more sunshine than Bournemouth —then it cannot hope to retain GPs. We must make it easier for foreign students who have studied and qualified in the UK to get the right to remain after their course, should they wish to do so.
As the new Government search for ways to boost growth, I say that it is here in front of them. There is no better investment in our future growth than good-quality primary healthcare, keeping patients healthy, able to provide for themselves and their families, and living healthy and fulfilling lives.