Hospice Funding and the NHS Pay Award

Julie Cooper Excerpts

Wednesday 31st October 2018 Westminster Hall

[Julie Cooper (Burnley) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies.

I am grateful for the contributions by Members from both sides of the Chamber; they obviously all value the hospices in their constituencies. I pay particular tribute to my hon. Friend the Member for Heywood and Middleton (Liz McInnes) for securing this important debate and for outlining so clearly the dilemma facing hospices, citing the example of her own excellent hospice, Springhill. The dilemma is that the delivery of excellent services, by an excellent and qualified workforce, must be balanced against the funding to deliver those services continually.

We are all aware that the NHS is facing massive workforce issues and that recruitment of skilled people is an issue right across the NHS; there is a shortage of such people. We are also very much aware that if hospices are to compete for staff and to recruit and—crucially—retain staff, they must be able to make this pay award, which is extremely welcome. That is the essence of this debate.

Hon. Members made some really important points about the wider issues of funding, which are important, and about the lack of funding. I am grateful to the hon. Member for St Ives (Derek Thomas) for sharing a very personal family experience from his local hospice and for making the important point that hospices allow people to live and die well, which is absolutely crucial.

It is important to set this debate, which is essentially about funding, in a wider context, looking in the first instance at the vast array of services provided by hospices. The majority of hospices are charitable organisations, and provide absolutely tremendous support to the NHS but are not directly part of it. There are in the region of 3,000 in-patient hospice beds in the UK, where patients are helped to manage pain and other symptoms. Hospices also provide respite for carers; it is important not to overlook that.

However, hospices offer far more than an in-patient bed for those reaching the end of their life. In fact, the majority of hospice care is provided in people’s own homes. Hospice UK reports that, in 2016, 51,000 people accessed in-patient hospice care, while 179,000 people received the support of trained hospice staff at home. Many hospices also offer daycare, which gives people the chance to spend time in a hospice and use the majority of the services it offers, while still living at home. In 2017, 37,000 people used day hospice services.

The majority of hospices also offer bereavement counselling. Hospices help to mitigate negative outcomes of loss, helping people to manage what can be a hugely painful and isolating experience. One gentleman in my constituency told me that he did not know how he and his daughters would have coped without the excellent Pendleside Hospice when he lost his wife, and his daughters lost their mother.

It is clear that our hospices are doing a fantastic job supporting people when they need it most. It is difficult to measure the level of demand, but it is a fact that, in 2016, 597,000 people died in the UK, and Hospice UK estimates that 450,000 of them could potentially have benefited from hospice services. It is also clear that there is much unmet demand and that provision varies widely from town to town. Given the changing demographics, though, it is very likely that demand for hospice services will continue to rise.

Consequently, it is imperative that, at the very least, we protect the provision that already exists. As I have said, the majority of hospice services are provided by charitable hospices, which rely on donations from, and fundraising in, their local community to meet the majority of their costs. It is a fact that hospices have a combined revenue of £1.4 billion, and yet the NHS pays only £350 million towards hospices. The average NHS contribution to hospices equates to 30%, and that proportion is falling because there has not been an uplift in funding to hospices for many years. Ten years ago, my own hospice received 32% of its funding from the NHS. That has now fallen to 22%, and in common with other charitable hospices it is reliant on the generosity of local people and businesses. Each year, hospices must raise millions of pounds to run their services and pay their staff.

I will briefly mention children’s hospices. Last week, I met staff from Derian House, and I was shocked to learn that although this excellent hospice supports children and young people from 38 constituencies, only 10% of its funding comes from the NHS. There are 49,000 babies, children and young people in the UK with life-limiting or life-threatening conditions. That number is growing as a result of advances in medical technology, and it is vital that these children and their families have access to palliative care that meets their needs.

Austerity has made fundraising more challenging, as many new and worthy charities now compete for funds. It is a fact that in this economic environment the financial stability and sustainability of many hospices is at risk, and implementing the NHS pay award will add to the financial pressures they face. It is unthinkable that, in the face of increasing demand, they may be forced to reduce services or even close.

At this point, I want to join colleagues in paying tribute to the dedicated staff who are the lifeblood of our hospices. The majority of charitable hospices, although outside the NHS Agenda for Change, attempt to match NHS pay and conditions, ensuring that staff who do that amazing work are properly remunerated. It is essential that those hospices are able to match NHS levels of pay if they are to continue to recruit and retain the staff they need.

I welcome the recently negotiated NHS pay award. That award, which has been hard won and is long overdue, will be hugely welcomed by clinical and non-clinical staff throughout the NHS. Crucially, though, it will not be funded for the charitable sector, and hospices will need to raise additional funds. Coming on top of existing funding pressures, that is going to push our hospices to breaking point. Pendleside Hospice, which serves my constituency, will need to raise an additional £500,000 to fully fund that award. I am sure that the Department of Health and Social Care did not intend to disadvantage hospices in this way, and that this was an unintended consequence. I hope that, in the first instance, the Minister will take the opportunity to announce that the Government will fund the staff pay award in all hospices.

In conclusion, I hope that the Minister will go further to ensure that NHS England resumes its work on developing a specialist palliative care currency, to inform future CCG commissioning of hospice care. It is an inescapable fact that a mechanism to increase the proportion of NHS funding paid to hospices is urgently needed. In a world without hospices, that clinical care would have to be entirely provided directly by the NHS, and would add significantly to NHS costs.

--- Later in debate ---

[Caroline Dinenage]

The hon. Lady makes an excellent point. She is right: there are services up and down the country delivering first-class care, but there are also areas where we know we need to do more. NHS England is firmly focused on providing both the support and the challenge to achieve that, and the hon. Lady is right to mention the incredible efforts of the imaginative and resourceful volunteers who do incredible work to raise much-needed funds for those vital hospices.

A key objective in delivering our commitment to strengthening the provision of end of life services out of hospital and in the community is that people should have that level of choice, and a quality choice, up and down the country. Work is ongoing nationally to provide sustainability and transformation partnerships with tailored information to assess and enhance end of life care services in their areas. We talked earlier about commissioning; NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. Historically, hospices have struggled to demonstrate strong evidence of the services they provide and the fabulous care that we all know they offer.

The hon. Member for Burnley (Julie Cooper) mentioned currency. NHS England is working to support local use of the specialist palliative care currency, which can help local areas to plan and deliver services, including hospice services. The currency can help local services better understand the complexity of palliative care and the investment needed to deliver it properly. It is also essential that we can assess how effectively commissioners are working to improve end of life care services. My hon. Friend the Member for St Ives hit the nail on the head when he spoke about that. This year we have a new indicator in place designed to help measure how well patients needing end of life care are supported in the community. Going forward, we are planning to do more work to develop indicators that will enable NHS England to further scrutinise the effectiveness of local health economies in delivering choice in end of life care and securing the progress we all want to see.

[Julie Cooper]

Can the Minister give some idea of the timescales? The point has been made that not only are these organisations at risk of closing, but the people who need the care have not got time. Timescales that indicate the urgency with which the Government are treating the matter would be welcome.

[Caroline Dinenage]

That is a very good point. NHS England will bring forward its report on hospice care very shortly, in November.

I want to talk about staff funding. In common with much of the sector, I know hospices have faced financial challenges. I recognise the concerns of hospices that the recently announced NHS pay rise is putting them under pressure to match the uplift awarded to staff employed on the Agenda for Change contract not only to retain the incredible staff they already have, but to attract the staff they need. We have agreed that for 2018-19, non-NHS organisations that employ existing and new staff on the Agenda for Change contract will be eligible to receive additional funding. Most hospices do not employ their staff on the Agenda for Change contract because of the cost that would entail and so are ineligible.