Hospice Services: South Devon

Kevin Foster Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster (Torbay) (Con)]

I beg to move,

That this House has considered support for hospice services in south Devon.

It is a genuine pleasure to serve under your chairmanship, Mr Sharma. It is probably worth saying in my introduction why I brought forward this debate. At its root is a subject we often do not want to talk about: the end of life, and death. It can be uncomfortable; there may be people listening to this debate who are facing a difficult illness, whose prognosis is uncertain, or for whom discussion of hospice services brings up memories of the loss of a loved one. This is never a subject we can discuss without doing this, and this effect includes me.

My mother, Linda, passed away in St Luke’s Hospice in Plymouth back in January 2014. This week would have seen my parents mark their golden wedding anniversary. My step-daughter, Anne, was also supported by both a hospice and NHS palliative care services prior to her death. These experiences are why I want to be sure hospice services will be there when they are needed, at what will be the most difficult time in anyone’s life, ensuring that not only the patient is supported, but their whole family is, too.

Debate on hospice services in south Devon must start with mention of the services provided by Rowcroft Hospice in Torquay. Established on 4 May 1982 and located in 23 acres of beautiful gardens, it delivers specialist palliative care, free of charge, to more than 2,500 adult patients each year, across 300 square miles of Torbay and south Devon. It does this 24/7, 365 days a year, with a clinical and professional staff supported by a small army of volunteers who give their time simply with the aim of helping others in need. The hospice is also innovative in its approach to supporting our whole community, having recently launched a new project to support homeless communities across south Devon. Funded by the Masonic Charitable Foundation, the project is a collaborative initiative working in partnership with other charities and organisations that support homeless people in the region, with the goal of improving access to end of life care and palliative care for them.

A debate on hospice services in south Devon should also include a mention of the vital support provided by Children’s Hospice South West, one of the largest children’s hospice organisations in the UK, which provides vital support to children with life-limiting diseases across the whole of the south-west peninsula. The charity, which Eddie Farwell and his late wife founded in 1991, offers care and support to around 600 children from their three hospices located in north Devon, north Somerset and Cornwall. They are currently supporting 29 children from Torquay postcodes, and a further 63 from the EX and PL postcodes, which cover south Devon.

[Anthony Mangnall (Totnes) (Con)]

I thank my hon. Friend not only for calling this debate but for his wise speech on an important subject that is often not talked about out in the public. I commend him for his reference to Rowcroft Hospice and the services that are provided across the south-west. He may intend to do so, but I encourage him to ensure that a collaborative approach is also supported by Government funding, and that we can bring Ministers down to see what is going on in the south-west and how our services are actually leading the charge in the UK in terms of high-quality hospice care and supporting those most in need.

[Kevin Foster]

I always welcome an intervention from my hon. Friend, who is absolutely right that we are seeing leading work. He will be unsurprised to hear that later in my speech I will refer to some of that and invite the Minister to see for herself what is being done.

Hospice services provide vital support to those with life-limiting conditions, but they do face challenges themselves. In terms of their income, a Hospice UK survey in March 2023 revealed that 96% of hospices were budgeting for a deficit. While some of this confirms planning based on the likelihood of receiving bequests from wills, which for obvious reasons cannot be specifically predicted, it reflects the way hospices must continually look for support to maintain their services. There is also strong regional variation in the percentage of statutory funding; to be clear, this is a balance between NHS funding, contract funding and the fundraising income they receive. The variation in the percentage of support provided through statutory funding is significant: for example, in London this accounts for an average of 43% of funding, whereas in the south-west it accounts for just 24%—the lowest overall percentage rate, which it shares with south central and Wales.

The range of statutory funding percentages for individual hospices is worth noting, with 23 getting over 50%, while 85 get less than 32% of their funds from statutory sources. I accept that fundraising abilities vary depending on the community and the type of services, as well as the type of services being contracted, but these figures are very stark in their difference.

[Peter Gibson (Darlington) (Con)]

I congratulate my hon. Friend on securing this important debate. As the co-chair of the all-party parliamentary group on hospice and end of life care, the opportunity to highlight the wonderful work that our hospices do is really incredible; we should all take the opportunity to do that.

My hon. Friend mentioned the challenges about funding from statutory sources. I wonder whether he agrees with me that, now that we have the statutory obligation to commission palliative care in the Health and Social Care Act 2012, our integrated care boards need to step up to the plate and properly commission these services universally across the country, ending the postcode lottery.

[Kevin Foster]

I thank my hon. Friend for his intervention and for the work that he does as the chair of the APPG. I could not have put it better myself; he is absolutely right that there can be postcode lottery. Also, the variations are quite significant; I accept that some areas may have different types of services and some may have a greater ability to fundraise, but we should certainly seek a level of consistency across the country, to ensure that people have access to that service when they need it.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. Hospice care is important for us all, but I want to note Horizon House in Belfast, which is a children’s in-patient unit. It is the only service of its kind in Northern Ireland. There are 10 cots and beds available in Horizon House, but it does not have funding for clinical care. Does the hon. Member recognise, as I do, that it is not just about the clinical funding that comes in, but the voluntary and charitable work that volunteers do to make it happen?

[Kevin Foster]

I must say that that is slightly far away from south Devon, but the hon. Member for Strangford (Jim Shannon) always manages to find a relevant point in his interventions. The nub of his point is rightly received, although he will, of course, recognise that there is devolution of healthcare responsibilities to Northern Ireland, which makes that slightly different from the responsibilities of the Minister who is here today.

Like other public services, businesses and community organisations, hospices have faced increase costs. For example, Rowcroft Hospice outlined to me that the cost pressures that they face include a 30% increase in total staff costs and a 52% increase in utilities bills, and yet NHS funding—what they receive for contracts—has only increased by 8% in five years.

Alongside these pressures, demand is growing. We should never talk about what I am about to say as if it were a problem: more people are living longer, in good health, well into their 70s, 80s and even 90s. That is the biggest and most positive achievement of modern science, healthcare and public health measures implemented since 1948. It is not a problem, which is how we sometimes talk about it. Many conditions that once cut lives short can now be cured or no longer circulate, yet there remain conditions that are likely to affect us later in life that will require palliative care. According to major study published by BMC Medicine in 2017, if age and sex-specific proportions relating to palliative care remain the same as in 2014, the number of people requiring palliative care will grow by 25% from just over 375,000 to just over 469,000 by 2040, but if the upward trend observed between 2006 and 2014 continues, it will increase by 41.2%, with the biggest drivers being conditions such as dementia and cancer. In south Devon, those estimates would see the demands on Rowcroft Hospice grow from 2,500 patients per year now to over 3,500 by 2040. The pressures outlined above apply not only to those working with adults, but also to children’s hospices where funding from local integrated care boards can be patchy—it actually fell on average between 2021-22 and 2022-23.

I note that the Department for Health and Social Care and NHS England have provided vital centrally distributed ring-fenced grants to children’s hospices since 2007. As the Minister will be aware, NHS England initially indicated to hospices that 2023-24 would be the final year of that grant, but I am pleased to note that, after a campaign by the group Together for Short Lives, it has been confirmed that NHS England will be renewing £25 million of funding for children’s hospices in 2024-25. That is excellent news, but I note that it has not yet been confirmed how children’s hospices will receive that funding or how much each of them will receive. I am sure the Minister does not need reminding of the potential impact on vital services if such funding is not available in future. Initial indications from hospices are that they will see a range of services reduced.

It is easy to outline problems in any debate, but there are also great opportunities to provide solutions, the greatest of which could help transform our view of the role of hospice care in south Devon. The Ella’s Gardens project is a transformative vision of what high-quality palliative, nursing and residential care should look like in the middle of this century. At its centre is the construction of a new in-patient unit and the remodelling of the existing hospice building to provide the very best specialist palliative care for generations to come. The proposal is to enhance hospice care for patients and their families by increasing the number of single beds from the current two to 14 to further support the local population and help to meet future demand for specialist palliative care, giving hospice patients and their families even greater independence and choice during those vital moments together. It also aims to enhance the level of care to ensure that patients’ physical, emotional, social, psychological and spiritual needs are being met, while enabling family and friends to stay overnight to be near loved ones.

Rowcroft’s vision is also to build greater financial resilience by reducing the reliance on current income streams such as retail and fundraising. A core part of that is the creation of a 60-bed, purpose-built specialist dementia and complex care nursing home, designed on the leading model of dementia care—I hope I pronounce this correctly—called the Hogeweyk, with six households of 10 residents. Alongside that is a 40-bed assisted living complex, with a proposal that would enable Rowcroft to meet the wider care needs of the local community, as well as providing an invaluable income stream to support the hospice’s ambitions.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the hon. Member for securing the debate. I wish him condolences for his mother and stepdaughter. He talks about physical space. Seaton Hospice at Home currently works out of the Seaton and District Hospital League of Friends, and relies on that physical space. I know that at Rowcroft, four out of five patients are treated at home. Does he agree with me that palliative care nurses, after working with patients, need somewhere to come back together and operate as a team?

[Kevin Foster]

The hon. Gentleman makes an important point in highlighting hospice at home. The service is growing because many people do not want to be in a hospice or a hospital, and if given the choice, they would rather pass away at home surrounded by their loved ones. My stepdaughter was supported to do that. It is quite an experience when it happens, but it was what she wanted.

The hon. Gentleman is right to say that there is a need for those groups to have the type of facilities they require and be supported in that. I accept that, given the sheer area that some hospices cover for that service, they may have to have some form of remote working arrangement for most of the day, but certainly, I see how Rowcroft provides that facility and it works well. There is that balance of the hospice for those who need it and are at that stage in their treatment and care, and the hospice at home to try to give people the choice they deserve at the end of their lives.

The plans have been developed in a way that allows residents to live in a caring, nurturing and vibrant home that supports as much independence, mobility and inclusion as possible. The Ella’s Gardens vision is not just one for patients and families, but one of being a hospice that is part of the community. Rowcroft’s large gardens are open to the public and are a popular community facility. There is never a sense of hiding away or being something that people only talk about when affected by it. The plans therefore include community facilities, a village hall and a day nursery. That creates opportunities for recreational activities and intergenerational connections, effectively making it a facility for the whole community with a unique side to it, and not just a hospice that people only attend if they need to be with a loved one.

Unsurprisingly, the plans have been widely acclaimed across our bay and have already received planning permission from Torbay Council. They could be under way in just over 18 months, providing support to our wider healthcare services, from a formal commission agreement with the integrated care service. The Minister will be pleased to hear that this is not a direct pitch for Government capital funding, although obviously if there were funding available, it would certainly help. That said, I would be delighted to welcome the Minister to Torquay so she can see at first hand the transformation the project will bring, not just to hospice and palliative care but to the future for that kind of care. A future that is about being not just part of the health and care system but at the heart of our community’s life, as well as being there when needed at a time when a loved one is passing away. I hope the Government will see it as a model for the future and one they want to get behind.

Given what I have already outlined, I would appreciate hearing the Minister’s responses to some specific points. As a matter of urgency, will she confirm how much of the £25 million children’s hospice grant each children’s hospice will receive in 2024-25, when they will receive it and how?

What assessment have Ministers made of the impact of integrated care board funding on children’s hospice care, and the risks of withdrawing the ringfenced grant? These services will work across regions; to ensure a more planned approach, will the Government direct ICBs to work with their neighbours on planning and funding children’s hospice and palliative care services?

More widely in the hospice sector, the variation in statutory funding between regions and hospices is stark. What thoughts have the Government had on ensuring a more consistent approach? Some hospice costs, including NHS pay rates, are decided by the Government. Would the Minister consider implementing a funding formula that would allow cost increases that are out of the hospice’s control to be reflected in local service contracts? Given the increase in costs this year, could the Government supply a simple fixed amount per hospice that forecasts a deficit? How do the Government see the future needs of palliative care being met? I am not requesting that hospices be publicly funded; the charity model offers many advantages and flexibilities. However, hospices must have predictability when planning for the future.

There is much more that I could say about the opportunities, challenges and pressures on hospices in South Devon, but I should draw my remarks to a close to allow the Minister adequate time to respond and perhaps take interventions. For families across South Devon, Rowcroft Hospice is a service that is not just valued, but treasured. It is a place where memories are made, conversations had that bring peace after a dispute that now seems petty, family events are held, news is shared and smiles may be raised, even as the end nears. In short, a hospice is a place where life is added to days, when days can no longer be added to life. We need to ensure that Rowcroft continues to be such a place for decades to come.

[Mr Virendra Sharma (in the Chair)]

Before I ask the Minister to respond, I point out that there might soon be votes in the Chamber. There will be multiple votes in the next debate.

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank my hon. Friend the Member for Torbay (Kevin Foster) for securing this debate about hospice care in South Devon. Like many of us, he has personal experience of the wonderful work of hospices. He spoke of his mother Linda and his step-daughter. I remember my grandmother being cared for in a hospice that was also in the south-west, just outside Yeovil. It made such a huge difference to the end of her life, not only for her but for family members like me. I remember going to visit her there. Whether the care is given in the hospice or at home, hospices are so important to our constituents.

Even though the debate was short, we had contributions from other Members, including my hon. Friend the Member for Totnes (Anthony Mangnall). He asked that Ministers come to the south-west to see hospice care for ourselves. Perhaps slightly ironically, today I was meant to be visiting a hospital in Devon, but instead I am responding to this debate. I will reschedule the visit, and will see what more I can do in the area at the same time. We also heard from my hon. Friend the Member for Darlington (Peter Gibson), who is chair of the all-party parliamentary group on hospice and end-of-life care. He does important work lobbying on behalf of the sector in that role. He spoke of the importance of ICBs effectively commissioning end-of-life and palliative care services.

It was wonderful to hear from the hon. Member for Strangford (Jim Shannon); it would not be a Westminster Hall debate without a contribution from him. He spoke of the importance of the work of fundraisers and volunteers in hospices. That clearly applies in Northern Ireland, but it is also important in England. The hon. Member for Tiverton and Honiton (Richard Foord) referred to hospice care at home, and made the point that although the traditional hospice model involves people being cared for in a hospice building, a significant and increasing proportion of what hospices do involves caring for people in their home.

Taking a step back from the situation in south Devon, thousands of people across the country are receiving palliative and end-of-life care at the moment. We have an ageing population, and many people live with complex health conditions. Around 600,000 people die every year in the UK, so it is a demographic fact that the number of people who will need palliative and end-of-life care is likely to increase in the years ahead. That care is so important; care during the hardest times makes an unquantifiable difference. As my hon. Friend the Member for Torbay said, it is not necessarily about extra days of life, but adding life to the days. It can make what seems to be unbearable somehow bearable, and it makes a difference not only for the individual being cared for, but for all those around them.

The majority of palliative and end-of-life care is provided by NHS staff and services, but hospices are an important part of our end-of-life and palliative care system; they support over 300,000 people with life-limiting conditions each year, in addition to providing bereavement support. As hon. Members have said, hospices are independent, charitable organisations that generally receive funding not only from statutory sources but, substantially, from communities and charitable donations. That range of funding, and the important role that hospices play in communities, are real strengths. As a Minister with hospices in my portfolio, I strongly support that, and want hospices to continue to play that important role, which gives them such strong local support.

In south Devon, the services reflect the national picture: there are significant NHS palliative and end-of-life services, including a specialist NHS team, community nursing care and a Marie Curie night care service. There is also Rowcroft hospice, which my hon. Friend the Member for Torbay mentioned. Given that my portfolio includes the oversight of dementia care, I was interested to hear about the hospice’s ambitions to develop its services further into dementia care; that sounds like a truly exciting proposal. Department of Health and Social Care officials are due to visit Rowcroft in the coming weeks to find out more, so I look forward to hearing from them. My hon. Friend also invited me down to see it for myself.

My hon. Friend mentioned the role of integrated care boards, which are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local population. In the Health and Care Act 2022, palliative care services were added to the list of services that an ICB must commission to ensure a more consistent national approach, and to support commissioners in prioritising palliative and end-of-life care. Back in July 2022, NHS England published statutory guidance on palliative and end-of-life care to support commissioners with that duty. The guidance refers to the need to ensure sufficient provision of specialist palliative care services and hospice beds, and to ensure future financial sustainability.

On financial sustainability, I acknowledge that, as my hon. Friend mentioned, hospices contend with significant financial pressures, including rising energy costs. Charities, including hospices, have already benefited from the energy bills discount scheme. Furthermore, hospices may be entitled to a reduction in VAT from 20% to 5%, and to exclusion from the main rate of the climate change levy on the energy that they use for non-business purposes, should they meet the scheme criteria.

On the question about the funding for pay uplifts for staff on “Agenda for Change” contracts, as my hon. Friend will know, his hospices are independent, charitable organisations that employ their staff themselves. They have the freedom to set salary rates and other terms and conditions at a level that reflects the skills and experience of their staff. Given the difficult economic context, the Government are providing additional funding on this occasion to support one-off payments to eligible staff employed by non-NHS organisations, where those organisations employ their staff on dynamically linked “Agenda for Change” contracts. Details for hospices that believe themselves to be eligible for that scheme are outlined in guidance published this week by NHS England. I encourage hospices in the south-west—and in fact around the country—to consider whether they are eligible, and to apply for the scheme if they are.

[Kevin Foster]

Will the Minister give may?

[Helen Whately]

I am happy to, although I am also watching the clock.

[Kevin Foster]

I will keep it fairly brief. I welcome some of the comments made. It is worth remembering that while the hospices are independent, paying a nurse or qualified medical personnel less than the NHS would is clearly not going to work. Rowcroft is one of the best sponsors of skilled worker visas, but of course, as the Minister will know, it is obliged to pay the equivalent of the NHS rate if it recruits internationally via that route.

[Helen Whately]

I cannot say, as I stand here, whether Rowcroft would be eligible for the support that I mentioned, but I would encourage it and others to look at whether that route would help it to address the point raised by my hon. Friend.

My hon. Friend spoke about hospice care for children and young people. NHS England recognises the importance of quality palliative and end-of-life care for children and young people; it has already confirmed that the £25 million children’s hospice grant is being renewed for 2024-25. I can assure him that NHS England will communicate details of that funding allocation in the coming weeks; that is far as I can go on that point. I cannot comment on the future of the children’s hospice grant beyond that financial year, but I can pick up briefly on my hon. Friend’s broader question about the future of palliative care. We recognise that demand for it is expected to grow. I reiterate the point about ICBs’ responsibility to plan to meet the needs for the local population’s palliative and end-of-life care.

At the national level, our NHS long-term workforce plan sets out how we will ensure that we have the necessary healthcare workforce for the future. For the first time ever, it looks 15 years ahead. It also recognises that we will need an increasing number of staff in community settings, providing people with care out of hospital and helping people with long-term conditions to live more healthily and independently. The plan recognises that people want to live in their own homes for as long as possible, and we know that many people would much rather die in their home as well.

To sum up, as I watch the clock, I fully agree with my hon. Friend on the important role of hospices in our community in palliative and end-of-life care. I can assure him and other hon. Members that I will continue to work closely with NHS England to ensure that ICBs deliver on their responsibility to commission palliative and end-of-life care in every area of the country. I thank my hon. Friend for his invitation to see the hospice care in his constituency for myself. As I will be rescheduling my Devon visit, I will do my very best to see if I can come his way.

Question put and agreed to