Hospice and Palliative Care
Luke Taylor Excerpts(2 months, 3 weeks ago)
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Mr Kohler
I agree with the hon. Member. We need more palliative care specialists and we need more training, and there is a real danger of burnout.
It is not just hospices that provide palliative care. When talking to specialists within and beyond the hospice sector, I have been struck by their commitment to giving patients a good death and their frustration that so many do not receive one. A palliative care doctor recently told The Guardian:
“I sometimes see patients…who come into hospital in unspeakable agony and want their lives to end. It is not because their pain cannot be prevented, but because they are not getting the care they need.”
A local oncologist told me:
“Demand for services is simply outstripping supply. The majority of patients are not getting their end of life care wishes met. The specialist palliative care teams are very good but there are not enough of them and they do not have adequate resources.”
Huge regional inequalities exist in the provision and quality of services due to the vagaries of the current funding model. The Health and Care Act 2022 included for the first time a statutory duty for ICBs to provide palliative care. However, it did not include a minimum standard of core provision, leaving it to what each ICB considers appropriate.
Freedom of information requests submitted by Hospice UK in 2023 found that adult hospice funding consequently ranged from just 23p to £10.33 per head of population across different ICBs. For children’s hospices, the variations were even starker. Research from the amazing charity Together for Short Lives found that spending per child with a life-limiting condition varied from an average of £531 in Norfolk and Waveney to just £28 in South Yorkshire.
Luke Taylor (Sutton and Cheam) (LD)
On the point about the postcode lottery—an oft-used cliché by politicians—I have heard from Hospice UK that, on one occasion, a single gift from a legacy covered the running costs for a hospice in the UK for five years. Does my hon. Friend agree that that is one of the starkest and most extreme illustrations of how the current system is so unbalanced and, from one street to the next, leaves people with such disparities of access to such an important element of healthcare?
Mr Kohler
I agree, and I will come to some solutions that might address this issue. We must increase the core responsibilities of ICBs in this area.
Inevitably, much palliative care is provided not by specialists but by generalists, such as GPs, trainee doctors and community nurses for whom care of the dying is not their primary focus. Many lack the training, time and resources needed to provide what is possible, not through their fault but due to a system that does not regard palliative care as a core function. That is all too evident at the outset of their careers, with one medical student telling me:
“I only received 2 mandatory days training on palliative care in my entire degree. This is simply not enough and we need to increase training across the board to ensure patients are given equal access to high-quality care.”
Since the Shipman case there is unacceptable legal uncertainty, particularly among non-palliative care specialists, about the extent to which analgesics can be given in a sufficient quantity to alleviate pain, even where that might hasten death. The system requires a complete overhaul. We need more palliative care specialists and better training for non-specialists, including robust advice on the legality of giving sufficient pain relief to alleviate suffering, buttressed if necessary and appropriate by more explicit guidance in the Director of Public Prosecutions’ code for Crown prosecutors and the Lord Chief Justice’s criminal practice directions.
ICBs should be required to provide a minimum level of palliative care as a core function. This would have a transformative effect on how palliative care is funded both within and beyond the hospice sector, rather than leaving it to the generosity of particular ICBs such as South West London and Surrey Heartlands, both of which do all they can to fund local hospices, but within the constraints of a funding model that limits their ability to do so.
In concluding, I want to return to where I began. The debate is a matter of life and death. Ensuring a good death is important not just for the individual at the end of their life, but for those they leave behind. Knowing that someone passed away peacefully can bring real comfort to those mourning their loss. I would like to end with the words of Fleur, whose son received end of life care at the wonderful Shooting Star hospice. She said:
“Hospices are not just places where life comes to a close…they are places where those left behind learn how to keep on living. When my son Toby died, our hospice didn’t just care for him—it cared for all of us, to give us a future not defined by trauma, but by love, resilience, and hope. Months later, when my daughter had to step back into a hospital—the place where we had first been told we would lose Toby—she froze, overwhelmed by fear and grief. When she returned to the hospice, the very place where Toby had taken his last breath, she ran inside, kicked off her shoes, and threw herself into the arms of a nurse.”
That is what it is possible to achieve. I hope the Government are listening.
Luke Taylor (Sutton and Cheam) (LD)
I begin by thanking my hon. Friend the Member for Wimbledon (Mr Kohler) for bringing forward this incredibly important debate. Anyone who has been paying attention to my contributions in this place will not be surprised that I am once again expressing my deepest possible concerns about St Raphael’s hospice in my constituency. Its case is emblematic of the problems across this undervalued and dramatically important sector.
One of my first visits after being elected as the MP in July was to St Raph’s hospice, where I saw the incredible care that it offers to residents in my constituency and beyond. I have met people from the hospice several times since then, including just this morning, and it is clear that while the Secretary of State’s £100 million announcement is welcome, it simply does not go far enough. The funding is restricted to capital expenditure fractions, such as refurbishments and digital services. While undoubtedly important to modernise and update the capability of our hospices, the funding does not address their immediate financial hardship, especially in the context of the Chancellor’s Budget.
St Raph’s is set to face an estimated £140,000 increase in staff costs this coming year due to the rise in employer national insurance contributions. This burden only adds to the significant strain on the hospice, which is currently funded by the NHS for just 28% of its budget. It is therefore reliant on the generosity of charitable donations for the remainder. If the Government fail to see sense and exempt hospices from this hike, structural deficits will only continue to grow in the sector, pushing many over the cliff edge altogether and forcing those who remain open to cut their services to the bone.
While the announcement of additional funding is appreciated, it does not address the root of the problem. The Government’s approach is dangerously akin to tackling a leaking roof with a mop and bucket. The Secretary of State spoke last week about the need to shift the focus of healthcare from the hospital to the community, yet I fear their treatment of the hospice sector has done exactly the opposite. Due to the limited funding that St Raph’s receives, it has been forced to cut its hospice at home scheme, a vital service where staff directly attend to patients in their own homes in the local community. Those on the Government Front Bench say they want community-based palliative care like that under the hospice at home scheme, but the scheme has been cut further due to their actions.
These issues show why they must bring forward a long-term funding arrangement for hospices, if the Government intend to keep their promise. My Hospices and Health Care (Report on Funding) Bill, presented last year and due for Second Reading in July, sets out ways for the Government to consider those options to deliver a long-term funding deal. However, I sincerely hope that by July the Government will have listened and the Bill will not need to be debated at all. I urge them to please make my Bill completely redundant.
NHS Backlog
Luke Taylor Excerpts(2 months, 4 weeks ago)
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Helen Maguire (Epsom and Ewell) (LD)
I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this debate. The backlog in the NHS is a national crisis, and it is acutely felt in my constituency. Patients, families and staff are bearing the brunt of an overstretched and under-resourced healthcare system. This morning I was delighted to see the Prime Minister and the Health Secretary at Epsom hospital in my constituency—part of the Epsom and St Helier trust—to announce this Government’s plans to tackle the backlog of tests, checks and treatments. I welcome many aspects of today’s announcement. Direct access to checks will cut unnecessary waiting times and, if implemented well, will result in better patient outcomes as health issues are found earlier.
The location of this announcement at a hospital connected to St Helier hospital was particularly potent. Over the Christmas period, St Helier hospital, which has been at the heart of healthcare in the community for generations, made the news again. Its sinking floors and leaky ceilings illustrate the failings of our NHS. The facility is failing. Some of the buildings are older than the NHS itself and are plagued by damp, mould and structural issues that impede patient care. The hard-working staff at St Helier hospital are doing their best in impossible circumstances, but the reality is that the current infrastructure hampers their ability to provide the level of service and the quality of care that my constituents deserve.
Epsom hospital, too, is struggling to cope with demand. Over the winter recess I heard harrowing stories from constituents who faced unacceptable A&E waiting times. One mother brought her child to Epsom hospital with a suspected broken wrist and endured a seven-hour wait for an X-ray, finally leaving in the early hours of the morning. While there, she encountered another mother with a nine-month-old baby who had a bump on its head. They left after six hours without being seen because they simply could not wait any longer. One constituent’s 86-year-old mother was told by the 111 service to go to A&E at Epsom hospital after an injury, only to be informed that there would be a 10-hour wait, meaning she would have to stay up until 2 am after a potentially serious injury. These are not isolated incidents, but rather the lived reality for many families. These delays stem from a combination of rising demand, staff shortages and an ageing infrastructure that cannot keep pace.
While I welcome the fact that elective care capacity will increase, hopefully reducing the waiting times for care for many patients, this must also come with a focus on improving emergency care. Ring-fencing elective beds while people waiting for emergency care are dying in corridors or leaving without being checked is nonsensical. We must increase the number of staffed hospital beds to end degrading corridor care. Further, there must be a qualified clinician in every waiting room to ensure that any deteriorating conditions are picked up on.
Locally, it is vital that the Epsom and St Helier hospitals are at the front of the queue for necessary repairs and that the new specialist emergency care hospital in Sutton is at the top of the priority list for this new hospital programme.
Luke Taylor (Sutton and Cheam) (LD)
The Epsom and St Helier hospitals trust covers my constituency as well, and many of our residents rely on those hospitals for their care. Does my hon. Friend agree that it was previous Conservative Government’s absolute failure to deliver one of the 40 new hospitals promised in 2019 that led to the degradation in care for residents across both our constituencies? In addition, does she agree that the Government must come forward with the funding that residents in both constituencies need, to reassure them that their healthcare needs will be met into the future?
Helen Maguire
I absolutely agree that it is partly a failure of the previous Conservative Government that the hospitals have not been built. It is vital that the Epsom and St Helier hospitals trust is put at the top of the list as a priority for a new hospital. A new hospital will improve outcomes by consolidating critical services under one roof, easing the strain on staff who are currently stretched across two sites. Moreover, it will enable the Epsom and St Helier hospitals to focus on elective care, diagnostics and out-patient services, which will help them to tackle the backlog more efficiently. Crucially, the new hospital will expand the overall number of beds. Centralising major acute services will address estate challenges, strengthen staffing levels and improve patient outcomes, which will reduce the intolerable waiting times experienced at Epsom and St Helier hospitals.
I turn to the distressing delay in attention deficit hyperactivity disorder assessments. In September 2024, the Darzi report highlighted the stark reality that demand for ADHD assessments has grown so significantly that it risks overwhelming available resources. Nationally, it could take an average of eight years to clear the backlog at the current rate.
My constituent Sophie has been facing the brunt of this backlog. She has been waiting since June 2020 for an adult ADHD assessment, and she will wait quite a bit longer, as Surrey and Borders partnership NHS foundation trust has informed me that it is addressing referrals from as far back as March 2019. The root cause is a mismatch between demand and funding. The service was commissioned to support 400 assessments annually, but it receives 400 referrals every two months. Sophie, like many others, has been advised to seek private assessment, an option that is financially out of reach, as she has been unemployed due to her symptoms. This inefficient system should be reconsidered to help reduce the enormous backlog. The situation is wholly unacceptable.
Income Tax (Charge)
Luke Taylor Excerpts(4 months, 4 weeks ago)
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Tim Roca (Macclesfield) (Lab)
The first Labour Budget in 14 years needs us to take a clear-eyed view of what has been inherited. Looking at the Conservative legacy for our country, we see: terrible, almost non-existent, average earnings growth; lower productivity per worker hour than in every G7 country besides Italy; GDP per capita growth stalling for the longest time since the end of the war; record debt; high taxes; and poor public services. The lack of growth in real wages is unprecedented in the last 200 years of British economic history. That is the Conservatives’ record, and that is what they have to face up to.
Particularly savage, as hon. Members have pointed out, were the cuts to public investment. The Conservative Government inherited a debt-to-GDP ratio in 2010 of 65%. Ten years later, pre-covid, it was 83%. The Conservative Government promised to eliminate the deficit in 2010; then they promised to eliminate it in the 2015 and 2017 elections; and then they gave up the ghost entirely in the 2019 election. After that dazzling record, we were treated to the Liz Truss magic—Liz, a prophet currently not recognised in her own land. She presented a mini-Budget with £45 billion of unfunded tax cuts. There were no forecasts—the Conservatives like the Office for Budget Responsibility today, but they did not like OBR then—and we know what happened. We saw Tory chaos, and we can never go back to that.
When my right hon. Friend came to office as Chancellor of the Exchequer and looked under the hood, what did she find? More chaos: unfunded policy decisions; undisclosed pressures; and overspends. The OBR listed them. The previous Government promised but did not allocate a penny for the £10 billion infected blood compensation scheme. They promised but did not budget for the £2 billion Horizon Post Office scandal. I am glad to see stability and common sense finally return. There are fiscal rules that make sense and will be adhered to; we are bringing the current budget into balance, so that we do not borrow to fund day-to-day spending; and we are moving to a proper recognition of net financial debt that takes into account investment that delivers. Those sound, sensible decisions put us on a sustainable path. Compare that to a Conservative party that would rather we continued
“to founder under old habits, rotting institutions,”
and that is content for Britain’s hull to be “encrusted with nostalgia”, and for us to drift off into the 21st century.
Luke Taylor (Sutton and Cheam) (LD)
Members of this House will have seen that the celebrated Scottish comedian Janey Godley passed away on Saturday, after her long struggle with cancer came to an end in the Prince and Princess of Wales hospice in Glasgow. In her final days, Janey used social media to highlight the wonderful hospice care she received, and when her daughter announced her death, she took time to mention that her mother’s passing was
“peaceful and a nice transition.”
That is the profound value of hospice care to our society and the nation’s families.
Janey Godley’s choice to highlight the care she was receiving in her final days should remind us all why hospices matter, yet across the country it is not an exaggeration to say that hospices are at breaking point, as we have heard from Members across the House this afternoon. Many hospices are grappling with severe staff shortages and tight budget constraints. Redundancies and supply shortages have become alarmingly common, highlighting systemic issues in the hospice sector. This most vital of services is reliant on an unsustainable model which, on average, requires two thirds of hospice funding to come from some sort of charitable donation. That leaves hospices vulnerable, reliant on charity shops and large contributions with no guarantee of financial stability, and it also adds to the postcode lottery for patients. Even the NHS funding that hospices receive fails to keep pace with inflation.
Nowhere is that crisis more evident than at St Raphael’s hospice in my constituency of Sutton and Cheam. St Raph’s is more than just a healthcare facility; it is a sanctuary for those seeking to die with dignity. The compassionate care provided there not only supports the dying, but brings comfort to their families in one of the most challenging times in their lives. However, it receives only 25% of its funding from the NHS, which is substantially below the national average. In recent months, the hospice has been forced to reduce its clinical community nurse team by 20% and has completely discontinued its hospice at home programme, which once made sure that patients who wanted to spend their final days in the comfort of their own home could do so with dignity and support.
Over the past four years, running costs for St Raph’s have risen by more than a million pounds, but NHS funding to the hospice has increased by only £140,000. In last week’s Budget, the Chancellor pledged £22.6 billion to the NHS, which is long overdue after years of Conservative neglect. However, hospices were notably absent from Labour’s 10-year plan for the NHS, and the rise in employer NI contributions threatens to push hospices already struggling with fragile finances over the cliff edge.
If this Government are serious about delivering change, they will exempt hospices from the rise in NI contributions and listen to calls from the sector and inside this very House to sort out a proper funding deal to rescue our hospices.
Access to Primary Healthcare
Luke Taylor Excerpts(5 months, 2 weeks 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.
Joy Morrissey (Beaconsfield) (Con)
On that point, will the hon. Member give way?
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.