Hospice Funding

Debate between Marie Rimmer and Rachael Maskell

Monday 22nd April 2024 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

I congratulate everyone who has spoken in the debate. The House has come together to highlight something that I am struggling with: when people are at their most vulnerable, they are having to beg for money to fund important services. That should not be the case, yet here we are with an NHS that is clearly not functioning and other services are also feeling the pain. The reorganisation of the NHS devolved powers to ICBs, but we must remember that it is the responsibility of the Government to ensure that the structures function. That is not happening at the moment, and our constituents are losing out. A word that keeps echoing in my mind, rolling off our lips as it always does, is the NHS: the “national” health service. Yet we are hearing about a postcode lottery, where different areas have different experiences, with different ICBs funding to different tunes and where you live accounts for how you die. Surely, we are better than that? In the words of one clinician about the extraordinary provision at St Leonard’s Hospice in York:

“Having worked with people at the end of life through my career, I didn’t know care like that was possible.”

However, as with all hospices, if funding is not addressed, such care will not be possible.

It was this Parliament that inferred the duty, through the Health and Care Act 2022, to address the inequality in access to palliative and end of life care, so that everyone can have the best clinical and holistic support possible, if the right funding is stabilised and put in place. Currently, however, we know that many people—Hospice UK says one in four—are not accessing palliative care. That is 150,000 people every year who die without the support they require. That number is set to rise 25% by 2048 and, according to Marie Curie, by 13% in the next decade. This debate cannot just be about what happens now, but what happens in the future.

In York, the hospice ran an £800,000 deficit last year. The hospice at home funding has remained static for the past seven years, while demand has doubled and the ICB has provided just a 1.2% increase. Sue Ryder believes that the real cost increase over the past year was 10%. Hospice UK figures released say there has been an 11% increase for the payroll this year to around £130 million. Martin House, the local children’s hospice, costs £9.9 million to run. With a total income of £8.6 million, it had a £1.3 million deficit. Only 18% of its funding came from the statutory sources, £1.1 million came from the national children’s hospice grant and £700,000 came from the ICB. Hospice UK estimates a £77 million deficit for the financial year just past—the worst for 20 years.

As demand and costs are rising, the funding is not rising to match. As of 12 April 2024, St Leonard’s hospice in York did not know how much money it was getting from the ICB: left to carry all the risk and left to depend on its reserves, and that, of course, not guaranteed for the future. Martin House, which is also using its reserves to expand its services, knows that it will have only six months of reserves. It certainly does not know what is happening with its funding after this financial year.

The children’s sector, yes, has received a grant, but what comes next? We cannot just run our hospices by running marathons and running charity shops. It is driving inequality. In areas of greater deprivation, fundraising is even harder and therefore the hospices are getting even less money.

[Ms Rimmer]

I thank my hon. Friend for giving way and I thank the hon. Member for Hastings and Rye (Sally-Ann Hart) for securing the debate. It has been a wonderful and sincere debate, but does my hon. Friend agree that there should be more equality between care at home—hospice at home—and care at the hospice? There is no doubt that there is nothing better than care in a hospice—absolutely no doubt. I have nursed four members of my family at end of life, and getting clinical support at home when it was needed was always a problem—my brother had to search for morphine at night. Does she agree that staff are funded even less and are on the minimum wage?

[Rachael Maskell]

I am really grateful to my hon. Friend for raising those points and I will come on to the issue of hospice at home. We know it is absolutely vital that people can choose where they die. Not everyone wants to die in a clinical setting—indeed, a hospice is barely a clinical setting—but many choose to die at home and they should be able to receive the care they need. She is right. We must have integration with the rest of the NHS. A district nurse may not be able to push palliative care to the extent that a palliative care specialist would in providing pain relief and the support somebody needs at the end of life at home. We need it to be timely and we need to ensure it is fully funded. The Health and Social Care Committee found that when it visited Royal Trinity hospice, as part its assisted dying inquiry. The point was made that we need to ensure we have the training so that clinicians have the competencies and the confidence to administer the pain relief and the palliative care that is necessary, and to ensure that the service is available universally. It is not and that must be addressed.

In York, of the 1,000 people who benefited from St Leonard’s hospice last year, 50% received hospice care at home. That number will grow over time and we need to ensure those services are there as they are needed. Of course, we know that if people are not on that pathway they end up in the acute service. They are put through the trauma of A&E, costing the NHS goodness knows how much, and then they do not get the care they need. Trinity Hospice talked about what it was doing to divert people away from that pathway and into proper care, either at home or within its wider services. There is much still to secure on that front.

If I may, Mr Deputy Speaker, I will raise just one more major point before I close, which relates to inequality. We know there is real inequality at the end of people’s lives. Some of it is based along socioeconomic lines, and some of it is emphasised within minority communities. We need to deal with that to ensure we have universal provision, address the death literacy of our nation, and ensure the support is there when it is needed. I am particularly concerned about the lack of comprehensive funding for our palliative care services.

I urge the Minister to look at funding staffing costs, which are 69% of all funding. It has been suggested by Marie Curie that 70% of funding come from the state, and I think that is about right. We can phase that in, but we need to ensure we address the inequality that is driven through the system. We need to put in the research that is needed, so there is better data on who is accessing care and who is not, and we need to ensure that we are pushing palliative care as far as we can. If we do not, and we debate assisted dying, I am worried that people will be fearful that they will not be able to access the care that could be possible should that service be properly funded. I really urge the Minister to make that a priority before that debate takes place. Mr Deputy Speaker, I will end on that point.

Public Health

Debate between Marie Rimmer and Rachael Maskell

Tuesday 14th December 2021 Commons Chamber

[Rachael Maskell]

I am grateful to my hon. Friend for making that intervention and he makes a point I wanted to make myself. The Government’s estimate on that in their impact assessment is 123,000, and even in the best-case scenario 62,000 will lose their jobs, which the NHS simply cannot afford.

[Ms Rimmer]

My hon. Friend knows about health and care workers—

[Ms Rimmer]

I apologise. I know my hon. Friend knows about care and health workers so she knows how dedicated they are; they have a vocation. Does my hon. Friend agree that the Government can and should stop going too far? Let us not break the trust between patient and worker and between Government. Let us go down the route, which has been proven to work, of persuasion and education, and ask them and work with them to distil the fear.

[Rachael Maskell]

I thank my hon. Friend, who represents her constituents so well. There is an alternative path and we can take it today. We know that the Prime Minister is allowing people to go to pubs and clubs unmasked, while he is sacking NHS staff who are wearing full PPE and testing. Some 93% of NHS staff are vaccinated; figures from the Office for National Statistics show that 4% of people are vaccine-hesitant, which rises to 21% among minoritised communities. As 22.1% of NHS staff are from minoritised communities, the regulations will target black workers. In fact, 26.8% of workers of mixed race are not vaccinated; that is in the Government’s impact assessment, which also gives the figures for black workers. The regulations therefore indirectly discriminate against black workers.

Unvaccinated staff are frightened. On Friday, I spoke to someone in my constituency who has worked for the NHS for 16 years. Her father had a vaccine. His heart stopped. Miraculously, NHS workers brought him back to life; he is now in a critical condition. She is frightened. She tests; she wears PPE; she has sacrificed everything. She will be sacked.

I want all NHS and care staff to have vaccine counselling and education with a qualified practitioner who holds the right competencies so that concerns can be explored, not with line managers, who just do not have the competencies. I want everyone to be vaccinated—I cannot stress that enough—but I want to win the trust of staff, not push them further away, as the Government’s approach will. In York, where we have focused on those trusted conversations, we have seen 99% of our social care staff vaccinated. It just shows what works and what makes the difference.

We do not want to push people further away. We want to bring them in, win their trust and win their confidence, because we will have to ask more from our health and care staff as things get harder—we certainly will if there are fewer people to deliver the service. Let us do what works—enforcement never does. The regulations are vaccine-illiterate.

If 123,000 people lose their job in the midst of a health and care crisis, it will be catastrophic, not least as people are starting to hand in their notice now. Why go through another tough winter of trauma when we do not have to? The regulations will make it worse. We know that two vaccines, or even three, will reduce transmission of the virus, so get your jabs! But they will not stop transmission, so let us move to better PPE, FFP3 masks, daily testing and better biosecurity. Rather than pushing the regulations today, I urge the Government to go away and come back to the House with a plan for us to vote on in January. That is good governance and the way forward.

As a trade unionist, I am not prepared to be complicit in the sacking of our NHS and care staff. Trade unionists fight for working people; we are never complicit in writing their P45. As a trade unionist, I came to this place to fight for working people. I therefore urge that we change course and put staff and the care that they have for their patients first.