Hospice and Palliative Care

Munira Wilson Excerpts

Monday 13th January 2025 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

I pay tribute to my hon. Friend the Member for Wimbledon (Mr Kohler) for securing this debate and I thank the Backbench Business Committee for granting it. As he stated, the debate has taken on an added salience since the hon. Member for Spen Valley (Kim Leadbeater) brought forward her Terminally Ill Adults (End of Life) Bill on assisted dying. I hope we can all agree that regardless of what happens to the passage of the Bill, there is an urgent need to address hospice and palliative care. I want to touch briefly on two points: on children’s hospice funding and support; and, more broadly, on inequalities in access to palliative care, which relate to the concerns many of us have about that Bill.

On children’s hospices, I am very proud to have Shooting Star children’s hospice in my constituency in Hampton, to which my hon. Friend the Member for Wimbledon referred. As he stated, as well as serving children and young people and their families in my constituency, it actually serves a very wide area of south-west London, west London and all of Surrey. It provides care and support to children with life-limiting conditions, respite care, family support and, importantly, a bereavement service. From talking to the mother of a teenager who died very unexpectedly from an asthma attack in my constituency, I know that her young teenage friends have been very well supported by Shooting Star as they have been grieving their friend who so unexpectedly and tragically lost her life. I want to take this opportunity to pay tribute to Shooting Star for its incredible work.

Like other hospices, Shooting Star relies on the goodwill and generosity of so many in our community and beyond, skydiving, running, donating clothes and toys to its shops. As my hon. Friend pointed out, it now faces a £200,000 bill as a result of the employers’ national insurance rise. While I welcome the Health Secretary’s announcement prior to Christmas to renew the children’s hospice grant, I reiterate its question which was echoed by my hon. Friend: is this a long-term commitment and not just for the next financial year, and will it be ringfenced? It has told me time and again that it cannot plan for the future if it is living hand to mouth, year to year in terms of recruiting staff and putting services in place.

Hospice funding is so variable. As we have heard, Together for Short Lives reports that NHS funding in 2022-23 for children varied by as much as £483 per child. Hospice UK made a freedom of information request which found, shockingly, that 40% of ICBs have absolutely no idea how much they are spending on children’s palliative care. We need to hold our ICBs much more accountable for children’s and adult palliative care. Together for Short Lives also highlights a £295 million spending gap in NHS spending on children’s palliative care, when compared against National Institute for Health and Care Excellence standards.

That brings me to my second substantive point, on the variability of palliative care with particular regard to how it compares to national standards. Marie Curie estimates that one in four people who could benefit from specialist palliative end of life care do not receive it. People are more likely to get good palliative care, frankly, if they are richer, more educated, white and younger. The inequalities across our society in access to palliative care are growing and demand is growing, too. I had a number of conversations with the hon. Member for Spen Valley. These inequalities are one of many reasons why I really struggled and could not support her Bill on Second Reading. They really, really concern me. Back in 2011—getting on for 14 years ago—NICE recommended that there should be a designated palliative care advice line out of hours implemented in every area of the country, but only one in three areas offers that service. That shows us just how poor we are at putting in place what we have already been told needs to be provided so that people can die a good death. If that happened in any other area of care, particularly in cancer, there would, rightly, be outrage that we were not implementing NICE recommendations.

The 2024 Marie Curie “Better End of Life” report said that large numbers of people were struggling to access services. There was late recognition of their needs and poor communication. It found that the impact on carers of poor end of life care was profound. The physical and emotional toll that it took on carers left one carer saying:

“The overall experience is that no one really cares.”

When we are at our most vulnerable at end of life and our loved ones are also struggling, we deserve so much better. We need far greater investment in palliative care and hospice care. I urge the Minister to take genuine action to address both the geographic disparities and the deep inequalities that exist in accessing palliative care. We have a moral imperative, particularly if the assisted dying Bill makes progress. We cannot be in a position where assisted death is available universally on the NHS to those identified in the Bill, but access to good palliative care is not. That is what grated with me most and why I could not walk through the Aye Lobby that day. I urge the Minister and the Bill Committee to ensure that duties are written into law so that there is genuine choice at the end of life. Whether the Bill passes or not, we need to see much greater action on good palliative care.

--- Later in debate ---

[Munira Wilson]

On the children’s hospice grant, will the Minister confirm that it will be ringfenced, and that it will go beyond the one-year settlement?

[Stephen Kinnock]

Again, that is on the agenda for discussion with officials. Having inherited a disastrous situation, we are using 2025-26 to stabilise and to try to enable the sector to survive. The hon. Lady will understand that as well as doing that, we are looking at long-term reform solutions, but when we came into power on 4 July, it was one minute to midnight, and we had to rescue the sector. That is what we are doing, and we will look at the long-term issues in due course.

A number of Members have raised the concern around employers’ national insurance contributions. Since we came to office in July, we have been completely focused on repairing the catastrophic legacy of 14 years of Conservative neglect and incompetence. The first step was to fix the foundations of the public finances at the autumn Budget, and that enabled the spending review settlement of a £22.6 billion increase in resource spending for our health and care system. Our approach to ENIC exemptions has been consistent with the Office for National Statistics definition and the approach taken by previous Governments. It does not include an exemption for independent contractors, including charities like hospices, although December’s record funding announcement was a clear recognition of our commitment to financially supporting this vital sector more broadly.

I ask Opposition Members from all parties who luxuriate in criticising the means by which we have raised the record funding for hospices what they would do. How would they have raised the £22 billion that our autumn Budget delivered? Which taxes would they raise? Which public services would they cut? Answer comes there none. The Government recognise the need to protect the smallest businesses and charities, such as hospices, which is why we have more than doubled the employment allowance to £10,500, meaning that more than half of businesses and charities with ENIC liabilities either gain or see no change next year.

While the debate is not about assisted dying, I want to say a word on the matter. My hon. Friend the Member for Spen Valley (Kim Leadbeater) put forward her Bill, and it has received its Second Reading. It is vital that our approach to end of life care and patient choice is holistic and driven by an in-depth understanding of patient need.

I thank everybody across the House for this excellent debate. Actions speak louder than words. This Government have acted to deliver the biggest financial contribution to hospices in a generation.