National Insurance Contributions: Healthcare
Munira Wilson Excerpts(1 week ago)
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Karin Smyth
My hon. Friend makes an excellent point. We have still not heard from the Opposition whether they agree with the extra investment that has gone into the sector or with Lord Darzi’s report that diagnosed their legacy, including why they left that legacy and the serious issues we now have to address.
Munira Wilson (Twickenham) (LD)
Shooting Star children’s hospice in Hampton serves children with life-limiting conditions and supports their families not just in my constituency but across south-west London and Surrey. With the national insurance hike, it faces a bill of £200,000, on top of all the inflationary costs that it has had to absorb. It is also waiting for confirmation as to whether the children’s hospice grant, which this year provided it with £1.8 million, will continue beyond April 2025. Will the Minister commit to making hospices exempt from the NI rise, not just for nursing staff but for all staff, and when will she be able to give Shooting Star and other children’s hospices confirmation on whether the children’s hospice grant will continue? They need to plan now.
Karin Smyth
I commend the hon. Lady for raising the great work done by hospices. We understand the pressures and the precarious situation that many have been left in after 14 years of the last Government. We are willing and keen to talk to representatives from all types of hospice, and others. We are going through the process of the allocations and we will be able to get back to them as soon as possible.
Access to Primary Healthcare
Munira Wilson Excerpts(1 month ago)
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Munira Wilson (Twickenham) (LD)
As well as needing more GPs, our GPs need decent premises from which to deliver high-quality care to patients. Park Road surgery in my constituency has been looking for new premises for more than a decade—it serves 13,000 patients out of an old Victorian house—but there simply is not the budget, and the processes are too complex. Will the Minister commit to both looking at the bureaucracy and pressing the Chancellor for more capital investment in primary care?
Stephen Kinnock
As the Darzi review shows, one of the most egregious examples of the neglect and incompetence of the past 14 years is the underspend on capital. We are clear that a number of premises across the country can be repurposed, and that the bureaucracy needs to be cleared out of its way. As the Prime Minister said earlier this week, we will have a mission about smart regulation and clearing the bureaucratic barriers to change.
We are also cutting red tape so that GPs spend less time pushing paper and more time face-to-face with the patients they serve. We are working to bring back the family doctors and to end the 8 am scramble. We have done more for primary care in the last 14 weeks than that lot did in the last 14 years.
On dentistry, we will introduce supervised tooth brushing for three to five-year-olds in deprived areas, ending the national scandal of tooth decay. And we are rebuilding the bridges that the Conservatives burned with the British Dental Association. I have already met the BDA, and we will deliver a rescue plan that gets NHS dentistry back on its feet, with 700,000 additional urgent appointments, starting as soon as possible, in those parts of our country that need them most.
Oral Answers to Questions
Munira Wilson Excerpts(1 month, 1 week ago)
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Stephen Kinnock
I thank the hon. Gentleman for that question and the passion with which he put it. We are committed to rolling out Young Futures hubs across the country and, of course, we need to prioritise areas of particular need. I would be happy to meet him to discuss that further.
Munira Wilson (Twickenham) (LD)
A recent review of children’s mental health services in my local authority, the London borough of Richmond, found that, staggeringly, children with mild to moderate needs in tier 2 waited on average 15 months before receiving treatment, and those with more severe needs waited on average nine months. The Minister does not need me to tell him that during that time, children’s conditions get worse; they need greater treatment and, sadly, too many present at A&E self-harming and attempting to take their own life. As well as committing to mental health professionals in every school, will he put some money into acute provision, so that children do not end up in A&E?
Stephen Kinnock
We are absolutely committed to the three shifts: from hospital to community, from sickness to prevention and from analogue to digital. The sickness to prevention aspect is important in the question that the hon. Member raises. Treatable mental health conditions such as anxiety and depression should be identified early to prevent them from developing into something more serious and into a crisis, so I absolutely share the sentiment behind her question. They will be at the heart of our 10-year strategy for the future of our health.
NHS Performance: Darzi Investigation
Munira Wilson Excerpts(1 month, 2 weeks ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
I beg to move,
That this House has considered Lord Darzi’s independent investigation into NHS performance.
I am pleased to have the opportunity to open this debate on Lord Darzi’s investigation into the national health service, not just so that we can debate the past and what went so badly wrong, but so that the House can also debate the future of our NHS, how it needs to change and the many reasons to be optimistic about what our health service can be.
We have to start with honesty. For too long, Conservative Governments swept problems under the carpet, more interested in scapegoats than solutions. [Interruption.] I know; it is terrible. That is why I asked Lord Darzi to conduct an independent investigation into our national health service. He is an eminent cancer surgeon, with 30 years’ experience in the NHS, yet what he found shocked even him: some 100,000 toddlers and babies were left waiting for six hours in A&E last year; more than one in 10 hospital beds are taken up by patients who do not need to be there; children are less healthy today than they were a decade ago; adults are living longer but getting sicker sooner; conditions such as diabetes and high blood pressure are rising relentlessly; mortality from preventable causes is far higher than in other advanced countries; almost 3 million people are off work sick; and waiting lists are at record highs while patient satisfaction is at a record low.
The fundamental promise of the NHS—that it will be there for us when we need it—has been broken for a decade. Why? Because of four knock-out blows. First, a decade of under-investment means NHS staff are forced to use pagers and fax machines, with fewer cancer scanners than Greece and buildings literally crumbling. That is not to mention the disgrace that the previous Government’s new hospitals programme was written according to fictitious timetables, with the funding running out this coming March.
Secondly, there was Andrew Lansley’s disastrous 2012 top-down reorganisation that nobody voted for, cost billions and took years. It was an enormous waste of time, talent and money that should have been spent on caring for patients.
Thirdly, there was a failure to reform. The reforms made by the last Labour Government, which delivered the shortest waiting times and highest patient satisfaction in history, were ditched—a golden inheritance squandered.
Fourthly, there was coronavirus. Lord Darzi found that the NHS was hit harder than any other comparable healthcare system because of the damage the Tories had already done. It is not just that they did not fix the roof when the sun was shining; they doused the house in petrol, left the gas on and covid just lit the match. That is why millions are stuck on waiting lists, ambulances do not arrive on time and people cannot see their GP. Never forgive, never forget and never let the Tories do it again.
Munira Wilson (Twickenham) (LD)
Lord Darzi’s report was utterly damning about the treatment of children in our health system. He said that too many children were being let down, and pointed out that they account for 24% of the population, but only 11% of NHS expenditure, and that over 100,000 children wait for over a year to be assessed for mental health treatment. He said we must do better, so will the Secretary of State commit to putting children front and centre of the 10-year plan, and to making them a priority, because for a decade, the Tories let our children down?
Wes Streeting
I strongly agree with the hon. Member. I will talk about the 10-year plan shortly, but I can guarantee that children and paediatric care will be front and centre of that plan. We can do much more to shine a spotlight on paediatric waiting lists, as well as doing much more in practice. She mentioned children and young people’s mental health, on which our parties strongly agree. We will deliver our manifesto commitment to put mental health support in every primary and secondary school in the country, as well as providing walk-in services in every community, so that young people receive the mental health and wellbeing support that they need and do not get to the crisis point reached by far too many of our children.
The hon. Member’s intervention is an example of why I am looking forward to the debate. I hope to listen to contributions and to challenge from all sides of the House. Before I take any interventions from Conservative Members, I advise them that if they want to get a hearing on the NHS ever again, then the first word that should pass their lips is, “Sorry”. Only last week, at the Conservative party conference, we did not see a single shred of remorse or contrition for their appalling record. Indeed, when it comes to the shadow Secretary of State and her party, it seems that sorry is the hardest word.
The NHS is broken. NHS staff do not want to accept that, but it is. According to YouGov, that is what the vast majority of patients say. It is also what staff tell me every time I am on the frontline, but I understand why some people find the word difficult. In the past few weeks, I have met some of the NHS team who happened to be on duty on Monday 29 July. I have listened to paramedics describe the scene they walked into at the community centre in Southport. Children and adults who had been dancing to Taylor Swift were lying bleeding and, in some cases, tragically dying as a result of an unimaginable, senseless, mindless attack. Those paramedics had to make split-second decisions about who to treat and in what order to give the injured the best chance of survival. Security teams cleared busy hospital corridors to shield as many people as possible from the horror. Lab teams mobilised blood supplies. Receptionists fielded calls from panic-stricken patients. Surgical teams across multiple hospitals worked together, fighting to save those young lives. Even now, months later, mental health staff are picking up the pieces for families who are either grieving or going through the unimaginable challenge of supporting their children through what they witnessed.
On that day, those NHS responders—the whole team involved—were the best of humanity confronting the worst. That is who NHS staff are. That is what they do. Let me be clear: the NHS may be broken, but NHS staff did not break it. I want to be clear about this too: what is broken can be fixed. While the NHS may be in the midst of the worst crisis in its history, the biggest asset that we have is the people who work in it. They are up for the challenge, and up for change. The NHS is broken, but it is not beaten. Together with the 1.5 million people working in the health service, this Government will turn our NHS around, get it back on its feet, and make it fit for the future.
Pharmacy Provision: Hampton
Munira Wilson Excerpts(3 months, 4 weeks ago)
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Munira Wilson (Twickenham) (LD)
May I start by congratulating you, Madam Deputy Speaker, on your election? It is a pleasure to see you in the Chair. I also congratulate the Minister on his appointment. We have worked closely together in recent years in the all-party parliamentary group on kinship care, so I have no doubt that he will do an excellent job. I suspect that young Lyle is very proud of his granddad right now.
I am delighted to have secured this Adjournment debate. You might be surprised to learn, Madam Deputy Speaker, that this is the first I have managed to secure since my election in 2019, so I want to use this exciting opportunity to bring to the Minister’s attention the impact of pharmacy closures on the local community in the Hampton area of my constituency, as well as the immense financial challenges facing community pharmacy right across England. I will also raise concerns about the impenetrable bureaucratic processes, which need overhauling, in new pharmacy licence applications and pharmacy closures.
Let me set the scene. Last autumn, two Boots pharmacies in the Hampton area were closed. One of those pharmacies was in the Hampton North ward, one of three wards of relative deprivation in the London borough of Richmond upon Thames. The west of the ward is within the 20% most deprived areas of the country; it is densely populated with a significant amount of social housing. As a result of that closure in Tangley Park, the entire ward is now without a community pharmacy.
Hampton North is poorly served by public transport: there is no station, and the two bus routes serving the area are notoriously unreliable. The nearest pharmacy is now a mile away on foot, a distance that is difficult to cover for the elderly and those with mobility issues. It is certainly more than a 20-minute walk away, which is the measure that previous Ministers liked to use to highlight pharmacy accessibility. Predictably, those closures have put a lot of pressure on the nearest remaining pharmacies, which face queues and stock issues. Again, that is not exactly convenient or practical for elderly and vulnerable patients.
At this point, I pay tribute to Mike Derry and Healthwatch Richmond for their brilliant work championing local patients and giving them a voice. Healthwatch undertook a survey of some 700 residents in the Hampton area at the start of the year to demonstrate the impact of the closures. One person said:
“I have gone without medication as I can’t stand very long. There are queues—I have waited over half an hour.”
Healthwatch England highlighted the plight of 87-year-old Gill. She used to just about be able to get across the road from her house to the Tangley Park pharmacy. Now the nearest pharmacy is over a mile away, and Gill, who does not drive, cannot access that service because of the distance that she would have to walk to get there. She even paid the nearest pharmacy to deliver her medicines to her home each month, but in the eight months since she purchased the delivery service, it has shown up only twice. Her carer has to travel to collect the medication in person for her.
Hampton is not unusual in losing pharmacy provision. I am sure that the Minister is aware of the crisis facing the community pharmacy sector. Data from the Community Chemists’ Association shows that there has been a net loss of over 1,200 pharmacies—1402 closures and only 179 openings—since 2015. More than a third of those losses have been in the most deprived areas of the country. The National Pharmacy Association reports that the number of pharmacies that have closed so far this calendar year—the equivalent of 10 pharmacies a week—is nearly 50% higher compared with the same point in 2023. As well as independent pharmacies, big chains such as Lloyds Pharmacy and Boots have significantly accelerated closure numbers over the past 18 months. A big driver of these closures is a significant real-terms reduction in funding for pharmacy; that funding has dropped by around 30% since 2015.
James MacCleary (Lewes) (LD)
Is my hon. Friend aware of the issue of overwhelmed surgeries referring increasing numbers of patients to local pharmacists? I have seen it in my Lewes constituency. Does she agree that this will only contribute further to closures?
Munira Wilson
I thank my hon. Friend for his intervention, and I congratulate him on his excellent maiden speech. I completely agree with him. We want doctors to use community pharmacy more to alleviate the pressure on other parts of the health service, but frankly, if the pharmacies are not there, the remaining ones will be overwhelmed. I talked to local GPs in the Hampton area following these closures, and they were desperate to see more provision. They thought about trying to set up their own community pharmacy provision, but they just could not make the numbers add up because of the funding shortfall.
The Company Chemists’ Association estimates an average funding shortfall of £67,000 per pharmacy. That is based on an analysis of data published by the Department of Health and Social Care in a written parliamentary answer at the beginning of last year. Many pharmacists are left out of pocket, as they are reimbursed less for a number of medications than the price they pay, and there are stories of some using credit cards and overdrafts to purchase medication.
These funding pressures are coupled with major workforce challenges. When I met Boots following the news that it is closing two branches in Hampton, it cited a lack of pharmacists as a major reason for closing some 300 pharmacies across the UK, although commercial pressures were clearly the main driver. Layered on top of these issues are regular medicine supply shortages, which add more work and create more stress for already overstretched pharmacists. Community Pharmacy England reported last year that 92% of pharmacies were having to manage supply issues daily.
It is a perfect storm for community pharmacy at a time when we need preventive healthcare and self-care more than ever. The potential of community pharmacies to improve patient health and reduce the pressure on NHS hospitals and GPs is immense, yet they are closing in their hundreds every year. We should be relying on pharmacies even more to keep the nation healthy. The previous Conservative Government’s announcement of the Pharmacy First initiative was very welcome in its ambition, but if pharmacies are not even funded for the basics right now, with big gaps in provision opening up all over the country, it is hard to see how Pharmacy First’s ambitions will be achieved.
The Liberal Democrats would like to see the Government building on the Pharmacy First principle and giving pharmacists more prescribing rights and public health responsibilities. As in so many areas of public health, the “invest to save” argument is compelling, and I look forward to hearing the Minister’s comments on what the new Labour Government will do on funding to enable community pharmacy to not just survive, but thrive and grow as an essential part of our primary care infrastructure.
Having addressed the causes of these closures, I will spend some time exploring the processes involved in local communities being informed of pharmacy closures, and their input, or lack thereof, in them, as well as discussing the complete lack of transparency or accountability in relation to applications for new pharmacy licences. For starters, only those organisations designated as “interested parties” in the regulations are informed of new applications, and only their feedback has to be taken into account. Anyone else who is interested, such as me as a local MP, needs to make a freedom of information request, unless someone in the local health community passes on the information. My views, and the views of other people in the community, can be ignored.
To describe the bureaucratic process that sits around new applications as byzantine would be generous. I hope the Minister, Madam Deputy Speaker and other hon. Members will bear with me while I try to explain what happened in Hampton. We are part of the South West London Integrated Care Board, but NHS England has delegated the pharmacy market entry function for the whole of London to the North East London ICB, which is on completely the opposite side of the city. Officials have no local knowledge of our area, no understanding of local transport links and no relationships with the local health system.
Let me start with the closures. The Minister will be aware of the statutory three-month notice period for pharmacy closures; last August, Boots would have had to give NHS England three months’ notice of its intentions in Hampton. That information was not passed by NHSE to the Richmond health and wellbeing board. I find that utterly staggering. The first that local councillors, the local health community in the area and I as the MP knew about the planned closures was when Boots placed signs in its windows to inform customers, and concerned constituents started to contact me about the likely impact of the closures.
At the end of August 2023, while this was going on and we were all in the dark, the local health and wellbeing board published a pharmaceutical needs assessment, but it was inaccurate and failed to identify an imminent future gap in need in the Hampton North area because it had not been notified of the closures. The Tangley Park Boots subsequently closed in late October. The Priory Road Boots, which was directly opposite a busy GP surgery, closed in early November.
In November, an application was received for a new independent pharmacy licence on the Tangley Park Boots site. Once again, the local health and wellbeing board was not notified of the application—this time, for two whole months. During this period of complete silence, the health and wellbeing board issued a supplementary statement to the local pharmaceutical needs assessment, which identified the gap in Hampton. However, because the application for a new pharmacy was made in November, and it referred to the original needs assessment that was made before the supplementary statement was published, it was rejected, even though the application itself identified the gap, which was officially made clear in the supplementary statement subsequently published in December. Not only that, but it took the North East London ICB a full eight months to issue the rejection; tht happened earlier this month, even though the decision used evidence received in December to justify the rejection.
Madam Deputy Speaker, if you and other hon. Members are still managing to follow this sorry story, I hope you will agree that this decision is utterly perverse. It is also utterly unreasonable that timely applications to open pharmacies in response to multiple closures should be inherently prevented in this way. The delays in sharing information with the local health and wellbeing board and the delays in decision making are unforgivable. During the lengthy delay, the local authority received a planning application to change the Tangley Park pharmacy site into a fast food outlet. Thankfully, that was rejected earlier this month after representations from the public health team and councillors, but I am sure the public health Minister will agree that it would be unfortunate, to put it mildly, if a pharmacy were replaced with a fast food outlet.
One local official told me yesterday that the systems architecture is too complicated, and that there is a need for clearer responsibilities and accountability. Amen to that, I say. Healthwatch Richmond has demanded answers from the North East London ICB, but it has received a frankly woeful response that does not address the substantive question of why the application was so badly handled. The response passes the buck and blames regulations. To be clear, Healthwatch and I are not qualified to comment on the merits of an application; what we are doing is challenging the unfathomable process.
I say to the Minister that the huge funding challenges facing community pharmacy are pressing. I appreciate that they may be extremely difficult for him to address, given that the Chancellor has an iron fist as far as any additional public spending is concerned, but the Minister must wage a campaign to improve the funding situation. It makes financial sense. We will not grow the economy without improving the nation’s health. In that campaign, he will have cross-party support from Members on the Opposition Benches.
Revisiting the regulations and how NHS England is implementing them will cost next to nothing. There should be proper consultation with and involvement from the local community on closure notices, and changes in the process for new licences could ensure that we can quickly plug pharmacy gaps when they open up in areas such as Hampton. Crucially, those powers need to be delegated to the local ICB, with full involvement from the local health and wellbeing board. They know their communities and their geography best—trust them.
Finally, if the Minister could step in on the specific issues in my constituency—the application that has been rejected and is going NHS Resolution on appeal—simply to ensure a common-sense approach, the residents of Hampton North and I would be very grateful. We desperately need a new pharmacy for our community. I look forward to his response.
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
May I start by welcoming you to the Chair, Madam Deputy Speaker? I congratulate you on your election earlier this week. I also congratulate the hon. Member for Twickenham (Munira Wilson) on securing a debate that is absolutely crucial, not just given the specifics of the case in her constituency, but for the precedent that it sets as we plan community pharmacy provision across England. I assure her that although Lyle missed out on his week in London for Whitsun half-term, because somebody called a general election, he is on his way to London as I speak, with Allison, so that we can do London as tourists this weekend.
I am responding on behalf of the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), who leads in this area. I start by paying tribute to pharmacists. It is a credit to them that surveys show that nine in 10 people who visit pharmacies feel positive about their experience. Colleagues appreciate how accessible pharmacies in towns and villages across our country are, but for too long, Governments have failed to recognise their essential role in safeguarding the nation’s health, not least in my constituency of Gorton and Denton. This Government know that people who work in pharmacies are highly trained specialists, and we are committed to helping pharmacists and pharmacy technicians reach their full potential.
Pharmacies already provide vital advice on prescriptions, over-the-counter medicines and minor ailments, but they do not just dispense medicines and proffer advice, important though that is; they must do much more than that. Many already offer blood-pressure checks, flu and covid-19 vaccinations, contraception consultations and treatment for the seven conditions covered by the Pharmacy First service. I supported Pharmacy First when I was in opposition, as I think the hon. Lady did, and my party pledged to build on the programme by making prescribing an integral part of the services delivered by community pharmacies. For that reason, in the next two years, we will ensure that every newly qualified pharmacist has a prescribing qualification, while we train up the existing workforce.
This year, NHS England is working closely with all integrated care boards on pilots to test how prescribing can work in community pharmacy, because like the hon. Lady, we want pharmacies delivering services that help patients to access advice, prevention and treatment more easily; services that ease the pressure on general practice and in other areas in the NHS; and services that unlock the knowledge and expertise that our pharmacists have to offer. This Government take the view that pharmacies can and should play an even greater role in providing healthcare on the high street. That is why we stood on a manifesto that promised to shift resources to primary care and to community services over time. Community pharmacies will play an important part in moving our health service from hospital to community, from analogue to digital, and from sickness to prevention. But we have only been in office for three weeks; this cannot happen overnight, and colleagues have been absolutely right to raise concerns with Ministers about the closure of pharmacies.
As we speak, well over 10,000 pharmacies in England are dispensing medicines, offering advice and delivering care, and despite closures, access to pharmacies remains good across most of the country. Four out of five people live within a 20-minute walk of their local pharmacy, but as we have heard in this really important debate, that is not the case everywhere in the country. I know, having listened to the hon. Lady, that in Twickenham it is higher than four in five, but in other parts of the country it is below one in two. In the most deprived parts of England there are almost twice as many pharmacies—a good thing—than in the least deprived, but we need better access across the country. To take the example of my own constituency, where access to pharmacies is fairly good, almost the entire population is within a 20-minute walk from a pharmacy. However, in certain rural areas, and in a growing number of urban areas because of the closure programme, that is not the case. In those rural areas, there are dispensing doctors who can supply medicines to patients, and patients across the country can access around 400 distance-selling pharmacies that deliver medicines to patients’ homes free of charge. It is true that experiences vary depending on where people live, but I am aware of the specific problem in Hampton following the closure of the two Boots pharmacies that she described.
Munira Wilson
On the point about the 20-minute walk and the four in five statistic, does the Minister recognise that a 20-minute walk for me or him is actually much longer for an elderly person or somebody with multiple health conditions or mobility issues? We have to work out what measure we are using. Yes, the Twickenham constituency may have many pharmacies, but we must look at that highly localised level. That is why we need the local authority and local health boards to be involved, because actually in Hampton, as a community, the transport links are terrible.
Andrew Gwynne
I completely understand the case the hon. Lady is making. I ask her please to understand that she is pushing on a bit of an open door. It is a completely different subject, but I have had exactly the same arguments about bank closures in my constituency. I am told that as long as the nearest bank branch is half an hour away by public transport, that is acceptable. Unfortunately, computer says no when it is two buses that do not meet up in between. I agree with her that there are complexities around drawing up arbitrary limits, but generally access to pharmacies is good. We need to maximise the use of the pharmacy network so that we get more pharmacists coming in.
Hospice Funding
Munira Wilson Excerpts(7 months ago)
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Sally-Ann Hart
I do, and I will be coming to that a little later.
The future of end of life care is uncertain, as increasing costs and demands are putting huge pressures on hospices and care providers. When it comes to the debate on assisted suicide, it is important that people feel confident that their end of life care will protect them from pain and suffering.
Certainly, we need increased funding. More resources are needed for end of life care services, including hospices, home care and palliative care teams. St Michael’s Hospice, for example, costs around £7 million a year to run and it receives about £2 million a year from the integrated care board and the remaining £5 million comes from the community in various forms. Like all hospices, St Michael’s is heavily dependent on the generosity of local individuals, companies, groups and trusts. This funding model is uncertain and unsustainable and places hospices under considerable strain.
Munira Wilson (Twickenham) (LD)
I thank the hon. Lady for giving way and congratulate her on this important debate. On the point that the hon. Member for Brent North (Barry Gardiner) made about children’s hospices, I have the fantastic Shooting Star children’s hospice in Hampton in my constituency, which serves a wide catchment area. The hon. Lady mentioned the statutory duty, introduced by the Government, on ICBs to commission and fund palliative care, but the problem is that there is such huge variability. Surrey Heartlands, which is one of the ICBs that Shooting Star serves, spends only a paltry £39 per child, even though the average should be about £151, and other ICBs will not even disclose the amount. Does she agree that we need multi-year contracts with ICBs to serve these hospices?
Sally-Ann Hart
I agree, and will come to that later in my speech.
Demelza receives just 10% of its income from the children’s hospice grant, which ends in March 2025, and just 4% of its income from spot purchases, so 86% of its income must come from fundraising. I am concerned that neither the UK Government nor NHS England has set out whether the children’s hospice grant, which is worth £25 million, will continue beyond 2024-25. The grant is a vital source of funding for children’s hospices. Dependence on the generosity of members of the public to pay for vital healthcare would not be tolerated in other core areas of healthcare such as maternity services, cancer care or A&E. Hospices are the only statutory service that relies on fundraising to keep going, despite end of life care being an essential service that so many of us will need.
Bambos Charalambous (Enfield, Southgate) (Lab)
I thank the hon. Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this important debate.
Hospices do incredible work. In communities across the country, they hundreds of thousands of people every year with essential palliative and end of life care. The services that hospices deliver are absolutely crucial to improving the quality of life for people in their final weeks and days, helping to provide a dignified, comfortable and compassionate end of life. That support is vital not just to people at the end of their lives, but to their family and friends. End of life care impacts not just the patient but all their loved ones, and the specialist support that hospices provide patients in their final stages of life, and their families who are watching them pass away without suffering or pain, is immeasurable. It is why hospices are so important.
In my Enfield, Southgate constituency, we are lucky to have a facility of the incredible North London Hospice, which has been caring for people since 1984. Its health and wellbeing centre in Barrowell Green helps to enable the best of life at the end of life for people across the boroughs of Enfield, Haringey and Barnet, providing tailored care, including physical, emotional, spiritual, wellbeing and bereavement support for patients, friends, carers and loved ones. I must also mention those in the wonderful North London Hospice photography club, who support each other and take amazing pictures, which they sell to raise funds for the hospice.
I remember hearing from a constituent of mine, Joy Watkins, who was receiving care and support at the hospice. Joy has sadly now passed away, but her words about the importance of the hospice and the care that she received were incredibly moving. Joy spoke about going to something called a death café—an informal space for people to talk about end of life, share their concerns and listen of others express their thoughts, hopes and experiences of death. She said that going to the death café enabled her to make choices about the end of her life. She could make choices about who to spend time with and about the finances that she would make use of at the end of her life. It transformed the way in which she viewed and handled the end of her life.
The way in which we talk about and approach dying matters, and Joy’s words have really stuck with me. Indeed, they were one of the reasons I introduced my private Member’s Bill—the Terminal Illness (Provision of Palliative Care and Support for Carers) Bill—back in 2018. Next month, Hospice UK will be promoting its campaign for Dying Matters Awareness Week, and I look forward to supporting its efforts on that important initiative. Honest and timely conversations about death and dying are essential to good end of life care, but barriers including lack of confidence, taboos around discussing death, and confusion about who should be having these conversations all too often mean that patients, carers and families may not understand what is happening or get all the information and support that they need. That is where hospices and their brilliant staff come in. More recently, a close family member of mine received support from North London Hospice, and although Gabby sadly passed away, I am so grateful for the hospice’s specialist care.
Yesterday I and about a dozen hon. Members ran the London marathon. I was proud to do so to raise money for North London Hospice. When pounding the streets of London in such a wonderful festival of community yesterday, I was struck by how many runners were, like me, raising money for their local hospices. That demonstrates the sad reality of inadequate central funding for hospices. I have been trying to bang the drum for North London Hospice since I was first elected, and although it took me a few years to muster the courage to put on the running vest and put my knees on the line, as each year passes it feels as if the challenges facing hospices grow greater and more acute.
As we know, hospices are an integral part of our health and social care system. They work in partnership with local health and care systems, helping to reduce the pressure on our NHS by caring for patients who would otherwise be directly supported by NHS services. As a community, we are reliant on hospices—they are important parts of the communities that they serve—but they are also reliant on us for support, through fundraising and donations, because they are largely charitably funded. On average, around two thirds of adult hospice income is raised through fundraising such as charity shops and marathons, and the figure is higher for children’s hospices, which must raise around four fifths of their income.
Munira Wilson
On children’s hospices, Shooting Star in my constituency, which I have already mentioned, is very grateful that the Minister has committed to the children’s hospice grant for 2024-25, which comes centrally from NHS England. The problem is that that is a year-to-year commitment, which does not help hospices such as Shooting Star to plan for the long term. Does the hon. Gentleman agree that a ringfence should be placed around that funding and that it should be pegged to inflation year on year so that children’s hospices can plan properly?
Bambos Charalambous
The hon. Member makes an excellent point. Long-term funding is absolutely essential if hospices, particularly children’s hospices, are to be able to plan ahead.
North London Hospice is reliant on donations from the community each year to fill its £10 million funding gap, as only a small proportion of its costs are funded by the NHS. Of course, the cost of living crisis continues to eat away at people’s finances, which directly impacts on our communities’ ability to provide the vital charitable support that hospices rely on. The reality of the current state of funding is that hospices are struggling to keep up with inflation and rising costs, which is leading to services being cut. However, demand for palliative care continues to grow—for North London Hospice, it has grown at a rate of 5% year on year. The costs of running hospice services, including energy bills and the cost of paying staff a fair wage, also continue to rise rapidly.
Hospices recruit from a small pool of staff in the NHS and care sector, but they are not provided with the same Government funding to meet NHS pay levels, meaning that many hospice staff are doing the same job as their NHS colleagues but being paid less for it. As a result, Hospice UK’s figures suggest an 11% growth in payroll costs this year, which means around £130 million of additional spending that is not met by increased statutory funding. As I have mentioned, those costs are not met with additional uplifts from NHS funding or contracts, and despite a legal requirement for ICBs to commission palliative care services that meet the needs of the local population, the funding that hospices receive from ICBs varies significantly across the country and means that charitable donations make up much of their income.
Children’s Cancer Care: South-East
Munira Wilson Excerpts(8 months, 1 week ago)
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Munira Wilson (Twickenham) (LD)
I beg to move,
That this House has considered children’s cancer care in the South East.
It is an honour to serve under your chairmanship, Sir Christopher. In 2020, Jackson’s parents received some of the worst news a parent possibly can: Jackson had been diagnosed with leukaemia, at just two years old. He soon began treatment at St George’s Hospital in Tooting; and after three years, in April 2023, he finally rang the bell that signified the end of his treatment. It was a very difficult experience for Jackson, but his family are extremely grateful for the treatment they received at St George’s Hospital. Reflecting on the experience, Jackson’s mum, Samantha, said:
“Thank you St George’s for being such a great hospital and to everyone who works there, you have made our journey so much easier to deal with because you’re the best team.”
Tomorrow, NHS England will make a decision about where to place a new children’s cancer centre, which will serve south-west London and the surrounding areas, such as Surrey, Sussex, Medway and Kent. NHS England will decide between two proposals: one submitted by St George’s Hospital, and the other by the Evelina London Children’s Hospital in Lambeth. After listening to staff, patients and others affected, I am here, with colleagues from both sides of the House, to make the case that children’s cancer care must remain with St George’s.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
I thank the hon. Member for making a powerful speech and for referring to Jackson. Does she agree that the independence of NHS England is important, that any decision it makes tomorrow has to be based on the clinical knowledge of medical experts, that the decision must be free from any political interference and that the world-class facilities at Evelina, which the hon. Lady has seen at first hand, should be considered alongside the other hospital? Does she agree that we must ensure that the decision is independent, and that we do not undermine the public reputation of NHS England or put undue pressure on it?
Munira Wilson
This is not about political interference; it is about ensuring that there has been a fair, balanced and transparent process. I will talk about the process in a moment, but that is the concern. The hon. Lady talks about clinical input. The consultation, albeit that it was run in a very flawed way, had 2,500 responses—some were from clinical experts, and many were from patients and their parents—and it provides very strong evidence that St George’s is best placed and that the Evelina has been predetermined. I have nothing against the Evelina, and in fact I was just about to sing its praises, because I have had personal experience.
To make myself clear, the Evelina is a brilliant hospital that does incredibly important work in treating children. My own daughter, who is nine, is currently undergoing treatment at the Evelina and has received outstanding care. This is not about pitting hospital against hospital; it is about looking at the process and the evidence before us. As the hon. Member for Vauxhall (Florence Eshalomi) has alluded to, I would like to personally thank the medical director at the Evelina, who showed me around its excellent facilities on Monday. However, as I have mentioned, the evidence overwhelmingly demonstrates that, in this case, St George’s is best placed to deliver for this highly specialist cancer service.
Before I come to that evidence, I want to raise serious questions about the decision-making process to date. [Interruption.]
Sir Christopher Chope (in the Chair)
Order. There is a Division in the House. I do not know whether there will be just one Division. If there is only one, we will come back in 15 minutes; if there are two, we will come back in 25 minutes.
Munira Wilson
To pick up where we left off, before we look at the evidence and arguments for keeping this precious service at St George’s, I want to raise the serious questions that have been highlighted around the decision-making process that has brought us to this point. NHS England first publicly expressed its preference for the Evelina proposal at the start of last year, long before it had even launched its public consultation. This has raised concerns that NHS England has created a process in which the views of patients, clinicians and patients’ families have not been seriously listened to and taken into account.
Stephen Hammond (Wimbledon) (Con)
The hon. Lady is quite right. I congratulate her on this debate. I have spoken to the Department and NHS England about the process, as there have been real concerns about the scoring and whether that has been based on evidence or preference. There is also real concern that clinical outcomes are not being given quite the highest priority they should be, which will be key if we are looking at the cancer survival rates for young children.
Munira Wilson
Absolutely. There is the point about transparency, the fact that it has been predetermined, and the point about outcomes, which I will touch on briefly in my speech.
In a consultation response submitted by Healthwatch Richmond and Healthwatch Merton, the groups concluded that the consultation design was insufficient because it “fails the legal test” for consultation and appears to have no prospect of altering the decision to award the new service to the Evelina. I am therefore keen to hear from the Minister what assessment her Department has made of how NHS England has carried out this process. Further, can she give an absolute assurance to Members that the decision made tomorrow will have been made fairly?
Regardless of the way in which it was carried out, the consultation received over 2,500 responses from affected groups, such as patients, their families, clinicians and professional organisations. Those voices must be heard, and I will seek to ensure that they are. One of the most important themes raised was specialist knowledge and experience of children’s cancer care. It is undeniable that St George’s has invaluable experience to offer: it has already been treating child cancer patients, in partnership with the Royal Marsden, for over a quarter century. Not only is that experience highly valued by patients and their families, but it has resulted in excellent outcomes, as the hon. Member for Wimbledon (Stephen Hammond) said. According to national data collected from intensive care units, St George’s children’s cancer intensive care outcomes are the best for a large unit in the UK. All the institutional knowledge, specialist expertise and professional networks that have been built over decades risk being lost if cancer care were to move away.
Another key theme that was repeatedly mentioned in responses was that the centre should be conveniently located. Travelling via public transport with a vulnerable and immunosuppressed child is both stressful and very risky, so patients and families have repeatedly stressed that a new centre must be easily accessible by car. Anyone who has lived or worked in central London knows how difficult and unpredictable driving in and out of central London can be. However, located in Tooting, St George’s is much easier to access, and has strong road links to parts of the south-east. That is particularly appreciated by those travelling from afar.
Finally, responses highlighted the importance of having most specialisms on a single site. One service that is particularly vital to child cancer patients is neurosurgery, which is required by one in four of them. Currently, out of the two options, only St George’s offers neurosurgery. According to the Children’s Cancer and Leukaemia Group, the fact that the Evelina does not currently provide cancer surgery is not an issue that can be resolved quickly, and relocating surgery services comes with associated risks to both patients and staff. In its consultation response, the British Association of Paediatric Surgeons notes that where that has happened in previous cases, a lack of support and structure has resulted in staff “leaving the relocated unit.”
Further, clinicians have shared concerns that, if children’s cancer care were to move from St George’s, other services could be disrupted, which may create unforeseen consequences for the many areas served by St George’s. By contrast, placing the new centre at St George’s would ensure that NHS services are not overly centralised, but rather evenly distributed across the region. What assessment have the Government made of this crucial clinical evidence and the associated potential risks to the cancer service and other children’s services?
The decision is such an important one because at its heart are children with cancer: a group who have dealt with the most challenging and frightening of circumstances so early on in their lives. In many cases, the children can go on to lead full lives. One such example is Zoe, a teenager who was treated by St George’s when she was just four. She has since recovered and now has dreams of becoming a children’s nurse. She says:
“I’m so grateful to the paediatric staff at St George’s Hospital for looking after me, and for always being there for me throughout my life. Thank you to the nurses who told me to follow my dreams and never give up.”
The experience, expertise and convenience that St George’s offers are extremely valued by patients and those who care for them. That must be reflected in the final decision that is made tomorrow, and that is why it is so crucial that no doubt is cast over whether the decision is being made fairly and transparently. Yet, as I have set out, the way that NHS England has handled the process means that it is very difficult to make that judgment at this point.
Last week, together with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey) and my hon. Friend the Member for Richmond Park (Sarah Olney) I wrote to the Secretary of State requesting that she uses her formal powers to call in this decision should NHS England press ahead tomorrow with awarding the children’s cancer service to the Evelina; and a group of cross-party council leaders from across south-west London and Surrey have done the same.
I conclude by urging the Minister in the strongest possible terms to join that call and to support us in saying that this decision must be called in tomorrow if the Evelina is chosen, because of the serious process and clinical arguments that I have laid out today.
Sir Christopher Chope (in the Chair)
Back Bench speeches in this debate will have to finish by 5.38 pm.
The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)
Thank you, Sir Christopher. It is a pleasure to serve under your chairmanship in what has been quite a drawn-out debate on such an important topic. The hon. Member for Twickenham (Munira Wilson) has raised an incredibly important issue. I hope she and all hon. Members accept that clinical assessment and knowledge are crucial to making vital decisions that affect children’s health at such a difficult time for them and their families.
I am responding to this debate on behalf of my right hon. Friend the Member for Pendle (Andrew Stephenson), but I will endeavour to respond to each colleague and commit to writing where necessary. The debate has understandably stirred some strong emotions, because every colleague has had direct or indirect exposure to some of the questions it has raised. I am therefore grateful to all hon. Members for their contributions, which demonstrate the huge importance to us all of getting the right outcome.
Each of us has helped a parent who has called our constituency offices seeking help at an incredibly difficult time. I want to assure everyone that each person in the Government, from the Prime Minister down, knows the importance of getting this right. That is why cancer services for children are an absolute priority. From my own work in the Start for Life programme, and in the few months I have been in my current role, I have seen a collective determination to ensure that children right across the country receive the highest possible standards of care. Children with cancer are the key priority.
The Royal Marsden Hospital and St George’s Hospital currently care for most of the children with cancer in south London and the south-east. I pay tribute to the work of those dedicated doctors and nurses who do everything they can to look after the children entrusted to their care, and I want to be clear that NHS England’s proposed changes do not reflect on the stellar service that those staff members have given and continue to give. Rather, the proposals follow advice from Professor Sir Mike Richards’ review, which made it a clinical requirement for cancer services to be placed in the same location as an intensive care unit in order to give critical life support to the most unwell children.
Sir Mike’s reasoning was simple. First, we need to end transfers between hospitals for very sick children, which add risks and stress for them, not to mention their families, during what is already an unimaginably difficult time. Secondly, while we will not compromise on safety, we need to ensure quality of care. As every Member will agree, children deserve to benefit from the very latest technology available. Thirdly, we need to ensure a seamless, joined-up approach.
NHS England has listened to patients, parents and clinical experts to hear how we might best improve their care. The NHS England process has been rigorous, and it has been immensely important for all those patients, parents and specialists to put forward their own significant insights. Last year, NHS England carried out a 12-week public consultation on two options for the future location of the principal treatment centre for south London and much of the south-east: Evelina London Children’s Hospital and St George’s Hospital. Under both options, all radiotherapy for children with cancer would be at University College Hospital.
Both Evelina London and St George’s deliver outstanding-rated children’s healthcare. They also provide outstanding-rated education in their hospital schools. Both are capable of delivering a future principal treatment centre that meets our high standards. They are also both adept at listening to children, young people and their families to improve on the care they deliver.
The experience and expertise of specialists working side-by-side with intensive care and surgical teams will make a real difference: enabling children to get care where they need it, when they need it, on a specialist cancer ward; bringing down the number of children admitted to intensive care; making it easier for different specialist teams treating the same child to work closely together; improving care for children; upskilling the workforce and supporting new kinds of research. Importantly, it will also mean that the future cancer centre will be capable of offering the most innovative and cutting-edge treatments, which may bring precious new hope for children and their families.
The centre will build on the strengths of the existing service, including high-quality care by expert staff and access to clinical trials. It will be a family-friendly centre for children and young people, at the forefront of groundbreaking research and continuing the close relationship with the Institute of Cancer Research.
Munira Wilson
The Minister said a moment ago that the new centre will build on the service and the experience. The point that I and many Members have made is that St George’s has that experience. While the Evelina is brilliant in many paediatric specialisms, it does not have children’s cancer experience, so what will it build on? On the point about process, it was already predetermined, as I pointed out. It has been made clear in meetings we have had that a lot of the responses will not be taken into account unless there is new evidence. The views of children, their parents and clinicians are not being listened to in the consultation.
Dame Andrea Leadsom
I am afraid I fundamentally disagree with the hon. Lady on that point. The consultation has been open, with an open mind and following the best principles of open consultation. I think she is taking quite a liberty to suggest it is a foregone conclusion. I do not think she is correct in her belief. It is essential that clinicians can take all the inputs from those consultations to come to the right decision.
Dame Andrea Leadsom
I absolutely agree with my hon. Friends that the consultation is critical, that it has been an open consultation and that all views are being taken into account. I am grateful to them for supporting the process. As Members of Parliament and constituency representatives, we all want the best for our constituents, but in the case of clinical care, it is vital that those with specialist knowledge and understanding should be able to make such important decisions that will affect life and death outcomes for children.
The new centre will be a family-friendly centre forusb children and young people at the forefront of groundbreaking research, continuing a close relationship with the Institute of Cancer Research. The centre will lead joined-up working between different children’s cancer services so that children get proper access to care, wherever they live. Importantly, it will have many more services on site, reducing the need for some families to travel, which will be particularly helpful for children with complex needs and families that struggle to speak English.
I assure colleagues, and anyone who might be watching at home, that once the decision has been taken, there will be no sudden changes to how patients receive care. Of course, some families will naturally be worried about what the change might mean for their children. That is entirely normal, and NHS England will carefully involve every clinical team currently providing care, keeping parents and families closely updated at every stage. NHS England will encourage experienced staff to move to the future centre so that they can continue to provide a friendly and familiar face to the children they serve. No one from among the clinical staff will be made redundant in any future changes resulting directly from this decision. NHS England has met staff to listen to their views, and they assure me that that will continue.
The consultation heard from children, their carers, and families who have received the worst news. They have talked about their own experiences selflessly to try to help others. The consultation closed in December last year, and an independent research organisation published its findings in January. NHS England has taken into account every word of feedback and every inch of evidence to inform the decision-making process. NHS England leaders are meeting tomorrow to decide the future location of the centre. The meeting will be livestreamed so that everyone who is interested can hear the discussion and the decision.
In conclusion, wherever the future centre is placed, I am confident that tomorrow’s decision will offer the right outcome for our children and take all views into account.
Dame Andrea Leadsom
No, the hon. Lady will have her chance in a moment. Throughout this process, the guiding principle has always been safety, quality of care and the best outcomes for children with cancer, now and for the long term. The children and their families deserve nothing less.
Munira Wilson
I am sorry that the Minister would not give way again; I wanted to ask her a direct question, but I do not believe that she has the opportunity now to come back to me.
I start by thanking all the right hon. and hon. Members who have participated in this rather drawn-out debate. I particularly thank my right hon. Friend the Member for Kingston and Surbiton (Ed Davey). I thought the clinical case that he made was forensic; he went into great detail in making the compelling case of why this service should be placed at St George’s, where it already exists and is being built upon. I did not quite understand the intervention of the hon. Member for Mole Valley (Sir Paul Beresford), in which he suggested that I was insulting clinicians; I was merely explaining that it is already there and it is being built on.
The hon. Member for Mole Valley and the hon Member for Carshalton and Wallington (Elliot Colburn), who is no longer in his place, laid out the huge research opportunity we have. The Minister talked about innovative therapies. My right hon. Friend the Member for Kingston and Surbiton talked about CAR-T and all the other innovative therapies that they are already working on at St George’s. He also highlighted staffing concerns, and both he and the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) talked about the cost implications of moving the service.
I thank my hon. Friend the Member for Richmond Park (Sarah Olney) and the hon. Member for Sutton and Cheam (Paul Scully) for highlighting the travel issues. I strongly agree with what they said, which came through very clearly. I want to repeat this again, because I think some Members have suggested that we are knocking the Evelina: everyone agrees that it is an outstanding children’s hospital. The point is that St George’s also has paediatric services that are recognised by the CQC as outstanding. The royal college of paediatric surgeons also recognises it as having some amazing specialities.
There is deep concern—not just from Members of Parliament and politicians, but from professional groups and local Healthwatch groups, as I mentioned in my opening remarks—that this consultation has not been transparent and fair and that the process has not been fair. I ask the Minister again: if the decision is made tomorrow by NHS England to move the service to the Evelina, will she urge the Secretary of State for Health and Social Care to call this in and have it looked at once again by Ministers so that all the very compelling arguments we have heard today on the clinical case and, most importantly, the risk to children’s cancer care and other services are taken into account? The voices of children, parents, clinicians and patient groups must be heard, and I do not believe that they are being heard at the moment.
Question put and agreed to.
Resolved,
That this House has considered children’s cancer care in the South East.
Pharmacy First
Munira Wilson Excerpts(9 months, 3 weeks ago)
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Dame Andrea Leadsom
I would love to hear more about that from my right hon. and learned Friend. I will be happy to look into it.
Munira Wilson (Twickenham) (LD)
In recent months, Boots has closed two of three pharmacies in the Hampton area of my constituency. That has left Hampton North, which is one of the most deprived wards in the London Borough of Richmond upon Thames, without a single pharmacy, so elderly residents and those with long-term conditions have to walk for a lot longer than 20 minutes to access a pharmacy. Local GPs tell me that it is just not viable to set up a community pharmacy facility. Will the Government review the pressures on community pharmacy and consider the community pharmacy contractual framework so that we can make this initiative work and take the pressure off GPs?
Dame Andrea Leadsom
As I have already mentioned, there are many community pharmacies starting up all the time, as well as closing down. The hon. Lady will appreciate that the Pharmacy First initiative is a real boost to community pharmacies. I am happy to discuss it with her, but I would imagine that there will be the capability to open new community pharmacies in her area.
Mental Health Treatment and Support
Munira Wilson Excerpts(1 year, 5 months ago)
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Dr Allin-Khan
I entirely agree with my hon. Friend, who works tirelessly on this issue.
After more than a decade of Tory Governments, if people need help, all too often no one is there. Last year, emergency service workers took more than a million sick days because of stress. NHS staff are at the sharp end of this mental health crisis. I know them, I work with them, and I see what they are coping with daily. They are heroes, but they simply do not have the resources, the staff or the leadership from Ministers that would enable them to do their jobs. They themselves suffer exhaustion, depression, stress and anxiety. About 17,000 staff—12% of the mental health workforce—left last year.
You will be pleased to know that I have had a look at the Government’s amendment, Mr Speaker—I do my homework. There is the tired old £2.3 billion figure. How many times have we heard that trotted out? Actually, I can tell the House that it has been used more than 90 times over five years, and it has been spent in myriad different ways. Then there is the £150 million for mental health crisis units. But the amendment fails to mention the serious patient safety concerns that doctors have raised, and it is clear that the pressure on A&E remains as fierce as ever. There is also nothing about the recent announcement from the Metropolitan police that they will not help people in a mental health crisis.
Ministers need to get out of Whitehall and see what is really happening in our mental health service. If they did so, they would see what I have seen in recent months. They would see the junior psychiatrists whom I met recently—junior doctors who have devoted all their training to this profession, and half of whom plan to leave the NHS at the end of their training. They would see the doctor who told me of an incident in which six police officers were in A&E for 18 hours with a patient detained under section 136 of the Mental Health Act 1983. They would see a child arriving at A&E after self-harming, having been referred by the GP a long time ago but not been seen for weeks, which led to an escalation point and a crisis in A&E. We are seeing a system in crisis, people in pain and families in distress.
Munira Wilson (Twickenham) (LD)
The shadow Minister has referred several times to children’s mental health and the crisis that often occurs when they present at A&E departments. Does she agree that schools have an important role to play when children have moderate mental health conditions, before those conditions escalate? The role of mental health support teams in schools is critical, but their funding is due to end abruptly next year, with only about half the programme complete. Will she join me in asking the Minister to commit himself to funding the full roll-out of mental health support teams or, better still, to back the Liberal Democrats’ plan to provide a qualified mental health practitioner in every school?
Dr Allin-Khan
I invite the hon. Member to have a look at the plans we already have in place. She will be pleased to learn that one of our pledges is the provision of a mental health specialist in every school. I invite her to support those Labour plans—and to come and join us over here if she feels like it.
Neil O’Brien
This is an extremely important issue that the hon. Gentleman is quite right to raise. We will be producing the results of the rapid review in the coming weeks, so he will not have to wait very long.
Munira Wilson
Like other colleagues, I see many children in my constituency waiting well over a year, sometimes two years, to access child and adolescent mental health services, so I was alarmed when NHS England recently told me that, on the latest modelling, the number of NHS-commissioned training posts in London for child and adolescent psychiatry will halve by 2031. I have no idea what is driving this modelling, but given that one in six seven to 16-year-olds have a probable mental health disorder, will the Minister at least look into these figures and undertake to write to me to explain why we are seeing such a drop in the number of training places?
Hospice Sector: Fiscal Support and Cost of Living
Munira Wilson Excerpts(1 year, 8 months ago)
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Munira Wilson (Twickenham) (LD)
I confess that I had planned to make a couple of interventions, as opposed to a speech, but given that more hon. Members could not be present, I will try to add a bit more to what I was going to say. Forgive me if I am a little rusty and not very well prepared.
I thank the hon. Member for North Ayrshire and Arran (Patricia Gibson) for securing this really important debate. I have a particular interest in children’s hospices, because there happens to be a Shooting Star children’s hospice in Hampton, in my constituency. It is a much-loved institution in the area that serves children not just from my constituency, but from right across London and Surrey, and well beyond. It looks after children with life-limiting conditions and those who, sadly, have terminal conditions, and it provides respite care as well as ongoing care, particularly at the end of life. The hospice is therefore highly valued by the families it has served, and they were keen for me to make representations to Ministers.
I am fond of the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), but I am disappointed that there is not a Treasury Minister present, given that the debate is about fiscal support for the hospice sector and hon. Members will be largely talking about funding streams. I know it is the job of the Department of Health and Social Care to advocate for them, but at the end of day it is a Treasury decision. We therefore call on the Chancellor and his Ministers to think about funding for hospices.
Demand has been rising, particularly in the children’s hospice sector; it rose about 40% between 2009-10 and 2017-18. At the same time, as we have heard, costs, including staff costs, are rising across the sector. From visiting Shooting Star, I know hospices are constantly trying to compete with the NHS and the rest of the social care sector, which are increasingly going after the same staff. The staff shortages across the sector are well documented. The hon. Member for North Ayrshire and Arran mentioned energy costs, but I will give a specific example from Shooting Star. It is paying £90,000 per year in energy costs. That is predicted to skyrocket to £230,000 per year by the end of September 2023—about two and a half times the current spend. That £140,000 increase is equal to the cost of covering the hospice’s family support line for three years, or the salary of three nurses.
As the hon. Member laid out, hospices have not been classified as an energy-intensive industry, whereas many other places—including even botanical gardens, I think—have been. Hospices are therefore not getting the additional support, yet supporting care for those with very serious conditions is an energy-intensive task. Hon. Members who have visited hospices will have seen the paraphernalia and the equipment, and children and their families also have to be kept warm. It is absurd. I plead with the Minister to make strong representations to his colleagues in the Treasury to ensure hospices are reclassified as energy intensive. Earlier this week in departmental questions, my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) asked the Secretary of State for Energy Security and Net Zero to consider a specific fund to support hospices with their energy costs. The Secretary of State said he would look at those concerns. I therefore task the Minister with speaking to both the Secretary of State and colleagues at the Treasury to see what can be done to support Shooting Star and many other hospices.
We have heard that food and other supply costs are rising, which brings me to funding streams. We know that hospices are heavily reliant on fundraising, and in recent years, children’s hospices have been receiving a children’s hospice grant from NHS England, which they are grateful for. In 2023-24, that funding is due to rise to £25 million. I recognise and welcome that, and I thank the Department of Health and Social Care for making the grant available. However—and this is an important “however”—beyond 2023-24, there is no guarantee that that funding will continue. The grant represents about £1 in every £6 that children’s hospices spend. Another important point is there is no commitment that NHS England will continue to deliver it as a ringfenced grant. If it is not directly distributed to children’s hospices as a ringfenced grant from NHS England centrally, but is instead devolved down to integrated care boards, some of which are already projecting deficits, there is concern that the grant may go to plug black holes in ICB budgets. When the Minister rises to speak, will he first give some sort of commitment on funding continuing between 2023 and 2024? Clearly the quantum cannot be specified while discussions are ongoing with the Treasury, but will he give some reassurance to the children’s hospice sector that that money will continue beyond 2023-24, and that it will be centrally administered as a ringfenced grant rather than going via ICBs?
Together for Short Lives says that if that grant were to be cut, nearly one in five children’s hospices would cut end of life care, over a quarter would cut symptom management services and nearly two thirds would cut short breaks for respite. Children who are critically ill and very sick deserve better, so I implore the Minister to provide those assurances to Shooting Star in my constituency and all the children’s hospices across the country that provide such vital support and care.
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this debate and thank her for the support that she gives to the palliative, end-of-life care and bereavement sectors. The Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), is unfortunately unable to be here today, so I am here to represent the Government. I extend my gratitude to all Members here today for their contributions, which I have heard and learned from. I pay tribute to my own local hospices in Leicestershire, LOROS—the Leicestershire and Rutland Organisation for the Relief of Suffering—and Rainbows, for the work that they do.
The Government are acutely aware of the pressures and challenges posed by the rising costs that have been mentioned in today’s debate. While they affect us all in every sector, the impact on the hospice sector has rightly been raised for debate. Everyone here recognises the incredible importance of palliative and end-of-life care services, and the invaluable work that hospices, charities and the people who support them do to ensure that dignity, care and compassion are present in our lives when we need them most.
The efforts of organisations such as Hospice UK and Together for Short Lives play a vital role in ensuring that we as a nation provide world-leading palliative and end-of-life care. Like pretty much everyone in the country, I thank them. I take this opportunity to say thank you for everything that they do.
The hospice sector supports more than 200,000 people with life-limiting conditions in the UK each year, as well as tens of thousands of family members with bereavement support. We know we have an ageing population presenting with more complex health needs for more years of life. On average, about 600,000 people die every year in the UK, and that number is expected to increase. With that expected increase, the number of people needing palliative care is also likely to rise. Health is of course a devolved policy area, so in terms of direct hospice policy, I can only speak to the English experience, although I will of course talk about some UK-wide areas that are highly relevant, such as energy policy.
While so much palliative and end-of-life care is provided by NHS staff and services, hospices also provide significant support to people at the end of their life and to those important to them. They are mainly independent charitable organisations that receive funding from a mix of public sources and charitable donations. The sense of purpose that is shared with the community—the community cares for the hospice and the hospice cares for the community—is something that we should cherish. I see that strongly in my constituency. It is emblematic of the incredible rallying of compassion and care that we see around hospices all over the country. We should also note the important role that hospices played at the height of the covid pandemic when considering their important place in their communities.
In England, integrated care boards are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local populations. In the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission. That will ensure a more consistent national approach and support commissioners in prioritising end-of-life and palliative care, as hon. Members have called for. In July 2022, NHS England published new statutory guidance on palliative and end-of-life care to support commissioners with that new duty. It includes specific reference to ensuring the sufficient provision of specialist palliative care services and hospice beds, and ensuring their future financial sustainability.
I recognise the importance of quality palliative and end-of-life care for children and young people. NHS England is investing £23 million via the children’s hospice grant by March 2023, rising to £25 million by 2023-24, in order to provide care close to home for seriously ill children when they need it.
On the question that the hon. Member for Twickenham (Munira Wilson) asked, although we only set out funding to date in the spending review, that does not mean that all funding will be cut off at that point. We are exploring exactly how that funding will be provided in the future. Furthermore, this financial year, NHS England has made £5 million of match funding available to ICBs for local children’s palliative and end-of-life care services. That will rise to £7 million in 2023-24, demonstrating the value of those services.
The funding of hospices and the sector is indicative of the Government’s commitment to their work and the vital societal role that they play. We recognise, however, that hospices, like every other organisation and household across the country, are having to contend with a range of budgetary pressures, including huge energy costs following the Russian invasion of Ukraine.
Munira Wilson
I thank the Minister for addressing one of my key questions about the children’s hospice grant. I am sure the sector will be grateful to hear that it is expected to continue. Although hospices will understand that he cannot commit to that at this stage, the problem is that if they do not know what they will get for the next three to four years, how can they make plans for their workforces and services? Will he say anything more than that something will continue? I do not know whether he is coming to this, but will he also say something about the ringfenced grant being administered directly, rather than via ICBs?
Neil O’Brien
Those are both really important points. The hon. Lady knows that it is not for me to set out the future of funding, but I hear the points she makes about ensuring that funding flows to hospices and that they are prioritised by ICBs, and about providing as much certainty as quickly as possible. Both those points have landed with me.
To meet the energy pressures, the UK Government’s energy bill relief scheme provides a price reduction in wholesale gas and electricity prices for all UK businesses and all other non-domestic customers. That means that they will pay wholesale energy costs below half of the expected prices this winter. A new scheme—the energy bills discount scheme, which has been mentioned— was announced in January, ahead of the current scheme ending in March. It is intended to help hospices’ budgetary planning into the future and provide certainty. That follows a Treasury-led review of the energy bill relief scheme some months ago.
The energy bills discount scheme will provide all eligible non-domestic energy users, such as hospices, with a discount on high energy bills until March 2024. It will apply to all UK domestic energy users in the voluntary and public sector, including hospices. We will invest up to £5.5 billion to support those non-domestic users. Furthermore, hospices may also be entitled to a reduction in VAT from 20% to 5% and exclusion from the main rates of the climate change levy on the energy they use for non-business purposes, as long as they meet the criteria in the scheme.
In addition to those two specifically energy-focused interventions, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflationary pressures, with local ICBs deciding how best to distribute that funding according to local need, including to palliative and end-of-life care providers such as hospices. I have previously mentioned the steps we have already taken in legislation and guidance to ensure that hospices are prioritised by ICBs.
A large part of hospice activity—probably the majority—actually takes place in people’s homes. That is why we are also taking action on domestic energy pressures. In fact, this winter we are spending a total of £55 billion to help households and businesses with their energy bills. That is among the largest support packages in Europe. A typical household will save about £900 this winter under the energy price guarantee, in addition to the £400 energy bill support scheme for households. On top of that, we are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making people’s homes easier and cheaper to heat.
To help with some of the other cost of living pressures on households—which is the last thing people need when they are in need of hospice care—we are taking measures such as the extra £900 cost of living payment for 8 million poorer households, the largest ever increase to the national living wage for 2 million workers, and a total of £26 billion for cost of living support next year. I hope some of these supportive measures will reassure Members about the Government’s commitment to the sustainability of the hospice sector, particularly during this challenging fiscal period. I understand that the rising cost of living has caused all kinds of uncertainties, and we continue to engage proactively with the sector to try to understand the issues it faces.
Neil O’Brien
I will close my speech by again expressing my thanks to those who have attended the debate—including the hon. Lady, to whom I now give way.
Munira Wilson
I thank the Minister for giving way again. On his point about the energy bill relief scheme, will he at least acknowledge the absurdity of leaving hospices out of the energy-intensive grouping, while botanical gardens, zoos and museums, deserving though they are, have been included? Does he not recognise that that is utterly absurd, given the sort of services that hospices are delivering?
Neil O’Brien
Although this is not my policy area, as I understand it, this applies to the energy-intensive and the traded sectors, so organisations need to pass through two different filters to qualify: they have to be very energy intensive and in the traded sector. That would explain the organisations that are chosen or not chosen, but as I said earlier, I absolutely hear the point that the hon. Lady is making.
I pay tribute to all those working in and supporting the palliative and end-of-life care sector and providing essential support to those who need it. I hope I have reassured Members of the Government’s commitment to supporting these invaluable services.