Hospice Sector: Fiscal Support and Cost of Living

Patricia Gibson Excerpts

Thursday 2nd March 2023 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I beg to move,

That this House has considered fiscal support to the hospice sector and increases in the cost of living.

I am delighted to have secured this debate on fiscal support for hospices and the hospice sector. Hospices across the UK care for some of the most vulnerable people in society and their families. I commend all the healthcare professionals and support staff, as well as the volunteers, who work in our hospices, such as Ayrshire Hospice. Ayrshire Hospice operates a number of charity shops, including two in my constituency in Largs and Kilwinning. We owe a debt of gratitude to all those who work in and for our hospices for the care they provide to our loved ones.

Some 300,000 people across the UK are cared for in hospices in their final weeks and days. Importantly, the families of those in the final stages of their life also receive vital support from hospices. I know this debate matters to Members across the House, and I want to congratulate the all-party parliamentary group on hospice and end of life care on its work. I also congratulate its co-chair, the hon. Member for Darlington (Peter Gibson), who wanted to be here but was unable to be. Last night, the all-party group launched a report on the impact of covid-19 on dying, death and bereavement. The report makes for quite harrowing reading, and I hope the Government will act on its recommendations. The report, launched by the hon. Gentleman, coincides timeously with this debate. I want to thank Hospice UK and Marie Curie for the excellent briefings they have provided to help inform today’s proceedings.

Since I was first elected in 2015, I have done as much as I can to highlight the challenges of bereavement and bereavement-related issues. Part of that conversation, of course, is hospices, which provide specialised care for terminally ill people, palliative care and incalculable levels of support for those watching their loved one pass away without suffering or pain—thanks, in great part, to the work of hospice staff. That is important because bereavement is debilitating in so many ways, and how a loved one dies affects how we grieve and the nature of that grief. We know that profound and persistent grief—complex grief disorder—can easily derail the lives of the bereaved and the wider family unit, because how a person dies is unfortunately very much part of how we remember them.

End of life care impacts not just the patient, but all their loved ones. The specialised support of compassionate palliative care cannot be easily replicated in a hospital setting. That is why hospices exist and why this debate matters. The need for hospice services is greater now than ever. More and more people have been developing serious illnesses since screening for diseases was badly disrupted during the pandemic, and many patients and families have subsequently found themselves referred for hospice care. The need for hospice care and palliative care is expected to increase over the coming years. Hospice UK is deeply concerned that the sector will simply and increasingly be unable to cope with that demand.

More generally, hospices are woven into the very fabric of bereavement services across the UK, and it is truly horrifying that they are facing an existential crisis. The reasons for that existential crisis are easy to understand. Hospices across the UK are facing up to fivefold increases in their energy costs. For some sectors, rationing and reducing energy consumption may be an option, but for hospices it is clearly not. They need to keep medical equipment running, and those in their care need to be in appropriately heated environments.

Frankly, no one can understand why, as of 1 April, hospices will be eligible for the same level of reduced support as other sectors under the new energy bills discount scheme—the same level of support as offered to pubs and restaurants. No one wishes to diminish the important role of pubs and restaurants, which are important parts of our community infrastructure, but we can hardly compare the services provided by a hospice to those provided by a pub. There is no equivalence, and for them to be eligible for the same level of energy support is, quite frankly, bewildering.

Moreover, hospices cannot pass on increased costs to customers. That is simply not an option for them, but it is always an option, at least to some extent, for private business. The reduced level of energy support that will come into effect on 1 April is so inadequate for hospices as to threaten their very existence. It cannot be the Government’s intention to leave hospices so exposed during the cost of living crisis that they simply cannot continue to operate. I hope that the Minister will listen carefully to the concerns that I and other participants in the debate will raise, and that this important matter will be addressed in the upcoming Budget.

At this juncture, let me quote the chief executive of Sue Ryder, who has thrown the challenges our hospices face into stark relief. Heidi Travis said:

“I think it will come as a surprise to many that their local hospice is reliant on the generosity of members of the public who choose to donate or fundraise.

Put plainly, in order to pay the salaries of our doctors and nurses who provide expert care, pain and symptom management to people at the end of their lives, we rely on people buying second-hand clothes from our charity shops or running a marathon and asking their friends and family for sponsorship. It is unfathomable that such a critical part of our healthcare system is hanging by a thread.”

That is a stark assessment of the challenges that hospices are dealing with. Charity shops are an important part of fundraising that I am sure we all try to support. There is no disputing, however, that Heidi Travis makes an important point. The way hospices are funded would be unacceptable in any other area of healthcare. Imagine, for example, if maternity services relied on second-hand jean sales to fund care. There would rightfully be uproar. Yet to care for dying people, hospices must rely on increasingly fragile sources of income at a time when their costs are soaring. NHS services have their energy bills paid for by the Government, but hospices are—uniquely, among providers of essential care—unreasonably expected to absorb astronomical and eye-watering energy costs so that they can continue to carry out the important work they do.

It is vital to remember that hospices receive only about 30% of their funding from statutory sources—in Scotland the figure is 40%. That is simply too low, and it is despite the fact that they are a critical part of our health and care system, play a role in reducing pressure on our NHS, and provide support and training for health and care workers. On average, two thirds of adult hospice income and four fifths of children’s hospice income is raised through fundraising. At best, that is an uncertain funding model, and as the cost of living bites deeper into household income, our communities’ ability to provide even that charitable support is diminished.

Hospices also need to keep pace with NHS pay rises. They spend 71% of their expenditure on staff, and as pay rates understandably rise to keep up with inflation, they have to fund the spiralling costs. The Scottish Government provided an additional £16.9 million to hospices during the pandemic, and have committed to ensuring that any and all consequential funding for them will be allocated to the sector in full. However, hospices desperately need to know that from 1 April—a few short weeks away—the Chancellor will deliver support for hospices in the spring statement to ensure they can continue to deliver their essential services every single day of every single year.

The services that our hospices provide cannot be valued simply in pounds, shillings and pence. They provide a peaceful and painless passing to our terminally ill loved ones, and we all agree that we cannot put a price on that. They need help to pay their costs, not least their energy costs, beyond the offer in the energy bills support scheme. The Government need a more comprehensive understanding and appreciation of the vital work they do, and must provide support to develop a more sustainable, secure funding model across the board. If we do not properly support and value our hospices, we are in danger of losing them. The situation is astonishingly stark.

Let us hope that the spring Budget will deliver a more sustainable, long-term, secure funding model for our hospices, because that is becoming increasingly urgent. If we can secure that, everyone across the UK, regardless of where their lives happen to end, will be able to access the best possible end-of-life care. I ask the Minister: who would want anything less for their loved one? I hope that, when he has heard hon. Members’ arguments, he will provide some hope and assurance to our beleaguered hospice sector.

--- Later in debate ---

[Patricia Gibson]

I thank everybody who has turned up to participate in this important debate and made important contributions from various parts of the UK about the challenges in their constituencies. I thank the Minister for coming along; I know that this is not his exact portfolio area, but I thank him for his answers.

We have heard from across the House about the invaluable support that hospices provide in helping our loved ones pass away free from pain and suffering, the importance of that for those left behind—the bereaved—and the intensity of the grief they suffer. It was remiss of me not to say this in my opening speech, but I specifically requested, as did the hospice sector, that a Treasury Minister respond to this debate. Despite that request—this does not reflect on the Minister who turned out—my debate was immediately passed to the Department of Health and Social Care. Given that the motion refers to “fiscal support”, that was disappointing, and I am sure that the hospice sector will share my disappointment. That is no meant as any disrespect to the Minister who has turned up. The reason why it was important for a Treasury Minister to be here is that we are on the verge of the spring Budget, and it was hoped that this would be a good time to catch their ear.

We have heard from every speaker today about concerns that the hospice sector has been classified in the same category as botanical gardens, pubs and restaurants for energy support from 1 April. The Minister said that that is because the businesses receiving additional support are energy-intensive and in the traded sector. The common-sense response to that is that we therefore need a specific sector for hospices. If they do not fit into the sectors to which additional support can be given, they deserve to be made a special case. I know that the Minister cannot speak on behalf of the Treasury, but I am concerned that the call for additional energy support for hospices does not appear to have made any progress. I am sure that everybody who participated in this debate will want to continue to pursue that.

I hope that the Minister will feed back to his colleagues in the Department for Health and Social Care that there is no denying that, whatever progress we make or do not make on energy bills, we need a more sustainable, long-term, comprehensive funding plan for hospices. They are struggling to survive. I mentioned the comment from the chief executive of Sue Ryder about hospices relying for essential income on bake sales, selling second-hand clothes and sponsored walks. All those things are very worthy, and they make a valuable contribution, but by themselves they inherently mean that the financial stability of hospices is undermined. As the hon. Member for Twickenham (Munira Wilson) said, long-term planning for the hospice sector is important.

I hope that the Minister will agree with the need for a long-term plan, and that he has paid close attention to the representations made across the Chamber today. No Government want to preside over the demise and loss of our hospice sector, and I am sure that the current Government do not want to be in that position. That is why we need urgent action now to save our hospices.

Question put and agreed to.

Resolved,

That this House has considered fiscal support to the hospice sector and increases in the cost of living.