Hospice Services: Support

Paul Holmes Excerpts

Wednesday 14th June 2023 Westminster Hall

[Paul Holmes (Eastleigh) (Con)]

I beg to move,

That this House has considered support for hospice services.

It is a pleasure to serve under your chairmanship, Ms Nokes. You are intrinsically linked to the Mountbatten hospice, which I will speak about this morning, in your role as the Member of Parliament for Romsey and Southampton North.

I thank the all-party parliamentary group on hospice and end of life care and its chair and co-chair, my hon. Friend the Member for Darlington (Peter Gibson), who is here today, and Baroness Finlay, for their work in promoting and championing the hospice sector. They have a lot of experience in the sector and I am grateful to them for lending me their support in this important debate.

The hospice sector in this country does incredible work for thousands of families and individuals every day. It is a fact of life that we all experience a bereavement at some point, and some of my colleagues know that we recently had the very sad task of saying goodbye to my office manager, Sue Hall. Sue was not just an employee of mine; she was my friend, confidante, an incredible wife and mum, and a friend to all. She was a magnificent woman—a local hero who helped people every day. She never baulked at a challenge or missed an opportunity to show people how much she cared. I am sure many, if not all, of those here have had that special support in their lives from someone they rely on. For me, that person was Sue. I never thought I would have to make do without her by my side.

Sue left us peacefully, surrounded by her family and friends on 30 March. She was comfortable and well looked after, and for that I will ever be grateful to Mountbatten hospice in my constituency, which cared for her at the end of her life. It made her final days and moments a special time for her family and friends. We can all hope at the end of our time on this earth to have an opportunity to say, “Thank you, I love you, and goodbye.” That is a truly special and incredible moment for everyone—one that the hospice Sue stayed in provides for people every day.

Sue’s journey had a profound impact on me as I spent time with her in the hospice learning about the work that it does and the struggles it faces. In a moment of weakness, her son-in-law, Miles Rogers—a good friend of mine—and I agreed to do a charity skydive for Mountbatten hospice on 24 June. The fundraising page is available on my Facebook page if anyone wants to contribute.

Mountbatten Hampshire is a hospice in my constituency that provides 24/7 in-patient and community domiciliary and palliative end of life care services to people across Southampton city and large parts of Hampshire. It also provides rehabilitation and enablement services, as well as psychological and bereavement support to parents and their families. Sue’s family and I will forever be grateful to it for its kindness during Sue’s last days. Having had the pleasure of meeting the hospice’s chief executive officer, Nigel Hartley, and the fantastic staff who work there, I know that their passion and commitment to providing the best possible care for all their patients is their top priority, and they give that care with skill, tact and grace every day.

[Alan Mak (Havant) (Con)]

I thank my hon. Friend for securing this debate. Rowans Hospice does great work in the Havant constituency, and as a result it engenders a lot of loyalty, including from fundraising and support groups. Will he join me in thanking such groups for their contribution alongside the full-time staff at hospices?

[Paul Holmes]

I pay tribute to Rowans Hospice and to all the hospices that we will no doubt hear about this morning, given the number of people attending this debate.

As I say, I had the pleasure of meeting the CEO of Mountbatten hospice. Its work does not come without cost, but, as a charity, its services are provided free of charge to all who need them, thanks to the generosity of its amazing community and incredible volunteers, who give their time to support the best possible care for local people during the last years and months of their lives. Mountbatten currently supports around 1,000 families every day, and demand for its services is predicted to rise by 40% in the next 18 months. It costs £11.5 million a year to keep the services running, and the hospice relies on charitable support to fund its 24/7, 365 days a year services to people who need them.

[Ellie Reeves (Lewisham West and Penge) (Lab)]

St Christopher’s Hospice in my constituency is widely regarded as the first modern hospice, and it is still pioneering today, but it has to fundraise £15 million a year. The cost of living crisis means that its costs are going up and its donations are at risk of going down. Does the hon. Member agree that the Government must review the current funding model?

[Paul Holmes]

The hon. Lady tempts me to come to content that I will cover later in my speech, but for now she can take it that I wholeheartedly agree, as do many Members here, I suspect.

No one will contest that our health and care staff deserve to be well paid for the incredible work they do, and in an ideal world we would see our life savers and carers never have to worry about their finances and pay, but it would be deeply irresponsible to facilitate pay rises without giving due consideration to the dramatic impact that rising wage costs have on these essential services. To give some specific context, Mountbatten Hampshire took over management of the hospice from the NHS in 2019. It has a contract with the NHS for roughly 35% of its costs, of which about £3.8 million comes from the local NHS commissioners in the form of an outcome-based contract. The hospice follows the NHS pay award each year to remain competitive and to retain and hire staff for its services, which means that the hospice has seen a 4.8% rise in costs this year and will see a further 5% next year, with no corresponding change in its NHS contract, leaving an increasing and worrying financial gap that the charity will find very hard to reconcile without public funding.

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

Will the hon. Member give way?

[Several hon. Members rose—]

[Paul Holmes]

I am spoilt for choice! I give way to the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier).

[Dame Meg Hillier]

It is interesting to hear about the Mountbatten, which I spent many years at when it opened, when I was a child. The hospice in my constituency, St. Joseph’s Hospice, is really cutting-edge, but the retrospective payment for nurses will cost it £470,000, and it cannot apply that yet because it has no certainty from commissioners about its funding. To keep it up will be another half a million a year, and it cannot afford that without certainty of funding. I am sure the hon. Member agrees that we need to press the Minister for some clarity on this.

[Paul Holmes]

I agree with the right hon. Lady; we do. In my experience, the uplift that has been given to local NHS commissioning groups is simply not making it through to those end of life services. I hope we will see some recognition of that from the Minister, and I am sure she will enforce this, to ensure that the funding to local commissioning groups gets through to these services.

[Andy McDonald (Middlesbrough) (Lab)]

Will the hon. Member give way?

[Several hon. Members rose—]

[Paul Holmes]

I do not want to be harsh, but I have been warned by the Chair that I should get through my speech. I will make some progress and then give way shortly.

Written evidence submitted to Parliament by Hospice UK records that hospices across the UK employ 12,000 nurses, with 8% of the nursing workforce drawn from bank or agency, which make up a 9,400 full-time equivalent nursing establishment, but they are struggling to recruit registered nurses. A clinical survey in 2021 found that there was an 11% vacancy rate in community-based hospices and a 7% vacancy rate in hospice-based nursing roles in adult hospices, with 16% vacancy rates for hospice-based nursing associate and community-based healthcare assistant roles. The written evidence states:

“Since this data was collected, between March and May 2021, the sense on the ground is that these figures have increased and workforce shortages in UK hospices and across other providers that deliver palliative and end of life care have worsened.”

This is clearly the tip of the iceberg, and further pressures are to follow. Hospices are desperate for more support from the Government. The Mountbatten will end the year with a £1.4 million deficit, with no foreseeable change in the financial forecast with the current funding arrangement. The impact will be felt not only in the care sector but throughout the whole NHS.

[Mrs Flick Drummond (Meon Valley) (Con)]

My hon. Friend paid a fantastic tribute to his office manager, Sue. Rowans Hospice in my constituency is thinking about increasing its number of beds from 19 to 22, but that will cost an extra £130,000 a year, and the trust is nervous about making that commitment. What he is saying is very important. Does he agree that the Government need to give more money to this valuable service?

[Paul Holmes]

I suspect that I will be in constant agreement with interventions this morning. My hon. Friend and constituency neighbour makes an astute point, as usual, and she is right to pay tribute to the hospice in her constituency.

Communities such as mine in Eastleigh will suffer as hospices such as Mountbatten have no choice but to reduce their services and the extraordinary high-quality care they offer, and this comes at a time when demand is only growing. As if that were not enough, staffing costs are but one consideration that care providers are having to take into account. As we all know, the soaring price of energy has hit businesses, families and individuals all over the country, and none more so than those in the charity care sector.

[Wendy Morton (Aldridge-Brownhills) (Con)]

Acorns Children’s Hospice in the Walsall borough supports families and children in my constituency. Does my hon. Friend agree that, in these challenging times when energy prices are on the rise, we want any additional help to include the hospice sector?

[Paul Holmes]

I thank my right hon. Friend for her intervention. She tempts me to talk about issues that I will come to later in my speech—it is only a couple of pages away, I assure you, Ms Nokes. She is right that hospices have not been included in the energy support given to other charities, even though their services are energy intensive due to the equipment they use. Her point is well made and will be recognised in her constituency.

The energy bill for Mountbatten has risen by an eye-watering £250,000—a fivefold increase—and there has been no additional financial support. One might think that that is surely as high as prices can go, but a London-based hospice has forecast that its energy costs will increase by almost £300,000 a year due to inflation pressures. A north London hospice told Civil Society Media that it faces an energy bill of £433,000 in 2023-24, based on predicted energy costs.

Adult hospices are not the only ones affected by this issue. As my hon. Friend the Member for Winchester (Steve Brine) said in his letters to the Department of Health and Social Care, there is also uncertainty about the children’s hospice grant—a vital source of funding that represented an average of 15% of children’s hospices’ income in 2021-22.

[Stephen Hammond (Wimbledon) (Con)]

My hon. Friend is absolutely right about the pressures on the sector, which also affect St Raphael’s in my constituency. The Government have been generous with the children’s hospice grant, but it runs out next year, and the lack of certainty is the problem. We would really like the Minister to stand up and say that she will renew the grant after 2023-24, which would provide a huge amount of certainty for the sector.

--- Later in debate ---

[Paul Holmes]

My hon. Friend, who is my past employer, makes a good point—although not as good as when I wrote his speeches. He is absolutely correct that there is uncertainty about that grant, and about how it is handed out by local commissioning groups. It is not getting through to children’s hospices, and I hope the Minister will have something to say about tweaking the way that grant is allocated to local areas.

[Jim Shannon (Strangford) (DUP)]

Sixty-six per cent. of adult hospice income and 80% of children’s hospice income is raised through fundraising—bake sales, charity shops and marathons—and Marie Curie depends on that more than others. Does the hon. Gentleman agree that we should put on the record our thanks to the volunteers who make the effort and get the money in?

[Paul Holmes]

The hon. Gentleman is absolutely correct. I only have to see Mountbatten local networks of fundraising and charity supporters, whether in charity shops or in fundraising roles. I am honoured that I may become part of that community—if I land on the ground safety, alongside Miles—but it will not end there. I will carry on fundraising for a fantastic cause.

When Mountbatten hospice wrote to me in January to outline those extraordinary energy costs, I was happy to write on its behalf to the Secretary of State. Unfortunately, the energy bill relief scheme and the later energy bills discount scheme did not ease the pressures, as the hospice was not eligible. Mountbatten still faces unsustainable pressure, as do hospices across the United Kingdom.

Of course, there are some people who ask whether a charity should not take the majority of its funding from its local community—from donations and contributions, rather than from Government funding. That is a fair question, but unfortunately it does not provide a solution, especially considering that community donations already support 70% of Mountbatten’s funding, which it has calculated to be the limit of what it can ask from people.

[Andy McDonald]

The hon. Gentleman is making an excellent speech. He is right about donations, but my local hospice, Teesside Hospice, is really struggling. I congratulate the hon. Member for Darlington (Peter Gibson) on his work in that respect. Is the hon. Member for Eastleigh (Paul Holmes) not describing a perfect storm? There is a statutory obligation on the NHS to fund hospices for medical care, but the NHS is entirely strapped. Can I divert him away from the solution of asking members of staff to tighten their belts even further? That is not an option. When we cannot recruit and retain, that is not the solution. We need a fundamental reset of the economic settlement.

[Paul Holmes]

I hope the hon. Gentleman has not taken from my speech that I am suggesting that staff tighten their belts. In fact, I am advocating that hospices be allowed to follow the NHS pay settlement model, and be funded properly to so do. I would say to the hon. Gentleman that the Government have put their hand in their pocket through the £1.5 billion uplift, although that is simply not getting through from the Department of Health and Social Care and local commissioning boards to the hospices. That is where the Government need to step in to a greater extent. Therefore, I ask the Government to take the issue seriously and to continue to treat the charity care sector with the priority it deserves.

Hospices do incredible work, and they represent spectacular value owing to the services they provide. We cannot allow that vital link in the care chain to be broken, or even weakened, particularly at this time. Evidence submitted to the all-party parliamentary group on hospice and end of life care’s report detailed how the covid-19 pandemic made fundraising even more challenging for hospices. Hospices experienced a massive decrease in income while facing unprecedented demand for their services. One hospice’s overnight sitting service had to end due to lack of funding to sustain it, which highlights how dependent those services are on charitable donations.

It is important to highlight the fact that the sustainability of the hospice sector continues to be tested due to the cost of living crisis. Some sort of long-term funding settlement for hospices would be in the interests of all concerned because 160,000 more people each year are expected to require palliative care by the end of 2040. Having sufficient staff and volunteer resourcing in the specialist palliative care field is essential. An ideal outcome would be the Government and the NHS working with the hospice sector to provide an ongoing financial settlement, with regular contractual reviews to ensure that the support that hospices receive is at least the minimum they require to keep services running. That should be directed to cover both staffing and energy cost rises.

Doing that would be in the best interests not only of hospices, because hospices play a vital role in reducing pressure on NHS services by providing bed space and crucial care capacity. The NHS can scarce afford to lose such space and capacity, particularly in the light of the current waiting lists, but lose them it may if action is not taken.

[Several hon. Members rose—]

--- Later in debate ---

[Helen Whately]

That alludes to exactly the point I made a moment ago. As flagged in that 2022 Act, ICBs have responsibility for commissioning that care, using the budgets they receive through NHS England. I am working to ensure the visibility of the commissioning, to be assured that that is taking place, so that we can be assured about the availability of end of life and palliative care for our communities.

I want to make a final point as I close; I am looking at the clock ticking. Against the backdrop of financial concerns, which I of course recognise and which we are discussing, is the strength of hospices in their communities, and the importance, as mentioned by hon. Friends, that they are not solely financially dependent on the state and the NHS for funding. They receive some NHS funding, but it is important that hospices are successful in fundraising and gaining support from our communities. That is one of the strengths of their model, and I want to continue to support that.

I pay tribute to all the volunteers and those involved in fundraising, including many hon. Members this morning who mentioned the fundraising efforts that they are personally making for hospices in their communities. I wish very good luck to my hon. Friend the Member for Eastleigh for his forthcoming skydive. All credit to him for having the courage to jump out of an aeroplane. I sincerely hope that he is successful.

[Paul Holmes]

Thank you!

[Helen Whately]

I wish him very good luck; it is fabulous that he is doing that for his own hospice. I also commend the efforts of many other hon. Members. I conclude by thanking all hon. Members for coming today and for their contributions to this important debate.

[Paul Holmes]

Thank you, Ms Nokes. I will briefly wind up by saying thanks to all hon. Members for the heartfelt contributions that they have made. It has been incredibly humbling sitting here. If my career does end on 24 June with my skydive, and this is the one thing I have managed to do, it will be entirely worth it. I thank the Minister for responding. I also thank Sue’s family—her husband Jerry and her girls Rosie and Phoebe—who have been immensely strong over the past year or so.

I hope the Minister has recognised that there are serious concerns about the funding of hospices. In the environment she set out of the ICBs being given the money, she should take credit for the uplift they have been given. I hope that after this morning’s debate she will take a stronger line in holding those ICBs to account because, frankly, that money is not getting through when it should.

Question put and agreed to.

Resolved,

That this House has considered support for hospice services.