Hospice Funding

Peter Gibson Excerpts

Monday 22nd April 2024 Commons Chamber

[Peter Gibson (Darlington) (Con)]

It is a pleasure to follow the hon. Member for Enfield, Southgate (Bambos Charalambous); it is great to see him in the Chamber after his performance yesterday in the London marathon. I congratulate him on completing it.

It is a pleasure to be called to speak in this long-awaited debate, and I thank and congratulate my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) for moving the motion. I thank hospices around the country that have engaged with me in my preparation for today’s debate, and I thank the Hospice UK team—Toby, Katie and Olivia in particular—for their ongoing support for me and the all-party parliamentary group on hospice and end of life care, which I co-chair along with Baroness Finlay of Llandaff.

I draw the House’s attention to my entry in the Register of Members’ Financial Interests: I am a trustee of North Yorkshire Hospice Care, which operates both Herriot Hospice Homecare and Saint Michael’s hospice in Harrogate. I have served as a trustee of that hospice for over a decade, and have seen the difficulties that piecemeal commissioning causes for our precious hospices. To my mind, this debate is not simply about asking the Government for more money—we know that there are serious public financial challenges post pandemic—but an opportunity to discuss on the Floor of the House solutions to the challenges that our hospices face. I thank the Backbench Business Committee for allowing us to have this debate. The number of Members who wish to speak in support of their local hospices today is testament to how much each and every one of our communities values its local hospices.

This is a matter of life and death. The hospice movement is there to deliver good deaths; that might seem a strange thing to say, but palliative care delivered in the right environment—be that a hospice, a children’s hospice, or a person’s home through a hospice at home service—is a truly wonderful thing. Those precious final few weeks of a person’s life are imprinted into our memories, and it is right that those who are dying, and those who are loving, supporting and caring for them, do so in an environment where there is proper funding and commissioning, and where we can plan and prepare to provide continuing care.

[Martin Vickers (Cleethorpes) (Con)]

I thank my hon. Friend for his contribution, as well as the Members who made the previous contributions, both of which focused to some extent on palliative and end of life care. Two hospices serve my constituency, St Andrew’s in Grimsby and Lindsey Lodge in Scunthorpe; both provide an excellent end of life environment. Does my hon. Friend agree that if we are to defuse the movement towards encouraging assisted dying, we need to ensure that our hospices provide a service as an alternative?

[Peter Gibson]

I am very grateful to my hon. Friend for his intervention. I have my personal views about assisted dying, and I am sure that in the fullness of time, this House will debate that issue. This debate is not about assisted dying: it is about our hospices, and how we fund and support them. With the greatest of respect to my hon. Friend, conflating the two issues is not helpful.

Even post death, our wonderful hospice movement provides much-needed bereavement care to those who have suffered the loss of a loved one. The Health and Social Care Act 2021 made provision for the very first time for the commissioning of palliative care. That is a landmark. Integrated care boards around the country now have responsibility for commissioning palliative care to meet the needs of the community that they serve, which is a good thing. It ensures that local commissioners, working together with local providers and local representatives, can deliver the palliative care needs of their respective communities.

[Steve Brine (Winchester) (Con)]

This is a timely debate. Tomorrow morning, the Health and Social Care Committee will have a topical session on hospice care. My hon. Friend mentioned “ICBs”, plural. I have Naomi House and Jacksplace hospice in my constituency. Its trouble is that on top of all the rising costs and inflationary pressures that it faces, it is negotiating with six ICBs for the same amount of grant. When my hon. Friend comes to summarise the recommendations of his excellent all-party group, will he recognise that challenge that many hospices face across multiple commissioning bodies?

[Peter Gibson]

I am very grateful to the Chairman of the Select Committee for his intervention, and for his continuing engagement with me on this important topic. He raises a really important issue. As I will come on to say, this is not simply about each ICB meeting its own challenges. We need national and Government attention to resolve the issue.

There is a very mixed patchwork picture across the country. During covid, the Government stepped up to the plate, acted decisively and provided much-needed financial support to the hospice movement. That support not only prevented many hospices from failing and collapsing, but ensured that much-needed palliative care could continue to be delivered around the country. The picture today, however, is one of immense challenges for our hospices. Many have failed to receive increased support under their contracts with ICBs to meet the rising costs of energy and staffing. At the same time, our hospitals face increased pressure for beds. It is a fact that one night in a hospice costs less than a night in a bed in hospital, and while there are reasons why a person may need to remain in hospital, better palliative care can be delivered in the more appropriate surroundings of a hospice.

Just last week, I met the chief executive of Sue Ryder, Heidi Travis, who also serves as a commissioner for Cambridgeshire and Peterborough ICB. It was interesting to learn that work is being undertaken to explore ways in which hospices can do more with the same funding, or in some cases less. However, if we are to explore creative new ways of delivering hospice care, either through hospice-at-home models or virtual wards, full and frank conversations need to be had between hospices and their integrated care boards to truly explore the art of the possible.

In the Tees Valley, I have been pleased to be able to bring together, on multiple occasions, St Teresa’s in Darlington, Alice House in Hartlepool, Butterwick hospice in Stockton, and Teesside hospice in Middlesbrough. They work collectively with all eight Members of Parliament covering the Tees Valley, so that there is a collective voice for the region, and so that we can be a beacon of excellence in the provision of palliative care in the north-east. The uplift in funding for those four hospices under the North East and North Cumbria integrated care board is simply not enough, but the fact that they are working together and meeting the ICB is a sign of improving relations, and there is hope for the future.

I wish to touch on the work of our children’s hospices, which a number of Members have mentioned. They are an integral part of palliative care across the country, and I am grateful for the engagement I have had in recent weeks and months with Together for Short Lives. The NHS children’s hospice grant of £25 million from the Government is gratefully received by the sector. However, that funding should be guaranteed for a minimum of three years to enable those hospices to plan properly and commission services, and the amount should be uprated in line with inflation each year. Furthermore, the money must be ringfenced, so that when it is passed on through regional ICBs, the entirety of the money flows to the frontline—to those children’s hospices. I ask the Minister to address that point in her summing up.

In preparing for today’s debate, I asked for information and evidence from Hospice UK about hospices in each of the four nations of our country. Saint Michael’s, a hospice of which I am a trustee, is the local hospice care charity supporting people affected by terminal illness and bereavement across Harrogate. Each year, the vital care it provides costs almost £6 million to deliver. Of that, just 17% is funded by the Government; that equates to a little over £1 million of its total running costs. That leaves over £5 million to be raised through the generosity of its supporters and community. The rise in inflation has put additional strain on its finances, but has been met with a funding increase of just 1.2% from the ICB.

Shalom House in Pembrokeshire needs to raise around £288,000 to keep running, which is equal to £24,000 per month. It receives only £5,000 per month from its health board, and this amount has been halved in the last five years from £10,000. It has not received an uplift for at least the last four years. It anticipates that funding ending in September 2024, when the new commissioning model in Wales comes into effect. Without a cash injection, it is in danger of closing within the next 12 months, as its reserves are low. While Shalom House is small, the impact on the community, like that of all hospices, is huge.

In Scotland, Ardgowan in Inverclyde is, despite a very generous community, facing a deficit of £100,000. It expects this to rise to £172,000 for the next financial year. In the last 18 months, it has seen utility costs rise by 67% and insurance costs by 10%. It needs increased support.

In Northern Ireland, 65% of the funding for Foyle hospice in Londonderry comes purely from fundraising. It is unable to plan ahead or reconfigure services because of the uncertainty about statutory funding, including the outcome of the recent day hospice review. It has received some non-recurrent funding through the cancer charities relief fund, but may be unable to provide those highly valuable services when that funding runs out in March 2025.

We are a compassionate and wealthy country. We have a national health service that, despite some of its challenges, does incredible things, but so too do our hospices—be they based in buildings or in patients’ homes. Our hospices really must be seen as an integral part of our national health service.

[Martin Docherty-Hughes]

I want to push the hon. Gentleman on the point I made to the hon. Member for Enfield, Southgate, because I have heard this notion of symbiosis with the NHS, but they are two very distinct approaches to care. From my perspective, the palliative care sector is at its best when it is run as a voluntary local body. Would he expand a wee bit more on what he means by that kind of convergence with the NHS? There is a fear among those in the voluntary hospice sector that what they are doing to push palliative care forward could be held back by more physical integration in the NHS.

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Before the hon. Member continues, I just remind everybody that there is quite a bit of interest in this debate. If we could ensure self-discipline in the length of speeches, that would be very helpful.

[Peter Gibson]

I am very grateful for the intervention, and the hon. Gentleman raises some really important points, which I am not sure I have time to go into in detail. If the Government are going to give the national health service enough money to increase the wages of everybody in the national health service and the integrated care boards are commissioning services from hospices around the country, the very least those hospices should expect is an equal minimum uplift so that they can maintain parity of wages. Our hospices are not seeking to be nationalised. They cherish their independence passionately, and it is because of their independence that they are so integrated into our community, but if we are going to rely on them to provide services, the least we can do as a society is to meet the costs of the services we are expecting them to provide.

Mr Deputy Speaker, mindful of your words, I will bring my remarks to a close in a moment. Philanthropy and charitable giving have been the foundations on which our wonderful hospice movement has been established. To my mind, hospices’ charitable status has enabled them to be flexible and to develop an holistic pattern of palliative care outside the NHS. However, in the 21st century it cannot be acceptable that funding is reliant on pensioners performing skydives and communities baking cakes to fund palliative care.

Much work has been done, and much work must be done by our ICBs and the Government to map the demands and needs for palliative care across the country. We must end this postcode-based patchwork of provision. It really is time that the Government established a rapid taskforce to collaborate with the entire hospice movement and our integrated care boards to ensure that we as a nation have the best provision in palliative care, and that everybody can have a good and peaceful death.

--- Later in debate ---

[Selaine Saxby (North Devon) (Con)]

I want to take advantage of tonight’s debate to raise the specific issue of the North Devon hospice and its hospice to home service. When I last met its excellent chief executive, Stephen Roberts, last October, he flagged to me that the hospice was no longer in a position to continue its non-commissioned service after the end of this financial year. At the time, he wrote to the then Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), detailing those concerns. I instantly phoned my hospital trust, because North Devon is home to the smallest hospital on the UK mainland and it already suffers with discharge issues and an overstretched A&E service.

In February when I met Dr Sarah Wollaston, the chair of the Devon integrated care board, I asked about the service and was assured that it was all fine and the money was being found. When this debate was announced —many thanks to my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing it—I contacted Stephen Roberts at the end of the recess and said that I would like to check that this was all okay. He told me that my email was timely because everything was not okay, despite having had endless meetings with the integrated care board. He asked me to share with the House tonight some of the email that he sent back to the integrated care board following a phone call with its new chief executive, in which he said:

“Thank you for your time yesterday. I thought it would be prudent to summarise in an email where we have got to as there is nothing on paper or email that corresponds to the discussions we had around your offer of £95k. As a summary as to where we stand today: North Devon Hospice’s Hospice to Home Service is dedicated to support palliative patients who are at the ‘end of life’ stage through: increasing care at home, reducing unplanned/avoidable hospital admissions, and expediting hospital discharges.”

He goes on to detail the 15 staff who deliver that vital service, which costs just £495,000 and which the North Devon Hospice charitable funds have covered for the last decade. He said:

“North Devon Hospice asked for funding support of £157,540 which represents the same level of commissioning support as our bedded unit and community nursing team receive. Devon ICB have stated that they are willing to provide £95k as a one off”

before the next commissioning review period. But he said that the hospice had to state in return:

“due to our year on year million-pound deficit, having funded the service for 10 years and propped up the cost of this service through cost management elsewhere in the organisation we are no longer able to support the service which is at its minimum establishment to be able to operate.”

The hospice has been advising the ICB of this for three years.

[Peter Gibson]

My hon. Friend illustrates one of the biggest single challenges for hospice at home. Hospice at home relies on transport, which in an urban community can be delivered at a relatively small cost, but in a deeply rural constituency like hers, those costs need to be addressed and met in order to deliver that care. Does she agree that the funding models need to address the cost of transport and travel in rural constituencies delivering a hospice at home service?

[Selaine Saxby]

I could not agree with my hon. Friend more. There are many elements of healthcare, but the rurality of constituencies like mine is not fully reflected in the funding settlements.

My hospice requested that the ICB find the additional £65,000 to get it through to the end of the year. The chief executive took this back to the board to see whether we could get that seven months of cover through. However, it has now been through a full board meeting and consultation, and this is where my email came in. He finished his email to the ICB by saying:

“I sincerely hope that the good faith you have asked of us extends to Devon ICB’s good faith in finding the extra £65k.”

The email that he sent to me at the end of the recess says that he met the ICB chief executive,

“and he asked for 8 more weeks to see if he can do something, no promises made. My Board met last night where we agreed to wait for his response before making any decisions on the service. Therefore, any pressure you can apply would be greatly appreciated. The headline is: ‘Has it really come to the point where we have to beg for £62k to stop 32 people dying in an Emergency Room?’”

That was four weeks ago, and the hospice has still heard nothing. Our ICB is also in special measures. I beg the Minister to intervene and see if we can help our much-loved hospice, as well as tackle the ever-growing issues we have with our integrated care board back home in Devon. The hospice to home service is hugely valued by families and ensures that their loved ones can spend their final days at home, not in hospital. It also helps by taking the pressure off North Devon’s much loved, very small hospital. As it says across the shops back home in North Devon for our hospice, “Your life is a story, and the ending matters.” I very much hope that there is a way to secure the future of this hospice to home service to ensure that we have many other happy endings.

--- Later in debate ---

[Jim Shannon]

That is good to remember. I will mention the volunteers.

The hon. Member for Walsall North (Eddie Hughes) is no longer here, but he mentioned a sponsored walk and encouraged the right hon. Member for Hayes and Harlington (John McDonnell) to be involved. Like the right hon. Gentleman, I could not run a marathon, and I probably could not walk it, but he and I could probably dander it—that is the third category. We are danderers. I could do 26 miles, but it would be at my own pace. I am sure everyone else would be on their way home whenever he and I crossed the line—that is a story for another day.

We cannot pay hospice workers enough, but we have a responsibility to ensure that there is enough money to pay them. I do not feel we are currently doing enough, as other Members have said very clearly. The consensus is that we all want to see them paid better, and we want to see the care continue.

Northern Ireland Hospice provides specialist palliative care for more than 4,000 infants, children and adults in Northern Ireland with life-limiting conditions. The charity, which includes the only children’s hospice in Northern Ireland, says that it faces a number of challenges,

“not least of which is the ever-growing cost of this service. Government funds approximately 30% of service costs”.

The hon. Member for Darlington (Peter Gibson) spoke about Foyle hospice, which has to find 65% of its service costs. Well, every other hospice in Northern Ireland has to find 70%, relying on the

“goodwill and generosity of voluntary donations and other fundraising activities.”

[Peter Gibson]

One thing that has not yet been brought out in any of the speeches is the fact that a significant amount of the money that goes to our hospices through their fundraising and charitable fundraising comes in the form of legacy giving. That in itself, because of the size of estates and the value of properties, creates a postcode lottery. Is that part of the problem? Could we use this debate to highlight legacy giving to hospices?

[Jim Shannon]

I understand the issue that the hon. Gentleman highlights, and I will speak about donations.

The people of Northern Ireland are generous to a fault. Understanding Society data suggests that Londoners donate the most, with an annual average of £346 per donor. That is due to a handful of large donors, which I understand is the issue. People from Northern Ireland donate £344 a year to charities in all sectors, not just hospice care, and last week’s figures show that Northern Ireland donates more than anywhere else in the United Kingdom of Great Britain and Northern Ireland. Scotland, at £282 a year, and the south-east, at £270 a year, are the next highest donors. I am proud that we in Northern Ireland are givers, but this has allowed what is tantamount to an abdication of responsibility by those whose duty it is to see this care carried out.

We all support the Marie Curie coffee mornings. They are bun fests, which is not good for a diabetic. People make their donation and drink their tea or coffee. That is what it is about. It is not about what people get out of it; it is about what they give. To me, the Macmillan coffee mornings and Northern Ireland Hospice events should be about providing additional help, not providing the foundation of their funding. We and the Government must step up.

People do not have great disposable incomes, so the coffee mornings intended to raise money for a nurse raise less than half the amount needed to pay for a nurse’s pay increase. We can no longer rely on public generosity to make the difference, and I therefore believe that we must step up and see hospice care not as a charitable extra but as an integral part of the NHS. That is what it needs to be, otherwise we have failed.

I am ever mindful of the seven-minute time limit, Madam Deputy Speaker. If we cannot supply children’s hospice places with specialised staff, we are failing, and we cannot afford to accept failure. The Minister is a good lady, and she believes in hospices. I know she will respond positively, but I want to ascertain how we can do better for palliative care hospices, not in the next budget round but starting here and now. There is a consensus on wanting it to happen, and I believe the Minister and the Government should ensure that it does.

--- Later in debate ---

[James Sunderland]

I commend all the staff in the Saint Francis hospice in Havering on what they do. It sounds remarkable. We have heard so many stories this evening of hospices and palliative care providers right across the country.

The message is clear: we need more funding. We must establish better funding models. We cannot rely so much on charities and donations. We must make sure that funding is provided up front. This is a life-and-death issue. Hospices take pressure off the NHS. The facilities at Thames hospice are state of the art; we can sweat the asset an awful lot more. Perhaps the underused capacity of hospices could sometimes be hired back to the NHS.

[Peter Gibson]

I want to make one final point in this final Back-Bencher contribution to the debate. Many people have called for multi-year funding settlements. That is not to make life easy for the hospices; it is just more sensible, so that they can plan into the future—sign leases, buy equipment, and train, recruit and retain staff. The request for multi-year funding settlements will allow them to put plans in place to provide the care that is needed.

[James Sunderland]

I thank my hon. Friend and I agree completely. Nobody can plan in a vacuum, so this is about more money, earlier money and the ability to plan so we know where the delta is.

I will conclude now. Madam Deputy Speaker, thank you for the opportunity to speak this evening. We need more money, Minister, and I know you will give it to us.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this debate. The number of speeches this evening reflects the strength of feeling, and the support, for hospices across the country. As the Minister with oversight of end of life care, I share the passion of many hon. Members for hospices and for what they do, caring for people towards and at the end of life, providing respite for carers and supporting families both before and after the death of a loved one. Many hon. Members have rightly praised the work of the hospices that serve their constituents and made special mention of the extraordinary work of hospices for children and young people. I also thank the hospices for all they do, and for all they are doing right now, as their staff work around the clock.

Beyond that, I thank everyone who gives palliative and end of life care, as part of hospice teams but also working in the NHS. How you die, how your loved ones die or how you live towards the end of your life, matters. As the hon. Member for Birmingham, Erdington (Mrs Hamilton) said so eloquently earlier this evening, and as all of us here this evening know, that is why palliative and end of life care matters. It matters when that care is provided by the NHS, as it is for the majority of people, and when it is provided by hospices. I emphasise that point, because there is sometimes a misunderstanding, which I have heard a few times this evening. The fact is that most palliative and end of life care is provided by the NHS, whether in hospitals, by primary care or through community trusts. Alongside and in addition to that, hospices do the wonderful work that they do. Recognising the importance of palliative and end of life care, we specified in the Health and Care Act 2022 that integrated care boards must commission these services to meet the needs of their populations.

Some hon. Members have argued this evening for hospice funding to be centralised, taken away from integrated care boards and, I assume, allocated by either NHS England or the Department of Health and Social Care. While I understand their motivation in making that call, I do not agree. We purposefully set up ICBs to understand the healthcare needs of our local communities, to plan and commission services to meet those needs and, in so doing, to reduce health disparities. Our communities and their needs, and the services they already have in place, are different, and rarely is a one-size-fits-all decision made in Westminster the right answer. I stand by a more localised approach, in which there is, of course, variation.

Another source of variation is historical. The hospice movement has grown organically, and the location of hospices has not been planned to meet demographic need, for instance. There are, therefore, inequalities in access to hospice services, especially for those living in rural and more deprived areas. This variation in access to hospice care has to be taken into account by ICBs in the decisions they must make to ensure that people have access to end of life care, whether or not they live in an area served by a hospice.

[Peter Gibson]

My hon. Friend makes an important point about the organic way in which our hospices have developed and emerged. Does she agree that our ICBs have the opportunity to use our hospices to address those shortfalls in certain communities by directing funding specifically to them to meet needs that have not previously been met?

Will the Minister further clarify one small point? She has made a clear distinction between NHS-provided care and hospice care, but there are many cases around the country where the NHS is funding, in full or in part, specific services from hospices. How would she distinguish between them? Is it NHS care or hospice care if it has been fully commissioned and fully funded by the NHS?

[Helen Whately]

I will pick up on a few of those points.

On the NHS providing palliative and end of life care, I have heard a misunderstanding in some speeches, both this evening and on other occasions, that all end of life and palliative care is provided by hospices. It is more mixed. Integrated care boards do, indeed, commission hospices to provide care, but hospices also provide care independently, and NHS services do so, too. These teams also work together collaboratively. That diversity is a strength.

In seeking to address inequalities, ICBs can look to hospices to do more in underserved areas, for instance. At other times it may be more appropriate for them to look to NHS services. It will vary by area, which is one reason why these decisions should be localised, rather than made by somebody sitting in my place saying, “This is how it should be done across the whole country.”

Although I do not agree with centralising hospice funding, I am working on the transparency and accountability of ICBs to their communities and hon. Members, as representatives. That is why I have regular meetings with NHS England leads on palliative and end of life care, and it is why I am pleased to have secured NHS England’s commitment to including palliative and end of life care in the topics discussed at its regular performance meetings with ICBs. It is also why I am pushing NHS England and ICBs to improve the data they collect on the access to and quality of palliative and end of life care.

NHS England has developed a palliative and end of life care data dashboard to help ICBs understand the needs of their populations and then address and track inequalities in access to end of life care. This is progress, but I want the transparency to go further so that we all have the data we need to assure ourselves that our ICBs are commissioning the care that our constituents need.

I have heard the calls for more funding for hospices and the stories of some fantastic fundraising efforts, from the “star trek” night walk and the “Santa sprint” to the magnificent marathon runners who have joined us in the Chamber tonight fresh from yesterday’s London marathon. I congratulate those who ran, and particularly those who did so on behalf of hospices, which is timely for this debate.

That said, I disagree with the hon. Member who said that people running a marathon for hospices is “sad”—it is not; it is a wonderful thing. It is a sign of the tremendous support that hospices have in our communities and that people are willing to choose to fund hospices, not just when the taxman comes along; they are choosing to have a hospice providing services to people in their area. It is a good thing because that fundraising gives hospices an independent funding stream, the freedom that goes with that to serve their communities as they see fit, and the strong ties with their communities and with all those people who fundraise for their hospices.