Palliative Care

Rachael Maskell Excerpts

Thursday 5th March 2026 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op) [R]]

I beg to move,

That this House notes the findings of the Independent Palliative Care Commission; calls on the Government to implement its recommendations in full, including to establish a comprehensive and specialist palliative care service that is equally accessible to everyone and properly funded, as well as a new commissioning framework that secures a service across all settings and is available from the point of a terminal diagnosis, the advancement of a life-limiting illness or latter stages of a chronic condition; and further calls on the Government to have a focus on workforce planning and training, to provide a comprehensive palliative care service, and to ensure that patients are empowered through future care plans to articulate what they want to happen towards the end of their life, while also establishing bereavement services for all.

I am grateful to you, Madam Deputy Speaker, and to the Backbench Business Committee for granting today’s debate on the future of palliative care. Although I applied for it last summer, it could not be more timely, as the Government consider their modern service framework.

Dame Cicely Saunders said:

“How people die remains in the memory of those who live on.”

By addressing what she called “total pain”—physical, psychological, emotional, spiritual and social pain—palliative medicine could transform not only the way we approach death, but how we embrace life. Her legacy has since driven palliative medicine, with dedicated teams delivering care. Someone told me in York that they did not know

“that such outstanding care was even possible.”

Every complexity is embraced and addressed.

In 2024, 532,000 people died in England. Marie Curie evidence published two weeks ago showed that one in three people fail to get the interventions they need. Despite requiring specialist palliative care, over 100,000 people received none. Demand is rising, and will grow by 42% in a decade. Where someone dies, on what day or at what time determines the care that they receive. Some 42% of all deaths occurred in hospital, 28% at home, 21% in care homes, 5% in hospices and 4% in other settings, such as prisons. According to Sue Ryder, just 50% died in the place of their choosing.

I have had the sheer privilege of working with leading academics and clinicians, health leaders, international experts, charities and people with lived experience, in establishing, with Baroness Finley, the independent commission on palliative and end-of-life care, which is chaired by Professor Sir Mike Richards. We sought solutions to establish equitable access to high-quality palliative and specialist palliative care. I am beyond grateful; I have been inspired and I have learned much.

I am also indebted to Professor Fliss Murtagh from the Wolfson Palliative Care Research Centre at the University of Hull. I make particular mention of Professors Katherine Sleeman and Irene Higginson of King’s College London; Oxford consultant Professor Bee Wee; Hospice UK; Marie Curie; Sue Ryder; the Association for Palliative Medicine; Together for Short Lives; my local hospice, St Leonard’s; and so many more. We held 10 evidence sessions and eight roundtables, received 506 written submissions from experts, and spoke to 129 witnesses. We then presented our report to the Minister.

Now that the Government have progressed to the modern service framework, they must commission a single pathway across all settings, focused on excellence, crisis prevention and investing in the community. We found that early identification for access to high-quality specialist interventions was transformative for patients. At the point of terminal diagnosis or increasing frailty, a serious illness conversation undertaken by well-trained clinicians—as recommended by Professor Sir Chris Whitty—injects an honest understanding to ensure the best patient-centred care, while capturing the patient’s wider social needs, priorities and goals. It facilitates good clinical planning. Co-produced, personalised and optimal care is supported with palliative medicine.

In York, the frailty hub brings all sectors, clinicians and services together. When that is intersected with palliative care, crisis admissions are avoided. Emergency services do not escalate without cause; rather, medicine integrates with the hospice at home team—one team, one set of records, one plan. Avoiding the need for crisis management avoids distress. In the last three months of life, however, almost half of people visited their emergency department, and one in eight spent more than 30 days in hospital. Placing palliative care professionals in emergency departments furthers the model, and allows patients to be triaged to the right service. Clinicians at the back door discharge into community palliative care teams. On the wards, hospital specialists connect with patients, introduce palliative care where appropriate, and seek to discharge to the community, hospice or special hospital unit, reducing hospital deaths and improving disease management.

As our bodies fail, high-stakes interventions add little to the quality or quantity of life, yet they carry risk—as do hospital stays—through infection, deconditioning and disorientation. In a far cry from what happened on the Liverpool care pathway, the focus is on enhancing life, not hastening death.

GPs have a significant role, and I ask the Minister to review the retiring of the palliative care register, which focuses GPs on identifying patients for palliation early, so that interventions can be considered. Can she set out how she will still achieve those aims? People are identified far too late for palliative support—just 56 days prior to death for cancer, and 27 days for non-malignant disease, like respiratory, neurological, renal or cardiac disease. Those with conditions like dementia are rarely ever referred.

While there has been a move away from prognostication of life expectancy, due to its unreliability and often significant inaccuracy, recognition of palliative needs early is key. Marie Curie’s “Better End of Life 2024” report identified that 40% of families had no conversation about deterioration or possible death; 20% were alerted in the last three months of life, and 15% in the last week. Its report, “Measuring unmet need for palliative care”, highlighted that one in three people do not receive specialist care. Its post-bereavement survey in 2024 showed a doubling of unmet need, compared with the 2015 VOICES—views of informal carers: evaluation of services—post-bereavement survey by the Office for National Statistics, which should be reintroduced. That highlights the fact that there is higher demand and poorer access.

Furthermore, we know that those from low socio- economic and ethnic minoritised communities are significantly disadvantaged, and face late identification of needs and poor palliative care access. Without agency and advocacy, outcomes are worse, and that is also the case for those with physical and intellectual disabilities. Such injustice demands change.

Variation exists across integrated care boards. The responses to Hospice UK’s freedom of information requests showed that spend ranged from just 23p to £10.33 per person. The National Audit Office’s report on this subject shows the inequity, too; figures range from one hospice bed per 2,900 patients to one per 54,300, yet provision is mandated by the Health and Care Act 2022. At night and over weekends, 75% of the time, the availability of advice and interventions available to relieve distress, difficulties and discomfort is inconsistent, although 24/7 services are needed. By day, a single point of contact is essential, as the Association for Palliative Medicine has impressed upon me.

Specialist palliative care from highly trained professionals must be commissioned to manage complex pain and symptoms through effective drug titration and interventions like palliative radiotherapy, nerve blocks and neuromodulation, which are often not available. The commission advised rapid escalation of complex cases to specialists, to improve outcomes across all settings. Psychological support is pivotal, yet only 19% of hospices can access clinical psychology. Early assessments can palliate depression or anxiety and their consequences.

Young people with life-limiting and life-threatening illnesses must have equal access to care. Paediatric palliative care differs from adult care but is as ambitious in driving excellence. Tailored, age-appropriate care is needed, and expert parents need recognition for their advocacy, too. I particularly note the concerns about transition into adult services; special attention is needed to get that right.

I turn to training. Family carers provide £28.7 billion-worth of care annually. They need training and support, to be listened to, and, above all, space to love, be and spend time. In addition to training and accreditation of the whole palliative health and social care workforce in domiciliary and residential settings, hospices and hospitals, we need a workforce plan for the whole pathway. All undergraduate programmes must have palliative care content. Specialist training to support GPs aspiring to consultant status needs dual accreditation, and the commission heard that overseas-trained staff need specific orientation to palliative medicine, as each jurisdiction approaches death differently. Across the whole service, we need high standards and united objectives.

In 2024, the cost of dying in England was £24,222. The total for England was £12.8 billion, and 78% of that was spent in hospital settings. By contrast, just £1,017 is spent per person on specialist palliative provision, and £862 on community nursing. Research published today shows that specialist palliative care can save the NHS £7,908 per patient when delivered at home, and £6,480 per patient in hospital. That would save around 1.5 million bed days, or £817 million. Funding for hospice provision—essential healthcare—can no longer depend on bake sales and parachute jumps. Two in five hospices are making cuts, and 380 beds have been lost in a year, according to Hospice UK. Staff reductions and redundancies have occurred. Paediatric palliative care faces a £310 million shortfall, and there has been an overreliance on charitable funding, which is inherently inequitable.

[Monica Harding (Esher and Walton) (LD)]

The hon. Member is making such a powerful speech. I wish to draw attention to Princess Alice hospice in my constituency. It receives 20% of its funding from the Government, and the rest through selling woolly jumpers. Most constituents are not aware of this, but the hospice says that it can provide only a quarter of the provision that is needed in Esher and Walton because of the state of its funding. Does the hon. Member agree that the situation needs to change, not least if we are to make things equitable for everybody in our society?

[Rachael Maskell]

The hon. Member makes such a powerful case. We are talking about essential medicine. We would not do this in any other field of medicine, yet we are dependent on charities, which do phenomenal work to fund essential healthcare. We must ensure that we fund it properly. I will come on to make a few suggestions about that.

Although I recognise the dedication of St. Leonard’s hospice in my constituency, and the whole community around it in York, which is both generous and caring, it receives less than 24% NHS funding. This year, it got just a 2% uplift from the integrated care board. To invest in equipping it, in staffing in the community, and in building the capacity to meet need, funding will be needed, and there is already a significant shortfall. Without that funding, transition will slow and the model will fail. The sector agrees. ICBs have no transition funding, and without a health transformation fund, how will the Minister be able to deliver proper care for everyone? If patients are moving into domiciliary or hospice settings, funding should follow. Clinical staff, pharma, capital, utilities, and other essential costs should be covered by the NHS, since patients are now transferred from secondary care into the community. The modern service framework is due for publication in a matter of months, and implementation is due in April 2027. It requires a strong framework of accountability and governance, and it would be helpful for the Minister to set out how the MSF will be evaluated, and how outcomes will be measured.

[Martin Vickers (Brigg and Immingham) (Con)]

I congratulate the hon. Lady on the work that she has done on this issue. Two hospices serve my constituency—Lindsey Lodge in Scunthorpe, and St Andrew’s in Grimsby—and the percentage of funding that they get through the NHS, as opposed to from charity, varies dramatically. Does she agree that, at very least, we must regularise the proportion of funding that hospices receive from the Government?

[Rachael Maskell]

The hon. Member is right, and we know how much palliative care, including specialist palliative care, costs. That must be built into the commissioning process at population level, so that we see equity. I am sure that many in his constituency will see certain demographics in his community excluded from being able to access that specialist care. We must drive the model, and if we do not have the funding, resources or staffing, it will be very difficult to deliver the comprehensive service that everybody deserves at the end of life, should they need palliative care.

[Gideon Amos (Taunton and Wellington) (LD)]

I am sure the whole House congratulates the hon. Member for York Central (Rachael Maskell) on her immense work on this topic—I certainly do. I am sure that she would sympathise with one of my constituents, whose case was brought to my attention by Marie Curie. The lack of a doctor on duty over a weekend meant that proper palliating medicine could not be prescribed, resulting in a distressing death. Does she agree that as well as consistency in funding, we need care to be consistently available seven days a week and 24 hours a day?

[Rachael Maskell]

I am grateful to the hon. Member for raising 24/7 provision, and provision in the evenings and at weekends. Research shows that only a small proportion of services are available at those times and access to them is inequitable across the country. We need to ensure that a specialist is available at the end of the phone to support clinicians, family members and patients themselves, and that we have the workforce available to come out to deliver changes to medication or an escalation in care. It is crucial that this is not a nine-to-five service, but a 24/7 service.

Finally, I want to mention bereavement. Bereavement support varies and is often underfunded, if funded at all. Grief costs the economy £23 billion a year, but it costs individuals far more. It can be complex and have a profound impact, especially on children. It is vital that we commission appropriate bereavement support, including counselling and, for some, social prescribing.

In conclusion, palliative care affirms life and regards death as a normal process. It neither hastens nor postpones death. However, to date, access to palliative care has been inequitable. This debate must be a catalyst to providing outstanding care. Our ambition must go beyond the modern service framework. Our duty is to secure excellence in life, until the final breath is taken.

[Several hon. Members rose—]

--- Later in debate ---

[Karin Smyth]

My hon. Friend pre-empts my next paragraph; I thank him for his contribution.

As part of the development of the MSF, we will be looking at some of the important aspects of care that my hon. Friend the Member for York Central mentioned, such as early identification of need, care delivered closer to home by integrated generalist and specialist teams, and strengthened out-of-hours community health support, including a dedicated phone line. I assure the right hon. Member for New Forest East that children, parents and carers will be included in that endeavour. As my hon. Friend the Member for Chelsea and Fulham (Ben Coleman) said, the experiences of people like Amy inform such work. Let me say to my hon. Friend the Member for Alloa and Grangemouth (Brian Leishman) that the experience of Calum and the Turner family must not be repeated.

Hospices do an amazing job for people at the end of life, those with life-limiting conditions, and the whole community of family and friends who support their loved ones on that journey, including through bereavement support, as we have talked about today. The quality of care, the compassion and the love that hospices provide are second to none. We absolutely recognise that the sector faces challenges, and we are determined to work with all our partners to understand those challenges. We are not talking about spending more; we are talking about focusing on the money we have at the moment and spending it better. We are developing a values-based, outcome-focused financial model to reflect people’s experience of care throughout their lifetime. While there are no easy answers, we are supporting them with record funding and reform.

[Rachael Maskell]

I am grateful to the Minister for her speech, but we have heard throughout the debate that 100,000 people are not getting the care they need. One in three people needs additional support. By maintaining the financial cap, how are we going to build enough capacity to ensure that everybody has access to excellent care at the end of life?

[Karin Smyth]

I thank my hon. Friend for her contribution. This issue warrants a longer debate, so that we can understand how to move the resources that exist. As we have heard this afternoon, when people are unnecessarily admitted to hospital, which is terribly distressing for them and their families, the resources follow them. It is about moving those resources towards neighbourhood health services, in which this cohort of people will be absolutely central, as I have said. That is what we need to be doing, and we will continue to discuss this with people as we move the service towards being community-based.

Colleagues are right to champion their cause in the House today, and we will continue to work on this issue to make sure that people have good-quality care across the country. Given the measures I have outlined this afternoon, I hope Members will agree that we are listening. We look forward to working with colleagues to make sure that we develop these services for the future.

[Rachael Maskell]

Will the Minister give way?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The Minister has finished speaking, but the hon. Member does get to wind up the debate.

[Rachael Maskell]

I thank all hon. Members for their contributions. We have had 20 contributions to the debate, with 12 excellent speeches from Back Benchers; I have to say that it has been a debate of the highest calibre. I heard so clearly such praise for the staff working in palliative medicine right across the country—in Scotland and in England—and I thank them myself, too.

I particularly acknowledge the speeches made by my hon. Friends the Members for Worcester (Tom Collins) and for St Helens South and Whiston (Ms Rimmer), who talked about the loss of their mothers, with very contrasting experiences. That demonstrates the inequity across palliative medicine, and it cannot be right that people are not getting the care that they absolutely must get.

I wanted to ask the Minister a follow-up question about how the transition takes place. If we do not frontload the funding, we will never see the development of community provision, because we will not be able to pull people out without the resourcing in the community. The challenge really arises from the whole model, which was the emphasis of my speech. I trust we will look very carefully at enabling the flow of patients into the community and getting care in the right place, but also at the sufficiency of funding, as so many hon. Members said, to ensure the excellence of the care itself.

We also heard about the challenges that all hon. Members have had, whether for child or adult services, and we need to ensure that we train the workforce and have a sufficient workforce in the future. We need to get the commissioning right, and address those very pertinent issues. Above all, we must invest in the time and the compassion that is needed to give families and patients excellence in palliative care. As a clinician, I have witnessed working with people at the end of life. In such special moments, the whole workforce crowds around the patients, and supports them and their families. It is so moving, and today I also heard my hon. Friends’ moving reflections, which is what the debate is all about. It is about ensuring that we have those really special moments at the end of life, and we should really invest in that time so people can have those memories and cherish everything they possibly can.

We have debated assisted dying so much in this place over the last year or so. I have heard so many examples of poor care, where I know that specialist palliative medicine could have made such a difference to the individuals. That is why today’s debate is not only timely, but necessary. We must really invest so that everyone has the opportunity to receive that amazing care, love and support at the end of life, and so they do not have to even contemplate assisted dying. I think we have a responsibility to put this front and centre. Let us move on from the debate on assisted dying to make sure we get care right for everyone.

I want to close by saying a huge thank you to everyone here; I really do appreciate it. I should put on record that I am the co-chair, with Baroness Finlay, of the all-party parliamentary group on dying well. I invite all hon. Members to join us as we really try to advance this debate.

Question put and agreed to.

Resolved,

That this House notes the findings of the Independent Palliative Care Commission; calls on the Government to implement its recommendations in full, including to establish a comprehensive and specialist palliative care service that is equally accessible to everyone and properly funded, as well as a new commissioning framework that secures a service across all settings and is available from the point of a terminal diagnosis, the advancement of a life-limiting illness or latter stages of a chronic condition; and further calls on the Government to have a focus on workforce planning and training, to provide a comprehensive palliative care service, and to ensure that patients are empowered through future care plans to articulate what they want to happen towards the end of their life, while also establishing bereavement services for all.