Hospice Funding

Debate between Rachael Maskell and Stephen Kinnock

Tuesday 8th April 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Member for Beaconsfield (Joy Morrissey) for securing this important debate. I wish to take this opportunity to thank all those who work or volunteer in the hospice and palliative care sector for the care and support that they provide to patients, families and loved ones when they need it most.

This Government want a society in which every person receives high-quality, compassionate care from diagnosis through to end of life. We are determined to shift more care out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting. Palliative and end-of-life care services, including hospices, will have a vital role to play in that shift.

In England, integrated care boards are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local population. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. Although the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at the end of life, as well as to their loved ones.

Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding that each charitable hospice receives varies, both within and between ICB areas. This variation is dependent on demand in that area and on the totality and type of palliative and end-of-life care provision from both NHS and non-NHS services, including charitable hospices within each ICB footprint.

This Government understand the financial pressures that hospices have been facing, which is why we have announced the biggest investment to hospices in England in a generation. We are ensuring that hospices in England can continue to deliver the highest quality end-of-life care possible for patients, and for their families and loved ones. We are supporting the hospice sector with a £100 million capital funding boost for adult and children’s hospices, to ensure that they have the best possible physical environment for the care they give.

We are pleased to confirm that the Government have released the first £25 million tranche of the £100 million capital funding, with Hospice UK kindly allocating and distributing the money to hospices throughout England. An additional £75 million will be allocated in the coming weeks for use in the 2025-26 financial year. The £100 million capital funding will help hospices to provide the best end-of-life care to patients and their families in a supportive and dignified physical environment. Funding will help support hospices and will enable much-needed improvements, including refurbishments, the overhauling of IT systems and improvement of facilities for patients and visitors.

We are also providing £26 million in revenue funding to support children and young people’s hospices. This is a continuation of the funding that, until recently, was known as the children and young people’s hospice grant. ICBs will once again administer the funding to their respective children and young people’s hospices on behalf of NHS England. This is in line with NHS devolution policies, and it promotes a more consistent national approach by supporting commissioners in prioritising the palliative and end-of-life care needs of their local population. I am pleased to confirm that NHS England has now communicated the details of the 2025-26 funding allocation and dissemination to individual hospices.

I do accept that there is unwarranted variation and inequality in access to, and quality of, palliative and end-of-life care in England, but we are working to reduce these variations. NHS England has published statutory guidance and service specifications to support commissioners in prioritising palliative and end-of-life care. It has also developed a palliative and end-of-life care dashboard, which brings together all relevant local data in one place. The dashboard helps commissioners to understand the palliative and end-of-life care needs of their local population, enabling ICBs to put plans in place to address and track the improvement of health inequalities and to ensure that funding is distributed fairly, based on prevalence.

NHS England has also published the ambitions framework, which sets out our vision to improve end-of-life care through partnership and collaborative action between organisations at a local level throughout England. Additionally, NHS England has developed an assurance system with specific steps and deadlines to ensure the timely dissemination of the £26 million revenue funding to children and young people’s hospices, because we know that there were some quite significant problems last year with the transmission from NHS England through the ICBs to hospices. These steps include regular oversight sessions with ICBs, regions and hospices and giving ICBs a hard deadline within the first quarter of the financial year by which they are expected to disseminate the funding to hospices, including escalating to NHS England if any ICB is unable to meet the deadline. If the deadline is missed, NHS England has put steps in place to ensure that all hospices receive the funding within the timescales outlined.

We, alongside key partners and NHS England, will continue to engage proactively with our stakeholders, including the voluntary sector and independent hospices on an ongoing basis to understand the issues they face. In fact, I recently visited Katharine House hospice in Stafford and heard from staff how important our record investment has been to them. More widely, in February I met key palliative and end of life care and hospice stakeholders in a roundtable format to discuss long-term sector sustainability in the context of our 10-year health plan.

I recognise the concerns that hon. Members have raised about funding and employer national insurance contributions. In July last year we inherited public finances in their worst state since the second world war, and we took the necessary decisions to fix the foundations in the public finances at the autumn Budget, enabling the spending review settlement of a £22.6 billion increase or uplift in resource spending for the Department of Health and Social Care from 2023-24 out-turn to 2025-26.

I gently point out to the Conservative party that while I believe it has welcomed that unprecedented settlement, to my knowledge it has been silent on its preferred means of generating that revenue. I gently say that Opposition Members cannot have it both ways. They cannot welcome the £22.6 billion on the one hand but, on the other hand, condemn the way in which the money is to be raised without coming up with their own plan and proposals for how they would raise those funds.

[Rachael Maskell]

We have to recognise that the hospice sector is in quite a difficult place financially. However, if there is good advance care planning, money currently spent in secondary care could be invested in the hospice sector and in more community provision. Surely that must be a first step that would not only get better clinical outcomes but be better for the whole of the palliative care pathway.

[Stephen Kinnock]

My hon. Friend speaks with tremendous and deep knowledge of the sector. I welcome the work that she is doing on the commission on palliative and end-of-life care, and we very much look forward to seeing the outcomes and results of that.

My hon. Friend is right that if we are to make the three big shifts at the heart of our 10-year plan—the shifts from hospital to community, from sickness to prevention, and from analogue to digital—the delivery of that will require a left shift in terms of both funding and reform. It is absolutely right that we take a hard-headed look at funding across our NHS and ensure that funding is going to where it is needed. She will know that the share that hospitals get of overall NHS funding has gone up dramatically since the early 2000s, to the detriment of primary care, community care and palliative care—all the things that happen outside hospital. That is something that we must address and shift upstream, because we will never solve the considerable challenges that our NHS is facing until we make that left shift.

I note that the funding announcement was warmly welcomed by the sector. Toby Porter, chief executive of Hospice UK, said:

“Today’s announcement will be hugely welcomed by hospices, and those who rely on their services. Hospices not only provide vital care for patients and families, but also relieve pressure on the NHS. This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need, when and where they need it.”

I hope that the measures I have outlined in my response to the hon. Lady will go some way to reassuring all Members of this Government’s unwavering commitment to the sustainability of the hospice and wider palliative and end-of-life care sector.

--- Later in debate ---

[Stephen Kinnock]

The exemption was given to 100% full-time workers within the NHS; in essence, hospitals. As regards GPs, dentists and care providers, ENICs are being levied on those other parts of the health and care sector. Every aspect of my portfolio is therefore seeing ENICs being levied.

[Rachael Maskell]

A suggestion to the Minister would be to integrate the staff working in hospices into the NHS payroll. It would be that simple to exempt them from those national insurance increases.

World Stroke Day

Debate between Rachael Maskell and Stephen Kinnock

Tuesday 29th October 2024 Commons Chamber

[Stephen Kinnock]

I am a little wary of generalising too much, because I know that so many decisions have to be made in real time by our skilled ambulance drivers and paramedics and the many others involved, but my hon. Friend makes a valid point. In a general sense, he is absolutely right that stroke needs to take priority. The red thread going through this entire debate is the need for speed. It is all about prioritising and acting quickly; he is absolutely right about that.

In the past year, we have seen a 30% increase in the number of thrombectomies delivered in England. Alongside that, our 20 integrated stroke delivery networks are looking to optimise care pathways. The General Medical Council is addressing critical workforce gaps through its thrombectomy credentialling programme, and our national optimal stroke imaging pathway is improving information sharing.

I am aware of the reconfiguration in the constituency of the hon. Member for Glastonbury and Somerton. NHS Somerset integrated care board has decided to close the hyper-acute stroke unit at Yeovil hospital and to establish a single hyper-acute stroke unit at Musgrove Park hospital in Taunton to provide 24/7 emergency treatment. All service changes should be based on clear evidence that they will deliver better outcomes for patients. A high bar is set out in guidance for intervening in contested reconfiguration cases, and the reconfiguration of services should be a matter for the local NHS. I would expect all avenues of local resolution to have been exhausted before a call-in request is made. The Department has received a formal request to call in NHS Somerset ICB’s decision, and Ministers will make a decision on whether to use their call-in powers in due course.

Unfortunately, there is still significant variation across the country in access and outcomes in relation to stroke. For example, the percentage of suspected stroke patients who received the necessary brain scan within an hour of arrival at hospital varies from 80% in Kent to only around 40% in Shropshire. That variation needs to change, and we need to bring the best of the NHS to the rest of the NHS. That will be one of the central challenges for the Government going forward.

The Government have a profound ambition to improve the lives and health outcomes of people who survive a stroke. At this point, I would like to pay tribute to my hon. Friend the Member for Stratford and Bow (Uma Kumaran) and to the man in the Public Gallery for what they have been through and for their fortitude. It was certainly not easy for my hon. Friend to come to this place and to have to go through the extremely difficult situation that she did. I also pay tribute to all the key partners and stakeholders who worked with her and her family to get through it. That really is a tribute to the immensely important work they do.

[Rachael Maskell]

As well as looking at acute triage to rapidly diagnose people who have had a stroke, it is important to invest in rehabilitation—something I did for 20 years in the NHS. I would be grateful if the Minister could set out how he proposes to have integrated rehabilitation teams that not only see people through the immediate aftercare, but continue to provide a top-up for them so that they do not backslide in their rehabilitation.

[Stephen Kinnock]

I can say a word about our national service model for an integrated community stroke service, which involves a number of specific projects aimed at improving delivery of psychological rehabilitation. The ICSS model is vital to support psychological recovery, return to work and improved quality of life, and I would be more than happy to discuss it further with my hon. Friend.

Before I close, I want to recognise the remarkable work of the charities that help people across the country to rebuild their lives after a stroke. Once again, I thank the hon. Member for Glastonbury and Somerton for this important debate, and I encourage every Member of the House to go to change.nhs.uk and to get involved in the biggest conversation about our health and care service since its foundation in 1948.

Question put and agreed to.

Oral Answers to Questions

Debate between Rachael Maskell and Stephen Kinnock

Tuesday 23rd July 2024 Commons Chamber

[Stephen Kinnock]

The hon. Gentleman was doing so well at the start, and then he kind of blew it a bit towards the end. It is absolutely right that we put country before party, and we will work with whoever has the best interests of rebuilding our public services at heart. The issue that he raises specifically sounds interesting. What I would say is that unless we get the bigger picture sorted, and unless we make NHS work pay for dentists, we will not be able to rebuild the NHS dentistry system that we should be cherishing and seeking to reform. I am of course always open to conversations with him.

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

Just 39.2% of my constituents were able to access an NHS dentist over the past two years. That is an absolute disgrace, but the Health and Social Care Committee put together a report into NHS dentistry, setting out a blueprint for how to resolve the challenges, including access, looking at tie-ins and ensuring that we get more dentists registered. Will the Minister look at that report and follow its recommendations?

[Stephen Kinnock]

I congratulate my hon. Friend on her re-election; it is wonderful to see her back in her place. She is absolutely right that the tie-in consultation deadline was 18 July. We are considering those responses with an open mind. On the broader issues that she mentions, our rescue plan is 700,000 more appointments, incentives for new graduates to go to under-served areas, reform of the dental contract and making work pay for dentists. That plan is at the heart of the reforms that she mentioned and that is what we will be doing.