Hospice Services: South Devon

Richard Foord Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster]

I must say that that is slightly far away from south Devon, but the hon. Member for Strangford (Jim Shannon) always manages to find a relevant point in his interventions. The nub of his point is rightly received, although he will, of course, recognise that there is devolution of healthcare responsibilities to Northern Ireland, which makes that slightly different from the responsibilities of the Minister who is here today.

Like other public services, businesses and community organisations, hospices have faced increase costs. For example, Rowcroft Hospice outlined to me that the cost pressures that they face include a 30% increase in total staff costs and a 52% increase in utilities bills, and yet NHS funding—what they receive for contracts—has only increased by 8% in five years.

Alongside these pressures, demand is growing. We should never talk about what I am about to say as if it were a problem: more people are living longer, in good health, well into their 70s, 80s and even 90s. That is the biggest and most positive achievement of modern science, healthcare and public health measures implemented since 1948. It is not a problem, which is how we sometimes talk about it. Many conditions that once cut lives short can now be cured or no longer circulate, yet there remain conditions that are likely to affect us later in life that will require palliative care. According to major study published by BMC Medicine in 2017, if age and sex-specific proportions relating to palliative care remain the same as in 2014, the number of people requiring palliative care will grow by 25% from just over 375,000 to just over 469,000 by 2040, but if the upward trend observed between 2006 and 2014 continues, it will increase by 41.2%, with the biggest drivers being conditions such as dementia and cancer. In south Devon, those estimates would see the demands on Rowcroft Hospice grow from 2,500 patients per year now to over 3,500 by 2040. The pressures outlined above apply not only to those working with adults, but also to children’s hospices where funding from local integrated care boards can be patchy—it actually fell on average between 2021-22 and 2022-23.

I note that the Department for Health and Social Care and NHS England have provided vital centrally distributed ring-fenced grants to children’s hospices since 2007. As the Minister will be aware, NHS England initially indicated to hospices that 2023-24 would be the final year of that grant, but I am pleased to note that, after a campaign by the group Together for Short Lives, it has been confirmed that NHS England will be renewing £25 million of funding for children’s hospices in 2024-25. That is excellent news, but I note that it has not yet been confirmed how children’s hospices will receive that funding or how much each of them will receive. I am sure the Minister does not need reminding of the potential impact on vital services if such funding is not available in future. Initial indications from hospices are that they will see a range of services reduced.

It is easy to outline problems in any debate, but there are also great opportunities to provide solutions, the greatest of which could help transform our view of the role of hospice care in south Devon. The Ella’s Gardens project is a transformative vision of what high-quality palliative, nursing and residential care should look like in the middle of this century. At its centre is the construction of a new in-patient unit and the remodelling of the existing hospice building to provide the very best specialist palliative care for generations to come. The proposal is to enhance hospice care for patients and their families by increasing the number of single beds from the current two to 14 to further support the local population and help to meet future demand for specialist palliative care, giving hospice patients and their families even greater independence and choice during those vital moments together. It also aims to enhance the level of care to ensure that patients’ physical, emotional, social, psychological and spiritual needs are being met, while enabling family and friends to stay overnight to be near loved ones.

Rowcroft’s vision is also to build greater financial resilience by reducing the reliance on current income streams such as retail and fundraising. A core part of that is the creation of a 60-bed, purpose-built specialist dementia and complex care nursing home, designed on the leading model of dementia care—I hope I pronounce this correctly—called the Hogeweyk, with six households of 10 residents. Alongside that is a 40-bed assisted living complex, with a proposal that would enable Rowcroft to meet the wider care needs of the local community, as well as providing an invaluable income stream to support the hospice’s ambitions.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the hon. Member for securing the debate. I wish him condolences for his mother and stepdaughter. He talks about physical space. Seaton Hospice at Home currently works out of the Seaton and District Hospital League of Friends, and relies on that physical space. I know that at Rowcroft, four out of five patients are treated at home. Does he agree with me that palliative care nurses, after working with patients, need somewhere to come back together and operate as a team?

[Kevin Foster]

The hon. Gentleman makes an important point in highlighting hospice at home. The service is growing because many people do not want to be in a hospice or a hospital, and if given the choice, they would rather pass away at home surrounded by their loved ones. My stepdaughter was supported to do that. It is quite an experience when it happens, but it was what she wanted.

The hon. Gentleman is right to say that there is a need for those groups to have the type of facilities they require and be supported in that. I accept that, given the sheer area that some hospices cover for that service, they may have to have some form of remote working arrangement for most of the day, but certainly, I see how Rowcroft provides that facility and it works well. There is that balance of the hospice for those who need it and are at that stage in their treatment and care, and the hospice at home to try to give people the choice they deserve at the end of their lives.

The plans have been developed in a way that allows residents to live in a caring, nurturing and vibrant home that supports as much independence, mobility and inclusion as possible. The Ella’s Gardens vision is not just one for patients and families, but one of being a hospice that is part of the community. Rowcroft’s large gardens are open to the public and are a popular community facility. There is never a sense of hiding away or being something that people only talk about when affected by it. The plans therefore include community facilities, a village hall and a day nursery. That creates opportunities for recreational activities and intergenerational connections, effectively making it a facility for the whole community with a unique side to it, and not just a hospice that people only attend if they need to be with a loved one.

Unsurprisingly, the plans have been widely acclaimed across our bay and have already received planning permission from Torbay Council. They could be under way in just over 18 months, providing support to our wider healthcare services, from a formal commission agreement with the integrated care service. The Minister will be pleased to hear that this is not a direct pitch for Government capital funding, although obviously if there were funding available, it would certainly help. That said, I would be delighted to welcome the Minister to Torquay so she can see at first hand the transformation the project will bring, not just to hospice and palliative care but to the future for that kind of care. A future that is about being not just part of the health and care system but at the heart of our community’s life, as well as being there when needed at a time when a loved one is passing away. I hope the Government will see it as a model for the future and one they want to get behind.

Given what I have already outlined, I would appreciate hearing the Minister’s responses to some specific points. As a matter of urgency, will she confirm how much of the £25 million children’s hospice grant each children’s hospice will receive in 2024-25, when they will receive it and how?

What assessment have Ministers made of the impact of integrated care board funding on children’s hospice care, and the risks of withdrawing the ringfenced grant? These services will work across regions; to ensure a more planned approach, will the Government direct ICBs to work with their neighbours on planning and funding children’s hospice and palliative care services?

More widely in the hospice sector, the variation in statutory funding between regions and hospices is stark. What thoughts have the Government had on ensuring a more consistent approach? Some hospice costs, including NHS pay rates, are decided by the Government. Would the Minister consider implementing a funding formula that would allow cost increases that are out of the hospice’s control to be reflected in local service contracts? Given the increase in costs this year, could the Government supply a simple fixed amount per hospice that forecasts a deficit? How do the Government see the future needs of palliative care being met? I am not requesting that hospices be publicly funded; the charity model offers many advantages and flexibilities. However, hospices must have predictability when planning for the future.

There is much more that I could say about the opportunities, challenges and pressures on hospices in South Devon, but I should draw my remarks to a close to allow the Minister adequate time to respond and perhaps take interventions. For families across South Devon, Rowcroft Hospice is a service that is not just valued, but treasured. It is a place where memories are made, conversations had that bring peace after a dispute that now seems petty, family events are held, news is shared and smiles may be raised, even as the end nears. In short, a hospice is a place where life is added to days, when days can no longer be added to life. We need to ensure that Rowcroft continues to be such a place for decades to come.