NHS Dentistry: Rural Areas

Richard Foord Excerpts

Tuesday 5th November 2024 Commons Chamber

[Sarah Gibson]

I agree. Hold on. [Interruption.] Sorry.

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

Will my hon. Friend give way?

[Sarah Gibson]

Yes—thank you, Richard.

[Richard Foord]

My hon. Friend is making an excellent speech. She has mentioned ICB commissioning. I wrote to the Minister to ask whether there were set criteria for knowing where a patient is on the waiting list, and I understand that that is entirely in the gift of individual practices. Does my hon. Friend think that it ought to be for ICBs, or for NHS Devon in my case, to determine where people are on the waiting list for NHS dental care?

[Sarah Gibson]

rose—

NHS Winter Readiness

Richard Foord Excerpts

Wednesday 30th October 2024 Westminster Hall

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

It is an honour to serve under your chairship, Sir Roger. I, too, pay tribute to my hon. Friend the Member for North Shropshire (Helen Morgan) for securing and speaking in this debate on a day when she, as the Liberal Democrat health spokesperson, has a lot else to do.

As we face another winter, our NHS is under severe strain. In east and mid Devon, where I am from, the situation is all too apparent. We have five community hospitals across Axminster, Honiton, Seaton, Ottery Saint Mary and Sidmouth, where we see hard-working staff do their absolute level best to deliver a whole range of vital services, such as audiology, X-ray and rheumatology. The hospitals have had their services reduced or even removed over time, which has led to the overburdening of the large acute hospitals.

The unfortunate reality is that the NHS is struggling in terms of acute hospitals like the Royal Devon and Exeter hospital in Exeter. The statistics in the south-west from last winter illustrate that well. Across Devon, 33% of patients in A&E waited more than four hours in February last winter, which is well above the national average. That means that rather than ambulances being out in the streets and lanes saving people’s lives, they spend 30 minutes or more waiting in queues outside, with 31% of ambulance arrivals at the RD&E last winter unable to offload patients in a timely manner. That might suggest to some that we need to put more money into ambulances and acute care, but that is not borne out in the research as the exclusive solution to the problem.

A King’s Fund report recently found that the failure to grow and invest in primary and community health and care services ranks as one of the most significant and long-running failures of health policy over the past 30 years. Today, we heard a Budget from the Government that pledges more funding for the NHS; we worry about what that might mean in respect of the absence of support for social care. Because the system is reactive, we spend increasing amounts on acute hospitals and crisis response rather than on the proactive primary and community care that could reduce hospital demand in the first place. That imbalance means that funding is funnelled into hospitals, where people go once they are very ill, and it leaves the community services that could prevent crises unable to do the preventive work they should be doing.

Our community hospitals in places like mid and east Devon are proof that effective healthcare is not just about big hospitals. I would like to see localised, specialised care that prevents and treats issues early and close to home. Community hospitals should offer more than just treatment; they are also about routine check-ups and screenings. They are places that people go to manage chronic conditions and to receive other ongoing care.

I stress that we have excellent healthcare staff in Devon—in the community hospitals, in primary care, in GP surgeries and in the acute hospitals—but year after year they are asked to do more with less. With more community-based teams, working closely with social care providers, we could avoid many of the delayed discharges we see in the acute hospitals. More than one in eight acute beds in England is essentially blocked, with 14,000 patients clogging the system. I do not mean to put it in those terms—I know that individuals filling acute beds because they are unable to be discharged sometimes feel like a burden, and I do not want that to be the case—but the fact of the matter is that there are acute beds that could be released for other needy patients.

Winter brings respiratory infections, flu and respiratory syncytial virus, all of which hit the elderly, the young and those with long-term health conditions the hardest. Flu vaccine uptake in the south-west is not where it needs to be, at only 46.5% last winter, and I urge people with long-term conditions to get vaccinated. When flu and other winter illnesses surge, the community health services and facilities can pick up some of the slack and reduce some of the pressure on hospital beds.

If we can shift to a focus on community help, it will be about preparation. I know it is challenging—it must be, or we would have done it in the last three decades—but we now need a concerted effort from national and local leaders to support that shift and support people in managing their own health before they are in crisis, so as to relieve the pressure on acute hospitals.

NHS: Independent Investigation

Richard Foord Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She might be from the wrong side of the river, but she is absolutely right about the importance of prioritising children’s health. As the Prime Minister said this morning, it is shocking that the No. 1 cause of hospital admission among children aged between six and 10 is tooth decay. I was criticised by the shadow Secretary of State, who said that I called our children “short and fat”; she is more outraged by my calling out the scourge of childhood obesity that her Government fuelled than she is by the scourge of child obesity itself. That is why we will act and why the Conservatives failed.

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

I welcome the fact that the Health Secretary talks about a shift from hospital to community care; that builds on Lord Darzi’s finding that 13% of beds are occupied by people who are waiting for care in more appropriate settings. Caring for patients in community hospitals is much more cost-effective than caring for patients in big acute hospitals like the Royal Devon and Exeter hospital where I live. What thought has the Secretary of State given to the use of community hospitals that have lost beds in the last decade, such as Seaton, Axminster, Honiton and Ottery St Mary?

[Wes Streeting]

The hon. Gentleman is absolutely right about the value of community hospitals, step-down accommodation and care close to people’s homes—or, better still, wherever possible, in their homes, so long as it is clinically safe and the right support and care is available. The shift from hospital to community will be at the heart of our 10-year plan for reform and modernisation. Like lots of his colleagues on the Liberal Democrat Benches and lots of those on the Government Benches behind me, the hon. Gentleman has already done a good job of putting his local lobbying of Ministers on the record in the House.

Unpaid Carers

Richard Foord Excerpts

Tuesday 3rd September 2024 Commons Chamber

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

Does my hon. Friend agree that one other Department that might be quite interested in a cross-Government strategy is the Treasury? My constituent Amanda had a civil penalty applied on the basis that she misrepresented her earnings, which has made her frightened to go back to work or to work more hours. Does my hon. Friend agree that it is damaging to the economy if we have people not going out to work?

[Wendy Chamberlain]

I agree with my hon. Friend. If the Government’s aim is to grow the economy, they must, in addition to other measures, be targeting those people who are economically inactive not because they cannot work as a result of their skills, knowledge or capacity, but because their caring responsibilities prevent them from doing so.

I am conscious of your direction, Madam Deputy Speaker, so if the House allows I intend not to take any further interventions. Otherwise, I will not get through the remarks that I want to make.

I want to mention Fife Young Carers, which supports 207 young people in North East Fife, and about 1,300 overall across Fife. Some of those carers are as young as five years old. Caring for a loved one as a child has a significant impact on their education. In the last Parliament, the all-party parliamentary group on young carers and young adult carers carried out an inquiry that found that young carers are missing on average 27 days of school each year and are 38% less likely to go to university than their peers. We know that how children do in school has a vital long-term impact on their future employment—indeed, the Education Secretary was talking about that the other day—and just about everything in their future. The position of young carers gives us a clear example of how the lack of an overarching strategy fails unpaid carers.

Earlier this year, I wanted to question the then Government over the exclusion of young carers from carer’s allowance, building on a question asked by the hon. Member for Slough (Mr Dhesi). The reason that the DWP gave me was that supposedly young carers in education can rely on educational grants for support. I therefore asked the Department for Education about support for young carers. It turns out that there is no specific support for them because they are not considered to be part of a vulnerable group. It means that the DWP can abandon financial support of young carers to the Department for Education, which seems to think that young carers can rely on their parents for income. That shows what happens and how support for arguably an incredibly vulnerable group can get lost without overall leadership.

Yet more Government Departments have a role in the health and wellbeing of unpaid carers. According to Carers UK’s 2023 state of caring report, 50% of unpaid carers are lonely and 58% of carers had to cut down on their hobbies and leisure activities. Caring for a loved one should not mean being isolated from your own support networks or having to give up the things that bring meaning and joy, but clearly it does for many, either because they cannot find the time in the day for themselves between work—if they can stay in it—and caring, or because often they simply cannot afford to participate any more. This is the moment for the Ministry of Housing, Communities and Local Government to get involved, with its overarching responsibility for leisure and the services provided at local level. I am talking about respite breaks, which the hon. Member for Strangford (Jim Shannon) mentioned, support services, and access to local leisure facilities. A cross-Government strategy could also engage the Scotland, Wales and Northern Ireland Offices, and ensure that similar priorities are discussed in intergovernmental meetings with the devolved nations.

There are many root causes and solutions to the problems faced by unpaid carers, and they span all Government Departments. The Minister is here as the Minister for Care, but I hope that he is also aware of the impact of all the cross-Government issues that I have set out on the health of unpaid carers. I am sure that he has learned much in recent weeks. Last year’s “State of Caring” report on health found that 82% of unpaid carers said that the impact of caring on their physical and mental health would be a challenge. It found a significant impact on mental health, with 79% saying that they were stressed or anxious and 49% saying that they were depressed. It is therefore no surprise that research carried out by Dr O’Dwyer at the University of Birmingham has found that unpaid carers are a group at high risk of suicide. That is particularly true for parent carers of children with a long-term illness or disability. Of the participants in her study, 41% of unpaid carers had thought about killing themselves.

It is clear that we need vital preventive healthcare for unpaid carers, but clearly that is not in the remit just of the Department of Health and Social Care. Again, I reiterate why we need a cross-Government strategy. I appreciate that even if a strategy were announced this evening, it would not just be in place overnight—it could not be and it should not be. Its goals need to be co-designed with unpaid carers and the organisations that represent them. It needs organisation, buy-in and leadership. For it to work and take meaningful action, it ought to be sponsored at the highest level of Government and engage all the Departments that I have mentioned. It needs ringfenced funding. It will not surprise the House that I have mentioned funding. The last strategy was supported by £255 million in funding. That may sound like a big figure when we keep being told that difficult decisions have to be made, but it is nothing compared with the economic value of unpaid care, which, as I have said, amounts to £190 billion per year.

I do not want to pre-empt the goals of the strategy—they need to be designed with unpaid carers themselves—but a first priority should be, as my hon. Friend the Member for Harrogate and Knaresborough said, the proper identification of unpaid carers. Unpaid carers may not recognise themselves as such or know what support services are available to them. Professionals and organisations play a vital role in identifying them, through GPs, hospitals, local authorities, workplaces and educational settings. A national carer’s strategy will provide leadership and strategic direction. It will put the needs of unpaid carers at the highest level of Government. Morally, practically and politically, it is the right thing for the Government to do.

I do not particularly like the title of this debate on the Order Paper. The word “potential” was inserted to keep me in line with the rules on neutrality in debate titles. It makes it sounds like the merits of the strategy are arguable, which clearly they are not. I chose to read “potential” in a different way: a national carer’s strategy has an abundance of potential to create improvements that have not yet been realised. I look forward to hearing the Minister’s remarks.

Dentistry: Access for Cancer Patients

Richard Foord Excerpts

Wednesday 17th April 2024 Westminster Hall

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

It is an honour to serve under your chairship, Mr Dowd. Since being elected to represent Tiverton and Honiton almost two years ago, one of the issues that has appeared most regularly in my inbox and mailbag is access to NHS dentistry. It is common across the country for someone to have difficulty accessing new NHS dentists if they are not already registered, but that is particularly difficult in some parts of the country, including in Devon, which is often regarded by many as a so-called “dental desert”.

In recent months, we have heard the Government suggest that a way to address the difficult shortages of dentists is to try to attract qualified dentists into an area regarded as a dental desert. For example, we have seen the proposal to pay one-off incentives to qualified dentists to move into a dental desert such as Devon, but the truth is that this is still very difficult. I appreciate that the new proposal has not come in yet, but given that it is a one-off incentive, there is still no long-term incentive for dentists to move into dental deserts. That is difficult for many of my constituents, but it is more deeply worrying for those who are living with cancer. This is not a hypothetical scenario; it is the experience for people in rural communities such as Devon where finding a new dentist is impossible.

I will recount a real-life story from one of my constituents who was caught in just that scenario. Robin Whatling lives in Tiverton and is aged just 55. He is struggling with advanced cancer. Because of the treatment and medication that he is on, his bones and teeth are weaker than they would otherwise be, which means that regular check-ups are more important for him.

Robin’s wife, Sharon, contacted me last December and told me how, after booking a check-up, he received an abrupt phone call just a few days before it was due to happen. He was informed that the practice was no longer treating NHS patients and that if he wanted to go ahead with his appointment, he would need to go private. That is clearly a massive issue for a couple like Robin and Sharon. Due to Robin’s vulnerable state, Sharon has had to go part-time to become his carer. That means that she is not able to work the hours that she used to, which would have possibly afforded her more money to pay for private healthcare treatment.

Instead, the couple pursued the idea of finding an NHS dentist. They were held on the phone for three hours before being cut off. In the end it all became too much, and Rob ended up removing one of the teeth that was causing him pain by himself at home. I do not need to tell the House that that is a shocking, appalling situation to have to contend with while suffering advanced cancer.

Despite years of working hard and paying into the system, this couple are now left adrift with no support or access to dental care. In some of the correspondence that Members receive, we have constituents who rage at us with anger, but this couple approached me with great modesty and humility. They absolutely were not seeking to score any sort of political point. They just wanted to let me know, in a very factual way, the experience of a rural couple contending with cancer and trying to find NHS dentistry on the state.

The British Dental Association has laid bare the facts. Oral cancer is one of the fastest-growing types of cancer and it is killing more people than car accidents every day. Dentists can play a key role in diagnosis and referral, and if oral cancer is diagnosed early, survival rates can be as high as 90% compared with just 50% if diagnosis takes place at a later date.

Let us say it as it is: NHS dentistry is in crisis. It is another example of the Government continuing to let people down and stand by as our vital services crumble. The NHS dental budget has been cut in real terms by £1 billion while the Conservatives have been in power. That is a shocking legacy of neglect. My constituents were not party political about this, but I am going to be: this Government have presided over the crumbling and decay of NHS dentistry, and have paid lip service to proposals to do bits and pieces that do not amount to contract reform. So I urge the Minister, for the sake of Rob, Sharon and everyone who is trapped in a situation like this, to take on board the urgency of the issue of NHS dental care for cancer patients and those who might become cancer patients.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Stretford and Urmston (Andrew Western) on securing this really important debate on behalf of Michele and all the other petitioners. I would of course be delighted to meet Michele to hear her views, and I particularly take note of her call for all cancer patients to be advised of the potential impact of cancer treatment on their oral health. That is a really solid and actionable thing that I undertake to take away today. I look forward to meeting Michele and the hon. Gentleman in due course.

I wish to take this chance to pay tribute to the Mouth Cancer Foundation, the Oral Health Foundation and Dentaid, to name just a few of the excellent charities that provide support and advice to so many.

I thank all Members who have spoken in what has been an excellent debate. I say to the hon. Member for Tiverton and Honiton (Richard Foord) that I fully appreciate the challenges in Devon. He will no doubt welcome the fact that a mobile dental van, which will be quite a boost for very underserved and geographically distant areas, will be forthcoming for Devon in the near future. In addition, one of the real problems in Devon—this is not the hon. Gentleman’s fault at all—is that in his area on average only around 57% of commissioned units of dental activity are actually undertaken by dentists. I am sure he might like to talk to his local integrated care board about that, if I can help in any way, I would be delighted to.

As I will come on to talk about, our dental recovery plan attempts to incentivise further NHS dentists to really ramp up delivery. In fact, we have already seen hundreds of thousands of new dental treatments just since 1 March, when the plan went live. Unfortunately, the data is not publishable as yet, but I feel really optimistic. I totally understand what Members say about it being not good enough—I totally get that—but we are seeing rapid improvements and I encourage the hon. Gentleman to talk to his local ICB.

[Richard Foord]

On the Minister’s point about only 57% of the units of dental activity being taken up in Devon, is that not a workforce issue?

[Dame Andrea Leadsom]

No. How it works is that the ICB commissions dentists to provide NHS dentistry, and the NHS contractor undertakes to fulfil a number of units of dental activity. If they do not do that, for whatever reason, at the end of the financial year the ICB claws back the money they gave the NHS dentist to fulfil that contract. I am not judging anything; I am merely giving the hon. Gentleman information that I hope is helpful to him.

Dementia Care in Hospital

Richard Foord Excerpts

Wednesday 6th March 2024 Commons Chamber

[Theresa Villiers (Chipping Barnet) (Con)]

My constituent Lisa Rutter is the founder of the charity Dementia Club UK, which hosts events in Barnet for people with dementia and their families, to provide support, advice and much-needed time out of the house to socialise with other people who are coping with similar life experiences. This work gives Lisa great insight into dementia care and the pressures on unpaid carers, and she asked me to meet a group of carers over Zoom to hear about their relatives’ traumatic experiences when admitted to hospital. I found the meeting deeply disturbing, which is why I applied for this debate.

In the time available, I can only include brief points about each case. I cannot hope to convey the emotional impact of the stories as told by the carers themselves, and I cannot hope to get across their real distress and anger that their loved ones had been let down, but I hope to give the House an indication of the seriousness of the problem.

I will start with Lisa’s own story. Her mother, Tasoulla Gavriel, was admitted to Barnet Hospital with covid in November 2020. Sadly, she died shortly afterwards. Tasoulla was a lovely lady, and I met her on a number of occasions. She was assessed by the hospital to be an eight on the Rockwood scale, meaning that she was viewed as severely frail and approaching the end of her life. Lisa believes that this diagnosis was entirely wrong. Her mother was sitting up and alert when admitted, and she did not have serious comorbidities, apart from advanced dementia, which meant she needed help with eating.

When Lisa was told by the hospital that her mother needed an oxygen mask, she asked for Mrs Gavriel to be put in hand mittens to prevent her from pulling off the mask and harming her treatment. The hospital refused, on the basis that this did not accord with hospital policy because it amounted to a deprivation of liberty. The hospital decided that it was neither proportionate nor in Mrs Gavriel’s best interests for her to be given mittens. That is despite mittens being used when Mrs Gavriel had been admitted the previous year for a hip operation. Lisa sincerely believes that mittens could have saved her mother’s life.

Another deeply distressing aspect of this case is that covid visitor restrictions meant that Lisa had only very limited time with her mother in hospital. I raised this in Parliament at the time, urging visitor restrictions to be eased for patients with dementia. I very much welcomed the subsequent introduction of greater flexibility for people to spend time with their loved ones in hospital. We must never again return to restrictions of the sort we saw during the pandemic.

Some of the group I spoke to did not want to be named, so I will simply refer to them as Carers 1 to 5. Unlike the others, Carer 1 is not a constituent and his experience does not relate to my local Barnet Hospital, but I do not want to leave him out. He emphasised how crucial it is that people with dementia continue to move and walk, if they are to stave off further loss of cognition, but he told me that staff at the hospital to which his wife was admitted refused to help her to walk. Even more worrying, he had to intervene twice to prevent a nurse from giving her the wrong dose of medication. Had he not spotted the mistake, a potentially lethal dose could have been administered.

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

I congratulate the right hon. Lady on securing this significant debate, as dementia is going to affect so many people’s lives in the coming decades, as more and more people are of retirement age. In Devon, the dementia specialist Jonathan Hanbury has suggested that we should place more funding and focus on community hospitals, community treatments and community services, so that people can keep their brain agile further upstream. He suggests that the NHS’s focus on funding for acute hospital services and expensive drugs misses the value of prevention. Does the right hon. Lady agree?

[Theresa Villiers]

Those are very valid points. It is important to keep people out of hospital for as often as possible, but that is particularly the case with dementia patients, given the dislocation and insecurity that comes with moving them to a different environment. Measures to keep people healthier for longer and to deliver care via the primary care system rather than in acute hospitals are an important way to address some of the problems I am outlining.

--- Later in debate ---

[Helen Whately]

I have very little time, so I am afraid I will not give way.

My right hon. Friend the Member for Chipping Barnet talked about the social care workforce, another subject close to my heart. We have a strategy for the care workforce. We are building care as a career, in particular to boost recruitment and retention among our home-grown workforce. We recently published the first ever national career structure for care workers, and we are launching a new national qualification to boost the supply of care workers.

Avoiding admission is another priority for me. Clearly, some people should be—absolutely must be—in hospital for the treatment they need, but we know that patients with dementia in particular can deteriorate in hospitals, so we are doing more work with the national health service and social care to avoid admission when it is not truly necessary by putting in place alternatives or, at the other end, supporting earlier discharge through the roll-out of the Hospital at Home initiative, or virtual wards, under which we committed to at least 10,000 hospital-at-home beds or equivalent as part of emergency care recovery plans. The NHS has over-delivered on that, so we now have more than 11,000 Hospital at Home beds, which help people who would otherwise be in hospital receiving acute care. They receive that care and are able to recuperate at home, avoiding the risk of a longer hospital stay and deconditioning.

My right hon. Friend talked about dementia research and the new treatments coming onstream. The Government have committed to doubling our investment in dementia research during this Parliament, and we are on track to do that with our dementia mission. We are also working very closely with NHS England to be ready for the breakthrough treatments lecanemab and donanemab coming onstream. I should be clear that we know very well—I have received clinical advice on this—that those treatments have quite significant side effects, so they will not be suitable for everybody and I put a note of caution there. We are waiting to hear whether they are approved by the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence. In the event of approval, NHS England is taking steps to be ready to put in place the levels of diagnosis required to be able to support those treatments.

That goes hand in hand with the work that we are doing with NHS England to improve the diagnosis rate for dementia. We have a target dementia diagnosis rate of 66.7%. That dropped during the pandemic because dementia services and assessment had to be closed, but it has been gradually building up, and I expect NHS England to get back up to that level during the course of this year. That is really important, because having a diagnosis helps people—the individual with dementia and their carers, for example—to access the support and back-up that they should be receiving.

I am conscious of the clock ticking, so I have tried cover some of the territory that my right hon. Friend set out in her speech, which I thought was very powerful in raising these significant issues for those with dementia receiving care in hospital, their carers and loved ones. I completely agree about the importance of dignified treatment and treating those with dementia with dignity at all times. I know that that can be particularly challenging in hospital, but we have to ensure that that is the case.

We will ensure that we get all the necessary care in place outside hospital, which avoids unnecessary admissions; support people to be discharged from hospital quicker; get ready for the arrival of new dementia treatments; and raise awareness about the significant proportion of dementia cases that can be prevented or at least delayed by looking after our health. In fact, the risk factors for dementia are similar to those for heart disease and other things, and there is relatively low awareness of that. We will see more people with dementia in the years ahead, but we can do more to raise awareness of how people can maintain their health and stave it off.

[Richard Foord]

Will the Minister give way?

[Helen Whately]

I am just coming to a close.

I thank my right hon. Friend for securing the debate. I will continue my work to pursue the topics that we have discussed this evening.

Question put and agreed to.

Oral Answers to Questions

Richard Foord Excerpts

Tuesday 5th March 2024 Commons Chamber

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

Wendy Hart had a high white blood cell count when she was discharged from the Royal Devon and Exeter Hospital. Her husband, Terence, described a dreadful, pointless 60-mile round trip home and back to hospital before Wendy died of sepsis. Will the Minister consider distances between acute hospitals and rural communities when reviewing hospital discharge guidance?

[Helen Whately]

I am very sorry to hear about what happened to the hon. Gentleman’s constituent. I send my condolences to her family and loved ones. Clearly, it is very important that discharge decisions are led by clinicians, who can make a clinical decision about whether somebody is medically ready to be discharged. I have no doubt that the family may well take up that decision with local NHS organisations.

NHS Property Services

Richard Foord Excerpts

Friday 23rd February 2024 Commons Chamber

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

My aim during this Adjournment debate is to get a plain answer to one simple question: to whom does NHS Property Services answer? That is a crucial question, because the organisation is in possession of an estate of more than 2,700 properties with a value of more than £3 billion. The company is responsible for roughly 10% of all NHS facilities, yet there is a need for clarity on how it is overseen. I aim to unpack some of the key questions that need answering and outline some ways in which we can improve the situation we find ourselves in, specifically in relation to Seaton Community Hospital in my constituency.

What exactly is NHS Property Services? I had to answer this question myself several months ago, when I learned of plans by NHS Devon to hand back part of Seaton Community Hospital to NHS Property Services, from which NHS Devon had been renting the building. I had little idea why NHS Property Services was the nominal owner of a full wing at Seaton Hospital. That is in spite of the fact that the wing was funded entirely through donations raised by the local community before the hospital was built and opened in 1988.

NHS Property Services is a Government-owned company with one single shareholder, the Secretary of State for Health and Social Care. To me, that implies that Ministers are ultimately responsible for the oversight of that company, even though I accept that the day-to-day running of the organisation is delegated. Yet ask a Minister about this, as I have, and Members might hear a rather different story. Each Minister who I have asked questions of has simply said that they cannot get involved in the decision-making processes in NHS Property Services in any meaningful way. I can understand Ministers not wanting to tinker in operational decisions, but there are some principles at stake in relation to Seaton Hospital that means it is not just an operational matter. Surely a company should be accountable to its shareholders—how otherwise can the company and its board be held accountable for their actions?

That is the paradox: we have a company worth billions that is solely owned by the Government, yet Ministers protest that they can have almost nothing to do with it. Far from being entirely detached from Government, the framework within which NHS Property Services operates is set by the Department of Health and Social Care. When I talk to regional representatives from NHS Property Services, as I have several times, they make it plain to me—in what they say and what they do not—that they are bound by policies emanating from Whitehall. That affects everything from how the organisation was established to its current operating framework, including how much NHS Property Services charges as rent for spaces that it lets to local NHS organisations such as integrated care boards.

That is a key barrier in the fight to save Seaton Hospital as one single entity. The current £140 per square metre market rent puts the embattled wing far out of the price range of any local, community-based organisation that wants to take over the space and use it for the improvement of health and wellbeing in the Axe valley. That is a crazy price: it is well over double what one would have to pay for office space here in Westminster—and, trust me, real estate prices in Seaton should not be comparable with those in Westminster.

My concern is that, on the one hand, the rent is extortionate because it is based on a clinical rate, and yet, on the other hand, the property directors—the people charged with running NHS Property Services—have a background in infrastructure and estates and want to get the maximum income they can from the estate they are running, so they pay little heed to the health context.

I will talk a little about the health context to bring this Seaton Hospital case study to life. The chief medical officer, Sir Chris Whitty, in his annual report last October called “Health in an Ageing Society”, wrote specifically about the tendency of older people to retire and move to rural areas, and specifically to coastal areas such as Seaton. He said:

“We’ve really got to get serious about the areas of the country where ageing is happening very fast, and we've got to do it now. It’s possible to compress the period of time that people spend in ill health...because otherwise we will end up with large numbers of people leading much more dependent lives.”

The report recommends:

“Providing services and environments suitable for older adults in these areas”

as an “absolute priority”. Sir Chris Whitty says that, specifically, we need policies to reduce disease, to reduce disability and to help people to exercise, eat well and stay fit.

That was the chief medical officer, and I will also refer to a report written just a couple of weeks ago by Beccy Baird from The King’s Fund. It calls for a radical refocusing of health and care, with primary care and community services at its core. The report says that

“progress has been hampered by an incorrect belief that moving care into the community will result in short-term cash savings. Other factors include a lack of data about primary and community services leading to a ‘cycle of invisibility’”,

with

“urgent challenges such as A&E waiting times and planned care backlogs becoming the priority for politicians tempted by quick fixes instead of fundamental improvement.”

Sir Chris Whitty and Beccy Baird are up against some in the public sector who are tempted to treat all estate management matters as the same. The head of the National Audit Office, Gareth Davies, talked in Parliament in January about asset management being one of the

“main areas of financial opportunity”

for the Government. I would caution the National Audit Office and NHS Property Services to read the Whitty and Baird reports, rather than simply seeking to divest all property in the NHS for as much as Property Services can get.

Seaton Hospital was transferred to NHS Property Services in 2017. The purpose of Property Services at that time was to centralise the holdings of various strategic health authorities and primary care trusts under one umbrella organisation. The aim was to remove the burden from local NHS organisations, and offer greater financial security by holding all those properties centrally. It was intended to provide better management of these important spaces, so as to ensure value for money and quality facilities, using economies of scale and of scope.

Fast forward to 2024, and it is clear that the model is broken. Rather than ensuring that our local health services get the space they need, we seem to be making perverse, false economies. The Government give money to integrated care boards only to have Government-owned NHS Property Services recoup a large portion of that money in rental fees for the buildings that ICBs use, at a rent set and advised by market rent auditors. This offers very little flexibility or security for our local NHS services, which, as in the case of Seaton Community Hospital, are left in a scenario in which the ICB is forced to cut services while still being lumbered with a bill for the space those services used to occupy. We lost the clinical beds we had at Seaton Hospital in 2017, and the space has since remained vacant. The only way to remove this item from the budget line is to turn over the space to NHS Property Services, which becomes liable for the amount charged in rent.

As hon. Members can see, this system is not only complex but incredibly backwards. The Government are effectively renting these buildings from themselves, despite the fact that many were previously directly owned by local health bodies. They are not even rented out at a fair price, despite the stated commitment to achieving fair market rates. These facilities are rented out as clinical spaces, even when they are not used for clinical purposes. This is based on an evaluation that must have been completely off the scale when it was made in 2016. Seaton Hospital was evaluated by the assessor Montagu Evans, and I do not know who it could possibly have talked to if it thinks that Seaton Hospital is worth £300,000 rent a year.

Why, we might ask, is the rent not adjusted to reflect the building’s current status? So far as I can gather, it is because the Government’s rental framework does not allow it. It places a huge roadblock in the way of community groups and hospital friends organisations that seek to convert such spaces into new settings aimed at providing non-clinical services of the sort to which Sir Chris Whitty and Beccy Baird were referring. Instead, the system seems analogous to a self-licking lollipop, or a dog blindly chasing its evasive tail without ever stopping to think why it cannot catch it.

During my many conversations with NHS Property Services in recent months, individual employees have sought to be helpful. However, they find themselves handcuffed by Government policy. They are unable to deviate from the Government’s framework, which, through the consolidated charging policy, first introduced in 2016, sets the rate that ICBs and, now, community organisations need to pay. The rate was introduced when the right hon. Member for South West Surrey (Jeremy Hunt), who is now Chancellor of the Exchequer, was Health Secretary.

In effect, the Government own all NHS facilities and have the power to direct the arrangements under which they are rented out, including the wing of Seaton Community Hospital that was funded, in whole, by local villagers, townspeople and the Seaton and District Hospital League of Friends charity. What on paper might seem like a prudent way to manage NHS facilities, and to make sure that they are properly maintained, means in reality that, in places like Seaton, the community no longer has a stake or a say in how its local hospital is used.

That begs the question: who is in charge? The answer should be the Secretary of State and Ministers reporting to her, but given her Department’s attempts to point the finger at this operational body and to divest itself of responsibility, it seems that nobody is in charge. People are pointing in several directions, and I cannot identify exactly who is setting the market rate. Simply put, the Government have let go of the wheel, and are content to let the car spin out of control so that they do not have to take responsibility. That is not good enough.

Our NHS is the envy of the world and one of our country’s greatest achievements. When the great Liberal thinker William Beveridge conceived of a service that was free at the point of use all those years ago, it was revolutionary and re-shaped the way in which modern democracies have approach public health. We cannot allow it to be eroded because of the unwillingness of the Government to face up to the challenge. The mark of leadership is honesty and accountability. I would like to see that from Ministers. Rather than the Government saying, “This is an operational matter for NHS Property Services, not me,” I would much rather someone from this Conservative Government admitted that they know what the so-called market rent is, why it is charged at that rate, and why the community must pay if it wants to use that space. Better still, that community should be given a concessionary rate, in recognition that clinical activity is not going on in that wing of the building at this stage. The community ought to be able to hire the space for a much more affordable rent.

I have three questions for the Minister. First, is the Department for Health and Social Care responsible for setting the amount that NHS Property Services charges local NHS services such as ICBs to rent the space? Secondly, could the consolidated charging policy, which I understand sets out those prices, be changed by the Secretary of State or Ministers? Thirdly, if the answer to those questions is yes, why have I been told repeatedly that Ministers cannot, so they say, get involved in operational matters relating to NHS Property Services?

Many ICBs are struggling to balance the books—NHS Devon is no different in that respect—and are seeking to downsize the space that they rent to make ends meet. This situation is not specific to Seaton, although I think it is a good case study because of the way in which local people bought a brick and built the hospital themselves with many small donations. The situation facing our local community hospital strikes me as an illustration of why change is needed. I have been campaigning with the Seaton and District Hospital League of Friends charity, which supports Seaton Hospital, to change the charging policy, so that NHS Property Services can have flexibility on rental fees. I want the company to enable underused space in NHS facilities to be rented out to local community groups that want to invest in preventive health and community wellbeing, and that want to fulfil some of the vision that Sir Chris wrote about in his annual report last October.

Ultimately, I would like an affordable concessionary rate to be offered to Seaton and District Hospital League of Friends and the working group that works with them. That would be of benefit to rural and coastal communities such as Seaton. We need to know how to ensure accountability for the current arrangements, and I hope that there can be concessions for local communities, such as the one that I represent in the Axe valley. I look forward to the Minister’s responses to my questions, and I hope that he is willing to engage with me to enact meaningful change that will benefit communities and constituents, such as those in my Tiverton and Honiton constituency.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

I congratulate the hon. Member for Tiverton and Honiton (Richard Foord) on securing the debate. I am grateful for the opportunity to set out the role of NHS Property Services. This subject is understandably of great interest to right hon. and hon. Members across the House.

The hon. Gentleman raised the issue of the future of Seaton community hospital. I will come to that in the latter part of my speech, but let me say for the record that I completely understand his desire to protect a much-loved community health facility. As the Member of Parliament for Pendle, I successfully fought to keep open Pendle Community Hospital in Nelson, and in the neighbouring constituency of Ribble Valley, the new £7.8 million Clitheroe Community Hospital opened in May 2014, so I recognise the importance of community hospitals, not just in offering in-patient care, but in acting as a hub for other healthcare services. It will be most useful for me to first set out to the House why and how NHS Property Services came into being.

Under the Health and Social Care Act 2012, the coalition Government abolished primary care trusts and transferred their commissioning responsibilities to clinical commissioning groups. Their property interests transferred to either NHS trusts or NHS Property Services, which was established in 2013 for this purpose. That decision was made because it allowed commissioners to focus on providing care for patients, rather than managing property. NHS Property Services took ownership of nearly 3,500 local facilities, such as community hospitals, health centres, GP surgeries and care homes. In the past 10 years, NHS Property Services has reduced the size of that estate by a fifth, saving over half a billion pounds of taxpayers’ money, every penny of which has been reinvested into the NHS.

[Richard Foord]

I understand the Minister’s point about reinvesting the proceeds from selling what might have been regarded as excess NHS property, but my concern relates to where that money goes. My understanding is that, following a sale, half the money might go back to the integrated care board, which would be Devon in this case. The problem with that situation is that it does not take account of the fact that local communities donated the money to build the infrastructure in the first place. That is certainly the case in the Axe valley with Seaton Community Hospital.

[Andrew Stephenson]

I appreciate the hon. Gentleman’s concern. I hope to provide reassurance in the latter part of my speech that the sale of Seaton Community Hospital is certainly not on the cards and is exceptionally unlikely. However, I appreciate that when property is sold, there is always tension between how much of that money will be reinvested in local communities—many of which have a stake in having created the facilities in the first place—and how much goes into the general NHS pot. The important point for me to land today is that all the money remains within the health services and none returns to the Treasury, so any sales of property from this portfolio are not a way for the Government to generate income, but simply a way of ensuring that the property estate is managed in the most effective fashion.

NHS Property Services was established as a limited company and is led by a board of executive and non-executive directors who are appointed for their property and healthcare expertise, including a departmental shareholder representative. The board’s directors all have the usual responsibilities relating to the proper governance of a limited company, with certain shareholder matters reserved, such as share issue or senior appointments. The board must work within the wider frameworks across Government, such as the Treasury’s guidance on managing public money, which rightly sets out the strict rules for delivering value for taxpayers’ money. The company therefore works with the Department to agree fiscal targets to work within, and is rightly held accountable for its use of public money. However, it is important to emphasise that my Department is not responsible for operational decisions, which are taken by the board and its executive management team.

One reason for the creation of NHS Property Services was to ensure that decisions could be taken without political interference. Although I appreciate that the hon. Member and others across the House may be of the view that my noble Friend Lord Markham, who has ministerial responsibility for NHS Property Services, can intervene to reduce the rents for unoccupied space at Seaton Community Hospital or similar facilities across the country, it would simply not be appropriate for him or any other Minister to intervene in any individual case.

The coalition Government established NHS Property Services through the cost recovery principle, which is the broad framework that the organisation works under. This means that it is funded through charging its costs to the occupiers of its buildings and the recipients of its services. As such, every pound it spends and does not recover is a pound that cannot be spent on delivering frontline care.

The Devon properties were transferred to NHS Property Services on the basis that their ongoing running costs would be funded through rents at market rate and service charges. This approach was taken to give real incentives to local commissioners to take the tough decisions on which properties were most suitable for delivering their clinical strategy, looking at areas as a whole and moving away from a situation whereby subsided property costs could lead to a less effective approach. I accept that that can sometimes lead to tensions about how reasonable charges are set, but the aim is that NHS bodies, and other voluntary and charitable organisations that wish to occupy NHS premises, must factor in the full cost of occupying and maintaining specialist facilities in their decision making.

I will now turn to the future of community hospitals in Devon, including Seaton Community Hospital. As the hon. Gentleman set out in his Adjournment debate in November, Seaton Hospital was part of a group of community hospitals that transferred to NHS Property Services in 2017, when large parts of Seaton Hospital and others in Devon were already vacant. The clinical commissioning group carried out a consultation on the model of community care and a new model of care was introduced, making it more integrated and more community based, with more people receiving care at home. That resulted in a significant reduction in the number of community hospital beds required across Devon. Since then, progress has been made to identify sustainable alternative healthcare uses for vacant spaces in community hospitals in Devon, such as Ottery St Mary and Axminster. In addition, NHS Property Services and Devon ICB have worked with the voluntary sector to support local initiatives in some properties, such as, as the hon. Gentleman will know, the Waffle café at Seaton Hospital.

I understand that Seaton Hospital and some other hospitals still have significant amounts of vacant space. Despite their best efforts, NHS Property Services’ commissioners have been unable to identify relevant services that could fill this gap. NHS Property Services has continued to manage the property, with the costs of the vacant space being charged to the ICB to ensure the costs attributed to the property are fully recovered, but recently the financial challenges facing Devon ICB have called the sustainability of that position into question and it has explored options for alleviating those costs. However, as I explained, simply seeking to pass those costs back to NHS Property Services would not result in the Department having any more money to spend on local healthcare services in Devon.

As I am sure the hon. Gentleman will appreciate, the responsibility for decisions about where to locate clinical services in Devon is a matter for the ICB. It is not a matter for Ministers. However, NHS Property Services is working closely with local leaders to identify options that would help to mitigate the cost pressures arising due to Seaton Community Hospital not operating at full capacity. If, and only if, the ICB determines the property is wholly surplus to its requirements, NHS Property Services would have the responsibility for selling the asset, following Treasury guidelines, but it is important to stress that the site remains an operational site and NHS Property Services therefore has no plans to sell it.

As has been mentioned in the local media, the idea of partial demolition of the hospital has been floated. Again, there are no plans for that course of action, which would very much be a last resort in any event. I believe the site has now been listed as an asset of community value, which means that such a drastic step is exceedingly unlikely to be supported by the local planning authority or other local stakeholders.

[Richard Foord]

It is true that the property has been registered as an asset of community value. To my mind that gives it a stay of execution, rather than that it is inevitable that it will be preserved intact. NHS Property Services talked through the very many options—I think 28 options—on the table for the vacant space at Seaton Hospital. One of that long list of options is indeed selling off the redundant ward, which could be demolished and used for houses. Did the Minister not know that?

[Andrew Stephenson]

I know the idea of demolition has been floated in a meeting, but I have been assured that there are certainly no plans for demolition. As the hon. Gentleman will know, an asset of community value nomination was accepted by the local authority, and as an ACV nomination remains live for five years, it will expire in January 2029, although I am pretty sure that local community groups and others would campaign for that to be extended. It is certainly much more than a stay of execution. I hope that has provided suitable reassurance to the local community that the threat of demolition is exceedingly remote, because the local planning authority and other local stakeholders simply would not agree to the demolition of this much-valued community asset.

I fully recognise that the local community has invested in the building of the hospital in the first place, and therefore is a key stakeholder in its future. The ICB and NHS Property Services continue in ongoing dialogue with a range of community groups about potential future uses, and the community has been invited by the ICB to develop a business case for the future use of the property by the end of June 2024. Any future decisions on the future of Seaton Hospital will be taken following evaluation of that business case. I sincerely hope that a financially sustainable solution can be found locally and in the best interests of the people of Devon.

Question put and agreed to.

NHS Dentistry: Recovery and Reform

Richard Foord Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

By 1 March, because that is when the new patient premium comes into force. Other aspects will take a little longer, but we are clear about the immediate benefits, and we want to get those out to people as quickly as possible.

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

In Devon and Cornwall last year, 57% of dental surgeries had at least one vacancy. Before 2016, more than 500 dentists registered in the UK had trained in European countries, and they made up a quarter of the workforce. Will the Secretary of State heed the call from the Association of Dental Groups for it to be made easier for qualified European dentists to practise here in the UK?

[Victoria Atkins]

That is exactly what we are doing, and not just in relation to other European nations but in relation to other countries around the world. We want the General Dental Council to ensure that qualified dentists from overseas are recognised and supported, and get on to our registers as quickly as possible.

Hospice Funding: Devon

Richard Foord Excerpts

Wednesday 17th January 2024 Commons Chamber

[Simon Jupp]

I completely agree with my hon. Friend. These services are dynamic and they are working, and the people of Torbay are well served.

I was reminded of the increasing importance of hospices by Dr Timothy Dudgeon, a constituent of mine from Ottery St Mary. He first approached me two years ago, and we met at one of my regular surgeries in Exmouth shortly afterwards. His plea was simple: Hospiscare, one of the charities I have mentioned, needs fairer funding from the NHS in Devon to cope with growing demand. I fully agree with him, but here we are two years later because the NHS simply is not listening.

I have raised the matter through meetings, letters and everything else to the NHS Devon integrated care board, and I am taking my call to the Floor of this House because I want the chair of the ICB, Dr Sarah Wollaston, formerly of this place, to realise that I am not letting this unfair deal for Devon’s hospices go without challenge. The issue here is obvious to all, and the solution is simply common sense, which is something we ought to try a little more often.

Hospices across our country and county are facing a perfect storm: income from fundraising is falling while costs and demand for their services are rising. Hospiscare in Devon has told me that it is facing a £2.5 million deficit in the next financial year. Meanwhile, Sidmouth Hospice at Home has told me that its average case load has risen by over 50% in the last year alone. Amid this perfect storm, I have been calling on the NHS Devon ICB to increase its funding for all of our hospices.

ICBs are responsible for determining the level of funding for palliative and end-of-life care in their area. This is devolution, and I support it. The Government do not decide how funding is spent; local organisations should know their area best and where to send their money. However, I question the situation in Devon. If the ICB needs more money to achieve fairer hospice funding, I would bang down the door of any Minister to help them, if asked, but they have not asked, and we have faced a wall of silence.

That was, intriguingly, until a couple of hours ago, when I received a letter from the NHS Devon ICB. It is intriguing timing, do we not think, given that it did not reply to previous letters I sent last year? Now it has finally responded to one of my letters from November. The NHS Devon ICB says that it is

“working on plans to move towards more equitable NHS funding”,

starting in the next financial year. I am sure colleagues here will be pressing for more details about that.

The wall of silence we have all faced in Devon is why I have launched a campaign and a petition on my website to put pressure on the ICB to increase funding to our local hospices, which residents across my constituency of East Devon and beyond are supporting. I first raised this with NHS Devon ICB two years ago after I met with Dr Timothy Dudgeon. I really hope the Minister can support my message to the ICB and its chair Dr Sarah Wollaston. Our message is crystal clear: there needs to be a fairer deal. Hospiscare is funded for 18% of its costs from NHS Devon ICB compared with the national average of 37% from ICBs across England. Sidmouth Hospice at Home receives no funding from the NHS in Devon at all, and that puts it in a small minority in the country receiving no money from a local NHS body. That simply cannot be right.

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

I am grateful to the hon. Member both for giving way and for securing the debate this evening which is a really significant one. I know from the Seaton and District Hospital League of Friends where there is the Seaton Hospice at Home facility that the palliative care nurses who work there are amazing people, and they help people to die in a very dignified fashion. Given that we have such fantastic people who work for such organisations as Hospice at Home in Seaton and Sidmouth, does the hon. Gentleman agree that they ought to continue to have a physical location in which to work from, as they do currently at Seaton Hospital? Does he also agree that the Minister might do well to talk to NHS Property Services so they can continue to have that facility at Seaton Hospital?

[Simon Jupp]

The hon. Gentleman makes a very good point about Seaton Hospice at Home, and it does a fantastic job for the residents of Seaton and the surrounding area. He also makes a good point about Seaton Hospital, which of course we face challenges with locally, as he knows all too well as the Member for Tiverton and Honiton. It is important to recognise that NHS Property Services is an arm’s length body. Having said that, recent meetings with one of the Ministers who has sponsorship of NHS Property Services has shed some light on the attempt to make sure that that building of Seaton Hospital is protected for future generations.

But I want to speak about somewhere else in Devon briefly. My hon. Friend the Member for North Devon (Selaine Saxby) cannot be here, but I am told North Devon Hospice has been trying to get its hospice at home service commissioned for a decade. The ICB agrees that it should be but will still not fund the service, which saves North Devon District Hospital £2.7 million through avoided admissions. Similarly, my hon. Friend the Member for South West Devon (Sir Gary Streeter) and the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) have raised the same issues with St Luke’s Hospice in Plymouth. This is plainly unfair; now must be the time to strengthen our hospices, give them fairer funding and help them take pressure off the NHS.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friend the Member for East Devon (Simon Jupp) for securing this debate about the funding of hospice care in Devon. I know that he is a huge supporter of hospices in his area, including Sidmouth Hospice at Home and Hospiscare. We have heard this evening how passionately he campaigns on behalf of the hospices that serve his constituency and how hard he is working to make sure they get the support and funding they need.

My hon. Friend may know—other Members in the Chamber for certain know—that I responded to a Westminster Hall debate in November on support for hospice services in south Devon. I know this subject is of great interest to Members who represent that part of the country, as well as to colleagues across the country. All of us here recognise the importance of palliative and end of life care, which supports people at some of the most difficult times, whether individual patients or their loved ones.

Most palliative and end of life care is provided by the national health service. Hospices are a crucial part of the network of end of life and palliative care, and they do a truly wonderful job caring for people during those difficult times. I experienced that with my grandmother, who spent the last few weeks of her life in a hospice a number of years ago. They did a wonderful job for her and her family as we spent some precious time with her towards the end of her life. I take this opportunity to send my thanks to everyone working in palliative care, whether in the NHS or in hospices, for what they do to support people at that time, and their loved ones.

Across the country, thousands of people receive palliative and end of life care. We have an ageing population, with many people living with complex health conditions. Approximately 600,000 people die every year in the UK, and it is a demographic fact that that number will increase, in turn likely increasing the number of people needing palliative and end of life care. Hospices specifically support more than 300,000 people with life-limiting conditions each year, in addition to providing hugely important bereavement support.

Most hospices are independent charitable organisations that generally receive funding from statutory sources and charitable donations. They are rooted in their local communities and are cherished for the compassionate care that they provide. Indeed, that funding model is one of hospices’ strengths. Although many will receive funding through the NHS, a significant majority of their funding will be raised from their communities. That is part of the strong relationship they have with their communities. That diversity of funding is another strength of the hospice model.

[Richard Foord]

On the sources of funding for end of life care, the Minister talks about it being a split model in which some is provided by the NHS and some provided as charitable donations and charitable giving. The work of Seaton and District Hospital League of Friends is 100% funded by charitable giving. The same is true for the model that Axminster Hospital League of Friends is seeking to set up. With that 100% funding, the Seaton league of friends built a wing of Seaton Hospital, yet it is expected that that will be given back to NHS Property Services. What can the Minister do about that?

[Helen Whately]

The hon. Member raised that question in the Westminster Hall debate I referred to. He is talking about a specific situation. Rather than spending the limited time I have addressing that, I am keen to respond to my hon. Friend the Member for East Devon, who has secured this debate on hospice funding in Devon.

I was talking about the enormous importance of hospices and their role in our communities, and the strengths of having hospices in our communities add to the significance of the care they provide. I mentioned my own experience. Hospices do this thing of making a time that can seem completely unbearable become somehow bearable. That makes a difference not only for the individual cared for by the hospice but for all those around them.

Let me turn to Devon specifically. Devon does reflect the national picture, with NHS palliative and end of life services such as a specialist NHS team, community nursing care and a Marie Curie night care service. I mention that because some people may think of hospices as the sole provider end of life care in any community. The picture is broader than that, but of course hospices are important. Indeed, NHS Devon has grant arrangements with four Devon hospices that operate in-patient beds. In East Devon specifically, patients can receive end of life care in hospital, at home, in a care home, or from Hospiscare or Sidmouth Hospice at Home, to which my hon. Friend referred.

In England, integrated care boards are responsible for the commissioning of end of life and palliative care services to meet the reasonable needs of their local populations. As part of the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission, reflecting the importance of end of life and palliative care in our healthcare system. Adding that will ensure a more consistent national approach and support commissioners in prioritising palliative and end of life care. In July 2022, NHS England published statutory guidance on palliative and end of life care to support commissioners with that duty. That includes specific reference to ensuring that there is sufficient provision of specialist palliative care services, hospice beds and future financial sustainability.

I acknowledge that hospices, like many organisations—and indeed households—are having to contend with financial pressures including rising energy costs. That is why charities including hospices have already benefited from the energy bills discount scheme, which provides a discount on high energy bills and is running until 31 of March 2024. Hospices may also be entitled to a reduction in VAT from 20% to 5%. In addition to that, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflation. ICBs were able to distribute that funding according to local need. It was therefore an option for them to support palliative and end of life care providers, such as NHS contracted hospices, with rising costs from inflation.

I recognise the financial challenges that hospices continue to face and the difficulty there is in raising funds from local communities when people themselves are facing pressures with the cost of living. My hon. Friend made a clear case for the financial support that the hospice in his area deserves. I encourage him to continue to argue that point. It is good to hear that he has been in touch with his local integrated care board, which is the organisation responsible for assessing palliative care needs in his community and ensuring that the need is met.

My hon. Friend is not the first Member to ask to meet me to discuss this topic, or to call a debate on it. I am working to increase the transparency and the information available to colleagues and our constituents, so that they can be assured about the provision of palliative and end of life care. To that end, I have organised a meeting next week with representatives from NHS England, and have invited Members from across the House to attend it, for an update on palliative and end of life care and to ask questions directly of NHS England on this topic.

I have welcomed the opportunity this evening to talk about the wonderful work of hospices not only in Devon but across the country. I assure my hon. Friend and other Members present that I am committed to supporting hospices to continue what they do so well in our communities, and to improving access to palliative and end of life care for people across the country, whether that care is given by a hospice or by the national health service.