Healthcare in Rural Areas

Debate between Rupa Huq and Stephen Kinnock

Wednesday 4th March 2026 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Mid Bedfordshire (Blake Stephenson) on securing this vital debate. I am also grateful to other hon. Members for making excellent contributions this afternoon.

We know that the NHS faces pressures all over the country, with rural communities experiencing unique health and wellbeing challenges shaped by geography, demography, infrastructure and access to services. Our 10-year health plan is a commitment to rewire our NHS, with the three shifts to improve access to healthcare for everyone—no matter where you live or how much you earn. Those three shifts—from hospital to community, sickness to prevention and analogue to digital—will support neighbourhood and community health services in getting the investment they need, and will greatly expand and improve access to digital services, bringing healthcare closer to everyone’s home.

The hon. Member focused quite a lot of his speech on our emerging neighbourhood health strategy. I will provide some further detail in response to some of his points. He highlighted the important differences between urban and rural. We recognise that neighbourhood services will need to look different across rural and urban areas to best meet the needs of each community. That is why their delivery will be locally led, with local systems determining how neighbourhood health is designed for their area. That work will start in the areas of greatest need, including rural towns and villages.

The hon. Member and others also asked about the definition of neighbourhoods in rural areas. First, neighbourhoods are natural communities that are recognisable by local residents. Secondly, neighbourhoods will typically have a population of around 50,000 people, but coherent geography is more important for defining neighbourhoods than population size. Thirdly, the geography of the neighbourhood will be determined locally by integrated care boards in partnership with their strategic partners, particularly local authorities.

The hon. Member also asked how rural areas will benefit from neighbourhood health. Neighbourhood health provides the unifying framework that will bring together what is already under way across primary care, community services, urgent care, prevention, digital, estates and population health more broadly. The neighbourhood health service will make it easier for people to access care closer to where they live, including in neighbourhood health centres. Delivery will be locally led, with systems determining how neighbourhood health is designed to meet local population need. That will factor in how services may need to look different across rural and urban areas.

The neighbourhood health service will also move us towards a fully digitally enabled health service. We are striving for digital services to improve access, experiences and outcomes for the widest range of people based on their preferences, as any digital healthcare benefit will be limited if people remain digitally excluded. We are working closely with the Department for Science, Innovation and Technology on the issues raised around improving access to broadband.

To deliver neighbourhood health services, the 10-year health plan introduces two new contracts, including one to create multi-neighbourhood providers covering populations of around 250,000 people. That will unlock the advantages and efficiencies possible from greater-scale working across all GP practices and small neighbourhood providers within the footprint. We will start in the areas of greatest need where healthy life expectancy is lowest, which includes rural towns. By targeting places where healthy life expectancy is lowest, we will deliver healthcare closer to home for those who need it most. Neighbourhood health plans will also be drawn up by local government, the NHS and its partners. The integrated care board will bring those together into a population health improvement plan for its footprint and will use that to inform commissioning decisions.

The medium-term planning framework, covering 2026-27 to 2028-29, sets out proposals for the further use of advice and guidance, asking systems to ensure all referrals go through a single point of access. That delivers a robust approach to triage so that patients are cared for closer to home, and there are fewer out-patient appointments in secondary care. That framework will also require a significant reduction in the number of clinically unnecessary follow-ups.

Turning to general practice, which came up a lot in the debate, we absolutely recognise the challenges facing rural communities in accessing GP services. We are expanding capacity across England, including to the areas that need it most. We are investing over £480 million extra into GP services this year, including investment in the primary care workforce, ensuring places like Mid Bedfordshire get the resources and GPs that they need.

Since October 2024, we have invested £160 million into the additional roles reimbursement scheme, which has supported the recruitment of over 2,000 GPs—smashing our manifesto pledge of 1,000 additional GPs. Furthermore, the introduction of a practice-level GP reimbursement scheme, worth £292 million, will enable practices to hire additional GPs or fund extra sessions with existing GPs. We are also seeing the results of those broad efforts. I am absolutely delighted that patient satisfaction has risen by over 15% since July 2024, from 60% to 75%, and an additional 6.8 million GP appointments have been delivered compared with the same period last year.

We know that patients are struggling to access NHS dentistry services, particularly in rural areas. To address that, we are reforming the dental contract to match resources to need and to improve access. As a first step, our 2026 reforms are focused on improving the dental contract to deliver the right care to the right people, including those in rural areas, while incentivising NHS dentists to provide more NHS care, with additional urgent appointments and new pathways for patients with complex needs. We are also continuing to recruit dentists under the golden hello scheme, which offers dentists £20,000 to work in underserved areas.

Urgent and emergency care is also a challenge for rural areas. We are ensuring that the country gets the care it needs, when it needs it. We launched our urgent and emergency care plan for 2025-26, supported by a substantial £450 million of capital investment. That will enable the upgrade of hundreds of ambulances and the expansion of urgent and emergency care capacity, reducing A&E wait times and getting more ambulances back on the road, more quickly.

Rural adult social care services are really important. Local authorities are responsible for shaping their care markets to meet the diverse needs of local people. However, the Government are also committed to ensuring adult social care funding reflects the costs that different communities face, which is why we have updated the formula used to distribute funding for adult social care to local authorities to include a remoteness adjustment. That means that the funding distribution better reflects the cost of providing care in different parts of the country. To give the local picture in the constituency of the hon. Member for Mid Bedfordshire, between 2025-26 and 2028-29, central Bedfordshire is set to see its notional allocation for adult social care services increase by £11.3 million, which is more than a 7% cash increase above budgeted adult social care spend.

I want to say a quick word on finance. To support remote or sparsely populated areas, the ICB target allocations formula includes an emergency ambulance cost adjustment to reflect longer travel times in sparsely populated areas; a travel time adjustment to the community services formula to reflect the additional time it takes patients to travel between appointments in sparsely populated areas; and an adjustment to support hospitals with 24-hour A&E services that are remote from the wider hospital network and have unavoidably higher costs. Those adjustments help to support rural communities in accessing the health services that they need.

I hope that I have managed to touch on some of the issues raised. It is a wide-ranging topic because rural healthcare, by definition, requires many different services. We absolutely recognise the challenges, and we recognise that we still have a mountain to climb before we can get our NHS back on its feet and fit for the future.

We believe that through the three shifts—from hospital to community, treatment to prevention and analogue to digital—and the strategies that we are pushing through on workforce, digital, better support for general practice, and neighbourhood health, we can get our NHS back on its feet and fit for the future. Once again, I thank all hon. Members present and I congratulate the hon. Member for Mid Bedfordshire on securing this debate.

[Dr Rupa Huq (in the Chair)]

I call Blake Stephenson to wind up in 20 seconds.

Palliative Care: North Derbyshire

Debate between Rupa Huq and Stephen Kinnock

Wednesday 17th December 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a real pleasure to serve under your chairship, Dr Huq, and I really thank my hon. Friend the Member for Chesterfield (Mr Perkins) for raising this important issue.

This year, I have seen at first hand—at the Wigan and Leigh hospice, the Noah’s Ark Children’s hospice in Barnet, and Katherine House hospice in Staffordshire—the vital role that hospices play in our communities, so I completely understand why my hon. Friend speaks so passionately about Ashgate hospice. And I will take a moment to thank everyone working or volunteering in the hospice care sector over Christmas, especially those who are spending Christmas day away from their own families just to bring a bit of joy to the people they care for.

This Government want a society where every person receives high-quality and compassionate care, from diagnosis through to the end of life. Hospices and wider palliative and end-of-life care services will play a key part in our efforts to shift more care out of hospitals and into the community. However, we inherited a palliative and end-of-life care system that is under pressure and we absolutely recognise the financial challenges that hospices face as a result of rising costs and reduced charitable income.

Let me echo what my hon. Friend said by also commending his constituents who came together to put their time, effort and money into fundraising. The fact that they managed to save two beds at Ashgate hospice from closing shows how important the hospice is to the wider community, even if challenges clearly remain.

Most hospices are charitable and independent organisations that receive some statutory funding for providing NHS services. The amount of funding that charitable hospices receive varies, both within and between ICB areas. Such variation can often be explained by the level of demand in a particular area, but it can also be explained by the totality and the type of provision from both NHS services and non-NHS services, including charitable hospices, within each ICB area.

Although the majority of palliative and end-of-life care is provided by NHS staff and services, of course voluntary sector organisations also play a vital part in supporting people at the end of their life. That is why a year ago, almost to the day, we announced a £100 million capital funding boost for adult hospices and children’s hospices, in order to ensure that they have the best physical environment in which to provide care.

Ashgate hospice is receiving over £845,000 of that money over the two years of funding and Blythe House hospice, another hospice in north Derbyshire, is receiving just under £160,000. All of this capital funding is a once in a generation investment into hospices in England, which will guarantee future savings by making them more sustainable, including by fixing draughty windows, repairing old boilers, installing solar panels, fixing roofs, etc.

We are also providing £26 million in revenue funding to support children and young people’s hospices that serve north Derbyshire. This year, Bluebell Wood children’s hospice is receiving £986,000, and Rainbows hospice for children and young people is receiving £1,462,000. Our priority was to protect children’s hospices from facing a cliff edge of yearly funding cycles through multi-year settlements, so we were delighted to confirm that this funding would be in place for the next three financial years. This money will be at least £26 million each year, adjusted for inflation, allocated via ICBs to children’s hospices in England, or around £80 million over the three years in total.

Having said all that, I do not for one second want to give the impression that I am downplaying the issues that my hon. Friend the Member for Chesterfield has raised, nor do I believe that this money is a silver bullet for all the issues we face. As he points out, integrated care boards are responsible for the commissioning of palliative care services to meet the needs of the people they serve. My understanding is that what NHS Derby and Derbyshire ICB calls its core contract value—the baseline funding in the contract with Ashgate hospice—has increased by 55% since 2022, which represents a higher share compared with uplifts the ICB has provided for other NHS services through its hospital trusts and other providers.

I am aware that the ICB has been working with the Ashgate team over several months to understand why their costs have risen significantly over the last financial year. It has also offered £100,000 towards an independent review, which would be linked to a future service specification—in other words, the way in which the ICB provides funding to the hospice in future. Derby and Derbyshire ICB has committed to develop a new service specification for palliative and end-of-life care to inform its contracting going into 2026-27, and to engage on a new model of palliative and end-of-life care across the ICB cluster, aligning to the three shifts set out in the 10-year plan and delivered through the neighbourhood health model of delivery.

However, it is clear from my hon. Friend’s speech that there are two sides to this story. It appears that there is a gulf in understanding between the ICB on the one hand and the management team of Ashgate and the community on the other—that is clear from everything my hon. Friend has said and from other interventions. I would therefore be more than happy to broker a discussion between the ICB, concerned Members of Parliament and the hospice to get to the bottom of what is going on, so that everyone is on the same page as to what is happening with the costs, where the problems lie in terms of provision and ensuring we do everything we can to retain this vital service. It feels like the dialogue between the ICB and the management team at the hospice is not working, and I am more than happy to intervene, to help to make that work. Perhaps I could sit down and discuss that further with my hon. Friend and other colleagues.

As I said earlier, the delivery of healthcare is largely devolved in England, and ICBs are responsible for the commissioning of palliative care services to meet the needs of local people. Beyond the £100 million of capital funding and the £80 million of revenue funding for children’s hospices, we are not able to offer additional funding from the centre as things stand, although we are looking at and exploring other opportunities. As I told the sector in a speech to the Hospice UK conference in Liverpool last month, I know that this is not the message the sector wants to hear, and it is certainly not the message that I want to deliver. But with the public finances in the state they are in—the state that we inherited them in—I have to recognise that the Chancellor has made some tough trade-offs to support our public services, especially the NHS, in the context of our debt interest payments surpassing the entirety of our education budget as things stand.

In these challenging circumstances, we are trying to support the sector in other ways. We are developing the first ever palliative care and end-of-life care modern service framework, or MSF, for England. That will be aligned with the ambitions set out in our 10-year health plan. We will closely monitor the shift towards strategic commissioning of palliative and end-of-life care services to ensure that services start bringing down variation in access and quality. While there is a lot of diversity in contracting models across the hospice sector, we will consider contracting and commissioning arrangements as part of this framework. In the long term, this will aid sustainability and help hospices to plan ahead.

The MSF will not just drive improvements to services that patients receive at the end of life; it will start helping ICBs to address challenges and variation in access, quality and sustainability. Further support is being provided to ICBs through the recent publication of NHS England’s strategic commissioning framework and medium-term planning guidance, which set out in black and white how ICBs should understand current and projected demand on services and associated costs, creating an overall plan to more effectively meet these needs through neighbourhood health. The medium-term planning guidance acknowledges the importance of high-quality palliative and end-of-life care. The guidance makes it clear that, from April next year, ICBs and providers must focus on reducing unnecessary non-elective admissions and bed days from high-priority cohorts—which include, importantly, people with palliative care and end-of-life care needs—and on enabling patients who require planned care to receive specialised support closer to home. That will be at the heart of the neighbourhood health service that we look to build. It is important to emphasise that the cohort of people who are reaching the end of life is a prioritised cohort within the framework of the shift to a neighbourhood health model.

I hope that those measures will reassure my hon. Friend the Member for Chesterfield of this Government’s commitment to the sustainability of the palliative and end-of-life care sector, including hospices such as Ashgate hospice. We will continue to work with NHS England in supporting ICBs to effectively commission the palliative and end-of-life care that is needed by their local populations. The work that our hospices do to support people in the sunset of their lives, to support families in their grief and to give such families bereavement counselling at their most vulnerable moments is utterly priceless. It is a sad reflection of the dire fiscal position that we inherited and the dire state of our public services in general that we cannot give more than the extra support that I have outlined, but we are doing everything that we can to support the sustainability of the sector in the long term while tackling inequalities and unwarranted variation in the quality and quantity of service provision.

To sum up, strategic commissioning of palliative and end-of-life care services is not working anything like as well as we want, frankly, across the country. It is clear that where there are gaps in an ICB’s understanding of the totality of the health and care needs of its population and in the capacity of partners and stakeholders in its ICB area to meet those needs, that process is not working as well as it needs to. That is what the modern service framework for palliative and end-of-life care seeks to address. We do not have many MSFs—we have commissioned, I think, three or four in total across the entirety of what the Department of Health and Social Care is doing—so that MSF reflects the importance that we attach to palliative and end-of-life care.

In the medium-term planning guidance, we have also emphasised that the palliative and end-of-life care cohort will be a top priority for our neighbourhood health strategy and the shift from hospital to community. That is what is happening at the strategic level, but I understand that at the constituency level, it also matters what is really happening for the community of my hon. Friend the Member for Chesterfield and the worrying issues around Ashgate hospice. On the detail of what is going on there, I would be very happy to work with him to see what we can do with the ICB and other key players and stakeholders to address the specifics of that issue. There is a strategic challenge, but also an opportunity, for us and a more specific issue on which I would be happy to work with him. Dr Huq, I am happy to give the floor back to my hon. Friend for any closing remarks he wishes to make.

[Dr Rupa Huq (in the Chair)]

This is a 30-minute debate so, as I said in the preamble, a wind-up speech is prohibited, but the two of you can confer after the debate.

[Stephen Kinnock]

Oh, okay. Does my hon. Friend wish to intervene?

European Free Trade Association

Debate between Rupa Huq and Stephen Kinnock

Wednesday 7th February 2018 Westminster Hall

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

As a fellow London MP, I am sure the hon. Gentleman receives numerous representations from constituents on EU citizens and financial passporting rights. Those people probably think the best course of action would be not to leave at all. Since that is not realistic, will he do all he can to exert pressure on the high command of his party and his namesake the Chancellor—sadly, he is not in the high command anymore—to ensure we have a pragmatic, not a purist Brexit? That way, if the arrangements are ready-made, some of the bumps can be avoided.

[Stephen Kinnock (Aberavon) (Lab)]

rose—

Palestinian Communities: Israeli Demolitions

Debate between Rupa Huq and Stephen Kinnock

Wednesday 6th December 2017 Westminster Hall

[Stephen Kinnock]

I agree that many of the things that my hon. Friend listed have taken place, but the fact remains that there has been a land, sea and air-based blockade of the Gaza strip throughout that entire period. Gaza is now described as the largest open-air prison in the world, and the UN has declared that it will be unliveable by 2020, so there is a humanitarian crisis that has to be resolved, and it is in the gift of the Israeli Government to take that forward.

I have described the harsh reality of the facts on the ground. I met the commissioner-general of the United Nations Relief and Works Agency yesterday, and his message to the international community was clear: conflict management is not enough, and we must do more to support an actual resolution to the conflict. I agree that we cannot continue with a wait-and-see approach. Where has that got us over the last 50 years, 25 years or the 10 years of the Gaza blockade? We are where we are because of choices that have been made—choices on both sides of the conflict. Foremost among them has been the active choice to continue the expansion of illegal settlements on Palestinian territory and the forcible transfer of Palestinian families and communities from their homes. Both those policies have created a coercive environment that seeks to undermine the ability of Palestinians to continue living where they are. They are at great risk of forcible transfer, which is a clear violation of the fourth Geneva convention.

Just over a month ago, a UN report found that Israel’s role as an occupying power in the Palestinian Territories has

“crossed a red line into illegality”.

International law is clear. An occupying power cannot treat occupied territory as its own or make claims of sovereignty. Occupation must be temporary, and the power must act in good faith and in the best interests of the protected or occupied population. However—these are the findings of the UN and its special rapporteur—that has been the repeated pattern of behaviour of successive Israeli Governments over the 50 years of the occupation.

A central plank of the occupation and spread of settlements has been the demolitions. It is estimated that almost 50,000 Palestinian structures have been demolished since 1967, with 1,500 homes demolished in Rafah alone between 2000 and 2004. That is despite warnings in 1968 from Theodor Meron, later the president of the International Criminal Tribunal for the Former Yugoslavia, that the demolitions, even on security grounds, broke international law and the fourth Geneva convention. Article 53 of that convention prohibits the destruction of private property by an occupying power, and it is unequivocal, so how do the Israeli Government respond? They respond not by denying the substance of the claims of demolition, but by claiming that Palestine is not a party to the Geneva convention because it is not a state. Astonishing! Stepping beyond the fact that the policies of the Israeli Government are the main obstacle to Palestinian statehood, that is an utterly specious argument, because a basic and fundamental principle of human rights law is that international human rights treaties apply in all areas in which a state exercises “effective control”, and the occupation clearly constitutes such control.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend mentioned the UN report and international structures. Is he aware of the EU report from March of this year that condemns the fact that, over six months, €311,692-worth of EU aid structures have also been demolished? I think that last year it was 182 structures. These are meant to be for humanitarian projects. The EU has condemned the destruction of its structures, and eight countries are putting together an approach to recover the moneys. That is seen as a very blunt diplomatic move, but desperate times possibly call for desperate measures.

[Stephen Kinnock]

I thank my hon. Friend. We have talked about all sides losing out from what is happening on the ground, and clearly Israel is not doing itself any favours with the international community when it is destroying structures that have been built with European Union aid money.

Clearly, Palestine is treated as an exception to the laws to which I was referring. Currently, 46 Bedouin communities are at risk of forcible transfer in Area C of the west bank. Why? For the implementation of Israel’s controversial and outright illegal E1 plan, which would allow Israel to connect its mega-settlements from north to south, in effect splitting the west bank in two and cutting off Jerusalem from any further Palestinian state.

I visited one of the communities during my last visit to the region with Caabu. The residents of Khan al-Ahmar told us how they lived under constant fear and threat of forcible transfer, not knowing when the bulldozers might arrive and raze their homes and school to the ground. A huge campaign is under way in the occupied territories right now to protect the school—the only one for miles—from demolition. While we were there, we were told how the children’s swings in the playground were uprooted because they violated Israeli planning laws. According to reports, there are at present more than 50 schools in the west bank with demolition or stop-work orders.

In August, on the eve of the new school year, the Israeli authorities requisitioned nine education-related structures in Area C and demolished a newly established kindergarten in the Bedouin community of Jabal al-Baba.