Hospice Funding

Sally-Ann Hart Excerpts

Monday 22nd April 2024 Commons Chamber

[Sally-Ann Hart (Hastings and Rye) (Con)]

I beg to move,

That this House has considered the postcode lottery of funding for hospices; and calls on integrated care boards to urgently address the funding for hospice-provided palliative care in their areas.

As a member of all-party parliamentary group for hospice and end of life care, I am very happy to be co-leading this debate with my lovely friend, the hon. Member for Darlington (Peter Gibson), who applied for this debate today.

I have so much admiration for hospice and palliative care providers, and empathy for those experiencing dying, death and bereavement. Both my parents died of cancer, and I will always be grateful for the amazing care that they received. Hospice care is important to so many people and we are very lucky to have St Michael’s Hospice in beautiful Hastings and Rye, and Demelza House, which offers palliative care for children—largely through outreach work.

When my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) was Health and Social Care Secretary, he announced the legal right to palliative care for all ages. This was in an amendment to the Health and Care Act 2022, which declared, for the first time, a duty for integrated care boards in England to commission palliative and end of life care that meets the needs and demographic of the population it serves.

I could not believe that end of life care was not already a legal right. We should all want to see the best support available for those people who are nearing the end of their lives as well as their families, and excellent palliative care—support for people physically, mentally and spiritually—is vital.

[Barry Gardiner (Brent North) (Lab)]

I agree with everything that the hon. Member has just said. I wish to highlight the importance of palliative care for children and the amazing support that some children’s hospices are able to provide not just for the child, but for the entire family. It really is wraparound care, and so important for those parents going through that bereavement process.

[Sally-Ann Hart]

I thank the hon. Member for his intervention, and I could not agree more; he is absolutely right.

[Anna Firth (Southend West) (Con)]

My hon. Friend asks why this support is not funded. In Southend we have the absolutely brilliant Havens hospice, which includes the children’s hospice Little Havens. More than 80% of its funding comes from donations, so it is dependent on sky dives and cycle rides, which is fantastic, but given that we fund, on the NHS, the beginning of life with maternity care, does she not think that we should be funding the end of life?

[Sally-Ann Hart]

I do, and I will be coming to that a little later.

The future of end of life care is uncertain, as increasing costs and demands are putting huge pressures on hospices and care providers. When it comes to the debate on assisted suicide, it is important that people feel confident that their end of life care will protect them from pain and suffering.

Certainly, we need increased funding. More resources are needed for end of life care services, including hospices, home care and palliative care teams. St Michael’s Hospice, for example, costs around £7 million a year to run and it receives about £2 million a year from the integrated care board and the remaining £5 million comes from the community in various forms. Like all hospices, St Michael’s is heavily dependent on the generosity of local individuals, companies, groups and trusts. This funding model is uncertain and unsustainable and places hospices under considerable strain.

[Munira Wilson (Twickenham) (LD)]

I thank the hon. Lady for giving way and congratulate her on this important debate. On the point that the hon. Member for Brent North (Barry Gardiner) made about children’s hospices, I have the fantastic Shooting Star children’s hospice in Hampton in my constituency, which serves a wide catchment area. The hon. Lady mentioned the statutory duty, introduced by the Government, on ICBs to commission and fund palliative care, but the problem is that there is such huge variability. Surrey Heartlands, which is one of the ICBs that Shooting Star serves, spends only a paltry £39 per child, even though the average should be about £151, and other ICBs will not even disclose the amount. Does she agree that we need multi-year contracts with ICBs to serve these hospices?

[Sally-Ann Hart]

I agree, and will come to that later in my speech.

Demelza receives just 10% of its income from the children’s hospice grant, which ends in March 2025, and just 4% of its income from spot purchases, so 86% of its income must come from fundraising. I am concerned that neither the UK Government nor NHS England has set out whether the children’s hospice grant, which is worth £25 million, will continue beyond 2024-25. The grant is a vital source of funding for children’s hospices. Dependence on the generosity of members of the public to pay for vital healthcare would not be tolerated in other core areas of healthcare such as maternity services, cancer care or A&E. Hospices are the only statutory service that relies on fundraising to keep going, despite end of life care being an essential service that so many of us will need.

[Sir Desmond Swayne (New Forest West) (Con)]

What makes hospices so remarkable is their independence. My fear is that the more one demands that they be funded by the state, that independence will be curtailed and questioned. The hon. Member for Twickenham (Munira Wilson) put her finger on the difficulty: the problem is in the difference between the policies of different ICBs. Were they funded centrally by the grants available, as they were during the pandemic, I think it would be much better.

[Sally-Ann Hart]

I agree. It is important to point out that most hospices do not want 100% funding from the Government because they need the flexibility to do what they want. Fundraising is a really important part of the local community effort, bringing people together, but when the dependence on fundraising is so vast we might need to intervene to provide extra funding.

End of life care is an essential service that so many of us will need, but the situation is made worse by inflationary pressures and rising demand. We have an excellent ICB in Sussex—NHS Sussex, led by Adam Doyle—which has highlighted that hospices are recognised as having become increasingly fragile in recent years, due to a lack of resilience in their funding model, which is heavily reliant on gifted income alongside NHS grants.

[Bell Ribeiro-Addy (Streatham) (Lab)]

Royal Trinity Hospice in my constituency supports people across central and south-west London to live and die well. Next year it will cost it £19 million to deliver care for its around 2,500 patients and support for their nearly 1,000 loved ones—a 20% on-year increase. Meanwhile, the NHS funding that it receives will decrease in real terms to 24% of the costs of running its services. Does the hon. Member agree that the Government should commit to maintaining the funding levels that hospices such as Royal Trinity require to ensure that people receive the quality of end of life care and the dignified death that they deserve?

[Sally-Ann Hart]

This is the point of the debate: to work out what sort of funding models we need. ICBs also need to be given the freedom to assess the priorities in their local areas, but I take that on board.

We have eight hospices across Sussex, and in 2019 seven of them formed the Sussex hospice collaborative—partnership working to ensure that the hospices’ combined resources can be used to maximise the impact, reach and cost-effectiveness of their activities. NHS Sussex works closely with that collaborative arrangement, which has supported the ability to have collective conversations. In January, the APPG on hospice and end of life care published a report on Government funding for hospices. The inquiry found that despite the introduction of a legal requirement for integrated care boards to commission palliative and end of life care, ICB commissioning of hospice services is currently not fit for purpose, and the value that hospices provide to individuals in the wider health system is at risk.

Hospice funding has historically not risen in line with inflation, which has been brought starkly to light during the periods of high inflation in recent years. Costs to keep palliative services running have increased rapidly over the past few years, but that is not reflected in the Government funding that hospices receive to deliver the services, which has increased by only 1% each year on average.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The hon. Member is being generous, and making an outstanding speech. I congratulate her on bringing this matter to the House. St Mary’s hospice, St John’s hospice and Eden Valley hospice, which serve the communities of Westmorland, struggle like others to find the funding that they need to keep going. One issue is increased pay settlements in the NHS, which are good, but to compete, and to get and retain staff, they need to raise their pay to keep pace. Does she agree that one model may well be that, rather than devolving this to ICBs, which are not elected and not directly accountable to anybody, the Government fund through the national health service pay rises at NHS pay rates directly to all our hospices, so they at least do not have to worry about that?

[Sally-Ann Hart]

The hon. Gentleman raises a valuable point, which I am sure the Minister will take onboard.

[Bob Seely (Isle of Wight) (Con)]

I am grateful to my hon. Friend for her excellent speech, and for securing this important debate. She comes to the crux of the matter. I am really interested to hear from the Minister, because our Mountbatten Isle of Wight hospice in Newport is much loved, and one of the core institutions on the Island. Its inflation costs in the last two years have been way above what it has been getting from the ICB.

Our ICB is in special measures. We had two meetings with the ICB last week, and it was very unclear about some of its long-term plans and how it is using its funding. Does she agree that we need to ensure that our ICBs are properly managed and run? I am delighted that she has a great ICB. For us, it is a little more complicated. We need to ensure that funding goes through to hospices, so that when there is a state element of funding—one can debate the important nature of fundraising—the NHS money gets through. Right now, it does not seem to be doing so.

[Sally-Ann Hart]

It is unfortunate that your ICB is not very good at all—

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. It is the hon. Gentleman’s ICB, not mine.

[Sally-Ann Hart]

Yes—my hon. Friend’s ICB is not very good. Obviously, leadership structure and a clear list of priorities is essential to deliver what the public need.

The significant funding challenges are particularly concerning in the context of increasing need. Sue Ryder, a palliative and bereavement support charity, projects that the demand for specialist palliative care services in England may rise by 55% over the current decade. That rise in demand is due to several factors, including increased mortality rates and a growing desire by patients to die at home rather than in hospital. We clearly need a commitment from Government to fund a much higher percentage of total palliative care costs than at present to ensure the sustainability of the hospice sector and the vital services that hospices provide in the medium term. ICBs cannot commission specialist services without the funding to do so.

The APPG’s report made a number of recommendations to Government, the NHS and local authorities. On funding, the APPG recommended that the Government produce a national plan to ensure the right funding flows to hospices, and conduct or commission a piece of work to understand the costs of providing different models of palliative and end of life care. It also called for Government funding to address immediate pressures of paying increased staffing costs for hospices, and said that ICBs must ensure uplifts to hospice contracts that are equitable with uplifts received by NHS-run services.

[Jim Shannon (Strangford) (DUP)]

We have a Marie Curie hospice in Belfast that gives excellent care to those who have cancer. Does the hon. Lady agree that, while it is important to have the financial part in place—without it, hospices cannot go on—the faith aspect is important as well? Many people need hospice care on their last journey, ever mindful that their last journey is not in this world; the next world is the one that matters. When it comes to ensuring that moneys are available, does she agree that faith is important as well, and that the faith care that the Marie Curie hospice gives in Belfast is an example of what we all need? Whatever our faith may be—Christianity or another religion—it is important to have something that looks after the hereafter.

[Sally-Ann Hart]

Faith is important for so many people. Even for those without a faith, there is a spiritual aspect that needs to be looked after.

My hon. Friend the Member for Darlington will cover the report in more detail. Hospices need to be able to plan and invest in their services and develop and train specialist staff, so they need to know in advance how much funding they are getting. Hospices already face issues of training and recruitment, and whether they will be able even to provide an adequate service because of funding restraints should not be another worry. My goddaughter is a young doctor who wants to specialise in palliative care, which is remarkable for a young person. We need more young people—more medics, nurses, occupational therapists and so on—in this growing area. A three-year funding cycle at least is required, as it would allow hospices and palliative care providers to plan accordingly.

I conclude my remarks with a worrying Hospice UK statistic: it estimates that the end of life care sector is on track for a £77 million collective deficit for the financial year 2023-24. That would present the worst end of year figures for the sector in around 20 years of tracking. Those losses are not sustainable, and our right to end of life care is at risk unless immediate action is taken. Our hospices, palliative care and end of life services need to be properly funded. Will the Minister outline what steps she is taking to ensure that that happens?

--- Later in debate ---

[Sally-Ann Hart]

I thank the members of the Backbench Business Committee for granting this important debate in this House, as well as all the Members who have spoken today and Hospice UK for their dedicated work and support. I especially thank St Michael’s Hospice and Demelza, their staff and all the volunteers, as well as local people for their donations and fundraising, especially during challenging economic times. I also thank my hon. Friend the Member for Darlington (Peter Gibson) for all his long-standing hard work and advocacy on behalf of hospices and end of life care.

Members from across the House have spoken collectively on this important issue, with a passion and consensus that shows that the funding of hospices and palliative and end of life care is not a political issue. The Government do financially support hospices through ICBs, but funding models also require closer consideration, ensuring parity with the NHS while maintaining hospices’ independence and flexibility. The Minister has heard many similar themes, mainly surrounding certainty of funding, on a sustainable basis, and better collaboration between ICBs, the NHS and hospices. I thank her for her work, her consideration and listening to the debate. Extra Government funding via ICBs can improve a localised approach. We all call for more funding to be included in the spending review.

Question put and agreed to.

Resolved,

That this House has considered the postcode lottery of funding for hospices; and calls on integrated care boards to urgently address the funding for hospice-provided palliative care in their areas.

Business of the House (Today) (No. 2)

Ordered,

That, at this day’s sitting, the Speaker shall not adjourn the House until any Messages from the Lords relating to the Safety of Rwanda (Asylum and Immigration) Bill shall have been received.—(Aaron Bell.)