Hospice Funding

Marie Rimmer Excerpts

Monday 22nd April 2024 Commons Chamber

[Mrs Hamilton]

I absolutely agree with what my hon. Friend says. We absolutely need those models. As I go through my speech, I will be agreeing with what she has just said.

John Taylor Hospice in my constituency, which is run by Birmingham Hospice, does unbelievably important work to support my constituents and their families in Erdington, Kingstanding and Castle Vale. The staff work day and night to make sure people are cared for while they are ill, and I could not be prouder to support them in this Chamber today. I must add that I have worked there in the past. Birmingham Hospice cares for almost 1,000 local people with a life-limiting illness every day. Last year, it cost more than £16 million to run its services, some 40% of which needs to be recovered through fundraising income. Over the past few years, the hospice has seen a significant increase in costs, including the price of energy, food and vital medicines, and a shortfall in funding for staff pay awards. At the same time, fundraising has declined across the hospice sector with the cost of living crisis hitting poorer areas like mine the hardest.

Birmingham Hospice is currently losing £200,000 a month. With inflationary costs and falling voluntary income, the only option to keep the hospice going is to reduce the services it provides. A reduced service will increase inequality across our city of Birmingham and the country. Sadly, more people will die in hospital or A&E as a result, when they could have had outstanding care at the hospice or at home with the support of the community team.

The hospice is dedicated to ensuring that outstanding care at the end of life is available to all, but it has recently been in the difficult position of having to make essential staff redundant to maintain financial security. That is not just happening in Birmingham; nationally, Hospice UK estimates that 100,000 people in the UK who could benefit from palliative care die without receiving it each year. Hospices play a huge role in alleviating pressure on our NHS, and they do not have the ability to reset their budgets on 1 April each year, as the NHS does. Instead, their deficits continue and the valuable care that they provide to local communities such as mine is at risk of being lost. I have worked in the health service all my adult life. When we speak about hospices, we rarely mention the vital role that they play in providing respite care and support to the family of someone who is ill.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

I thank my hon. Friend for her wonderful contribution to the debate. Many people want to stay at home—I have stayed with four people right through to their deaths at home—but hospices give a different care from hospitals. If you go into hospital, you might not get into the hospice. We have 10 beds in the most beautiful hospice, which is funded 71% from fundraising. If they are not in a hospice, and they do not have care at home—not everybody can do it at home; they might not have the family to provide the care they need—they can end up in a hospital for hours. Does my hon. Friend find that in her area? They can get triaged in an ambulance outside the hospital, and they do not get the palliative care and support, and their families do not get support—it is a completely different service. Do you agree that we should be looking for more hospice care, not less, but we should not be changing it to a hospital ward? It is a different atmosphere in a hospice. Do you find that is the case? That is not decrying hospitals, but hospital is not somewhere to die.

[Mrs Hamilton]

I absolutely agree with your sentiments and statement. As was said earlier, we need to move away from looking at individuals to look at population health and how we will support the local community. I will move on swiftly so that I can finish.

My constituency is the fifth poorest in the UK, and our communities are in some of the UK’s so-called left behind neighbourhoods. For places like mine, respite care is so important to ensure that carers get the break and support they need to keep them doing the incredible work that they do.

I am a nurse, and it breaks my heart that the NHS is in the worst state it has ever been in. Throughout the 14 years of this Tory Government, I have seen doctors striking, nurses striking, technicians striking, people queuing around the block for a GP appointment, people pulling out their own teeth, the highest waiting times in history, and complete disdain for the service that quite literally serves us from birth to death. We must have a national care service and we must properly invest in our NHS. It is no longer acceptable for hospices to rely on charitable donations to try to survive. Now more than ever, our hospices and our NHS need a Labour Government.

--- Later in debate ---

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

I congratulate everyone who has spoken in the debate. The House has come together to highlight something that I am struggling with: when people are at their most vulnerable, they are having to beg for money to fund important services. That should not be the case, yet here we are with an NHS that is clearly not functioning and other services are also feeling the pain. The reorganisation of the NHS devolved powers to ICBs, but we must remember that it is the responsibility of the Government to ensure that the structures function. That is not happening at the moment, and our constituents are losing out. A word that keeps echoing in my mind, rolling off our lips as it always does, is the NHS: the “national” health service. Yet we are hearing about a postcode lottery, where different areas have different experiences, with different ICBs funding to different tunes and where you live accounts for how you die. Surely, we are better than that? In the words of one clinician about the extraordinary provision at St Leonard’s Hospice in York:

“Having worked with people at the end of life through my career, I didn’t know care like that was possible.”

However, as with all hospices, if funding is not addressed, such care will not be possible.

It was this Parliament that inferred the duty, through the Health and Care Act 2022, to address the inequality in access to palliative and end of life care, so that everyone can have the best clinical and holistic support possible, if the right funding is stabilised and put in place. Currently, however, we know that many people—Hospice UK says one in four—are not accessing palliative care. That is 150,000 people every year who die without the support they require. That number is set to rise 25% by 2048 and, according to Marie Curie, by 13% in the next decade. This debate cannot just be about what happens now, but what happens in the future.

In York, the hospice ran an £800,000 deficit last year. The hospice at home funding has remained static for the past seven years, while demand has doubled and the ICB has provided just a 1.2% increase. Sue Ryder believes that the real cost increase over the past year was 10%. Hospice UK figures released say there has been an 11% increase for the payroll this year to around £130 million. Martin House, the local children’s hospice, costs £9.9 million to run. With a total income of £8.6 million, it had a £1.3 million deficit. Only 18% of its funding came from the statutory sources, £1.1 million came from the national children’s hospice grant and £700,000 came from the ICB. Hospice UK estimates a £77 million deficit for the financial year just past—the worst for 20 years.

As demand and costs are rising, the funding is not rising to match. As of 12 April 2024, St Leonard’s hospice in York did not know how much money it was getting from the ICB: left to carry all the risk and left to depend on its reserves, and that, of course, not guaranteed for the future. Martin House, which is also using its reserves to expand its services, knows that it will have only six months of reserves. It certainly does not know what is happening with its funding after this financial year.

The children’s sector, yes, has received a grant, but what comes next? We cannot just run our hospices by running marathons and running charity shops. It is driving inequality. In areas of greater deprivation, fundraising is even harder and therefore the hospices are getting even less money.

[Ms Rimmer]

I thank my hon. Friend for giving way and I thank the hon. Member for Hastings and Rye (Sally-Ann Hart) for securing the debate. It has been a wonderful and sincere debate, but does my hon. Friend agree that there should be more equality between care at home—hospice at home—and care at the hospice? There is no doubt that there is nothing better than care in a hospice—absolutely no doubt. I have nursed four members of my family at end of life, and getting clinical support at home when it was needed was always a problem—my brother had to search for morphine at night. Does she agree that staff are funded even less and are on the minimum wage?

[Rachael Maskell]

I am really grateful to my hon. Friend for raising those points and I will come on to the issue of hospice at home. We know it is absolutely vital that people can choose where they die. Not everyone wants to die in a clinical setting—indeed, a hospice is barely a clinical setting—but many choose to die at home and they should be able to receive the care they need. She is right. We must have integration with the rest of the NHS. A district nurse may not be able to push palliative care to the extent that a palliative care specialist would in providing pain relief and the support somebody needs at the end of life at home. We need it to be timely and we need to ensure it is fully funded. The Health and Social Care Committee found that when it visited Royal Trinity hospice, as part its assisted dying inquiry. The point was made that we need to ensure we have the training so that clinicians have the competencies and the confidence to administer the pain relief and the palliative care that is necessary, and to ensure that the service is available universally. It is not and that must be addressed.

In York, of the 1,000 people who benefited from St Leonard’s hospice last year, 50% received hospice care at home. That number will grow over time and we need to ensure those services are there as they are needed. Of course, we know that if people are not on that pathway they end up in the acute service. They are put through the trauma of A&E, costing the NHS goodness knows how much, and then they do not get the care they need. Trinity Hospice talked about what it was doing to divert people away from that pathway and into proper care, either at home or within its wider services. There is much still to secure on that front.

If I may, Mr Deputy Speaker, I will raise just one more major point before I close, which relates to inequality. We know there is real inequality at the end of people’s lives. Some of it is based along socioeconomic lines, and some of it is emphasised within minority communities. We need to deal with that to ensure we have universal provision, address the death literacy of our nation, and ensure the support is there when it is needed. I am particularly concerned about the lack of comprehensive funding for our palliative care services.

I urge the Minister to look at funding staffing costs, which are 69% of all funding. It has been suggested by Marie Curie that 70% of funding come from the state, and I think that is about right. We can phase that in, but we need to ensure we address the inequality that is driven through the system. We need to put in the research that is needed, so there is better data on who is accessing care and who is not, and we need to ensure that we are pushing palliative care as far as we can. If we do not, and we debate assisted dying, I am worried that people will be fearful that they will not be able to access the care that could be possible should that service be properly funded. I really urge the Minister to make that a priority before that debate takes place. Mr Deputy Speaker, I will end on that point.