Hospice Sector: Fiscal Support and Cost of Living

Thursday 2nd March 2023 Westminster Hall

13:30

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I beg to move,

That this House has considered fiscal support to the hospice sector and increases in the cost of living.

I am delighted to have secured this debate on fiscal support for hospices and the hospice sector. Hospices across the UK care for some of the most vulnerable people in society and their families. I commend all the healthcare professionals and support staff, as well as the volunteers, who work in our hospices, such as Ayrshire Hospice. Ayrshire Hospice operates a number of charity shops, including two in my constituency in Largs and Kilwinning. We owe a debt of gratitude to all those who work in and for our hospices for the care they provide to our loved ones.

Some 300,000 people across the UK are cared for in hospices in their final weeks and days. Importantly, the families of those in the final stages of their life also receive vital support from hospices. I know this debate matters to Members across the House, and I want to congratulate the all-party parliamentary group on hospice and end of life care on its work. I also congratulate its co-chair, the hon. Member for Darlington (Peter Gibson), who wanted to be here but was unable to be. Last night, the all-party group launched a report on the impact of covid-19 on dying, death and bereavement. The report makes for quite harrowing reading, and I hope the Government will act on its recommendations. The report, launched by the hon. Gentleman, coincides timeously with this debate. I want to thank Hospice UK and Marie Curie for the excellent briefings they have provided to help inform today’s proceedings.

Since I was first elected in 2015, I have done as much as I can to highlight the challenges of bereavement and bereavement-related issues. Part of that conversation, of course, is hospices, which provide specialised care for terminally ill people, palliative care and incalculable levels of support for those watching their loved one pass away without suffering or pain—thanks, in great part, to the work of hospice staff. That is important because bereavement is debilitating in so many ways, and how a loved one dies affects how we grieve and the nature of that grief. We know that profound and persistent grief—complex grief disorder—can easily derail the lives of the bereaved and the wider family unit, because how a person dies is unfortunately very much part of how we remember them.

End of life care impacts not just the patient, but all their loved ones. The specialised support of compassionate palliative care cannot be easily replicated in a hospital setting. That is why hospices exist and why this debate matters. The need for hospice services is greater now than ever. More and more people have been developing serious illnesses since screening for diseases was badly disrupted during the pandemic, and many patients and families have subsequently found themselves referred for hospice care. The need for hospice care and palliative care is expected to increase over the coming years. Hospice UK is deeply concerned that the sector will simply and increasingly be unable to cope with that demand.

More generally, hospices are woven into the very fabric of bereavement services across the UK, and it is truly horrifying that they are facing an existential crisis. The reasons for that existential crisis are easy to understand. Hospices across the UK are facing up to fivefold increases in their energy costs. For some sectors, rationing and reducing energy consumption may be an option, but for hospices it is clearly not. They need to keep medical equipment running, and those in their care need to be in appropriately heated environments.

Frankly, no one can understand why, as of 1 April, hospices will be eligible for the same level of reduced support as other sectors under the new energy bills discount scheme—the same level of support as offered to pubs and restaurants. No one wishes to diminish the important role of pubs and restaurants, which are important parts of our community infrastructure, but we can hardly compare the services provided by a hospice to those provided by a pub. There is no equivalence, and for them to be eligible for the same level of energy support is, quite frankly, bewildering.

Moreover, hospices cannot pass on increased costs to customers. That is simply not an option for them, but it is always an option, at least to some extent, for private business. The reduced level of energy support that will come into effect on 1 April is so inadequate for hospices as to threaten their very existence. It cannot be the Government’s intention to leave hospices so exposed during the cost of living crisis that they simply cannot continue to operate. I hope that the Minister will listen carefully to the concerns that I and other participants in the debate will raise, and that this important matter will be addressed in the upcoming Budget.

At this juncture, let me quote the chief executive of Sue Ryder, who has thrown the challenges our hospices face into stark relief. Heidi Travis said:

“I think it will come as a surprise to many that their local hospice is reliant on the generosity of members of the public who choose to donate or fundraise.

Put plainly, in order to pay the salaries of our doctors and nurses who provide expert care, pain and symptom management to people at the end of their lives, we rely on people buying second-hand clothes from our charity shops or running a marathon and asking their friends and family for sponsorship. It is unfathomable that such a critical part of our healthcare system is hanging by a thread.”

That is a stark assessment of the challenges that hospices are dealing with. Charity shops are an important part of fundraising that I am sure we all try to support. There is no disputing, however, that Heidi Travis makes an important point. The way hospices are funded would be unacceptable in any other area of healthcare. Imagine, for example, if maternity services relied on second-hand jean sales to fund care. There would rightfully be uproar. Yet to care for dying people, hospices must rely on increasingly fragile sources of income at a time when their costs are soaring. NHS services have their energy bills paid for by the Government, but hospices are—uniquely, among providers of essential care—unreasonably expected to absorb astronomical and eye-watering energy costs so that they can continue to carry out the important work they do.

It is vital to remember that hospices receive only about 30% of their funding from statutory sources—in Scotland the figure is 40%. That is simply too low, and it is despite the fact that they are a critical part of our health and care system, play a role in reducing pressure on our NHS, and provide support and training for health and care workers. On average, two thirds of adult hospice income and four fifths of children’s hospice income is raised through fundraising. At best, that is an uncertain funding model, and as the cost of living bites deeper into household income, our communities’ ability to provide even that charitable support is diminished.

Hospices also need to keep pace with NHS pay rises. They spend 71% of their expenditure on staff, and as pay rates understandably rise to keep up with inflation, they have to fund the spiralling costs. The Scottish Government provided an additional £16.9 million to hospices during the pandemic, and have committed to ensuring that any and all consequential funding for them will be allocated to the sector in full. However, hospices desperately need to know that from 1 April—a few short weeks away—the Chancellor will deliver support for hospices in the spring statement to ensure they can continue to deliver their essential services every single day of every single year.

The services that our hospices provide cannot be valued simply in pounds, shillings and pence. They provide a peaceful and painless passing to our terminally ill loved ones, and we all agree that we cannot put a price on that. They need help to pay their costs, not least their energy costs, beyond the offer in the energy bills support scheme. The Government need a more comprehensive understanding and appreciation of the vital work they do, and must provide support to develop a more sustainable, secure funding model across the board. If we do not properly support and value our hospices, we are in danger of losing them. The situation is astonishingly stark.

Let us hope that the spring Budget will deliver a more sustainable, long-term, secure funding model for our hospices, because that is becoming increasingly urgent. If we can secure that, everyone across the UK, regardless of where their lives happen to end, will be able to access the best possible end-of-life care. I ask the Minister: who would want anything less for their loved one? I hope that, when he has heard hon. Members’ arguments, he will provide some hope and assurance to our beleaguered hospice sector.

13:42

[Bambos Charalambous (Enfield, Southgate) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this timely and important debate.

The work of hospices is incredible. I am lucky that North London Hospice has a facility in my constituency, as well as others in north London. The support it provides is absolutely essential, not just to people at the end of their lives, but to their family and friends. In my constituency, we have a wellbeing centre that provides therapies and counselling. We also have something called a death café, where people can talk about end of life. I was very lucky to know a constituent, Joy Watkins, who has sadly passed away now. She said that going to the death café enabled her to make choices about the end of her life. She could make choices about who to spend time with and about the finances that she would make use of at the end of her life. It transformed the way in which she handled the end of her life. The work of hospices is clearly incredible, and we need to celebrate it.

Hospices are very much part of the community. As the hon. Lady said, they rely on fundraising for much of their support. The statutory support from the clinical commissioning groups can range from 1% to 50%, and the rest of it has to be found through fundraising. Marie Curie said in its briefing that as much as 80% of hospices’ finances come from fundraising efforts such as marathon runs.

I do not know whether many people read in yesterday’s newspapers that a 13-year-old boy, Max Woosey, has raised over £700,000 for his hospice in north Devon by camping outside in a tent for three years. People make those superhuman efforts because they care so much about the services provided by hospices.

As has been the case for many charities, hospices have been hit by the cost of living crisis. People are tightening their belts because they are struggling to make ends meet, which has an impact on the amount of money raised by charities. It hits them hard because there is less money to go around, so they have to make savings. Hospices are different from most charities, however, because they have no choice about the support they provide. People are there to receive end-of-life care, and hospices have to meet their energy costs to provide that care. They also have to provide support through the specially trained hospice staff who assist people at the end of life. Clearly, hospices do not have any choice about whether they spend their money on energy bills, so they are in desperate need of support.

In my constituency, North London Hospice now faces an energy bill of more than £460,000 in 2023-24—an increase of £280,000. That is a huge amount of money, and it is more that can be bridged by any additional fundraising efforts. Although the energy bills discount scheme is welcome, it needs to be extended because, as I mentioned earlier, hospices do not have any other means of finding extra money. Fundraising is already very tight for hospices, so we need to make sure that we ask the Government for this funding. The Budget is only a couple of weeks away, and I hope that the Chancellor listens to our request.

There is also a wider argument, which I am not proposing to make today, about the funding for hospices generally. The service they provide should not just be a voluntary service that is topped up by whatever fundraising available. Hospices actually help the NHS by providing additional assistance. There should not be a postcode lottery whereby clinical commissioning groups choose to give hospices funding according to how they are prioritised in their areas. We need to look at the funding model for hospices.

Today, however, we are asking, in these very unusual and extreme circumstances, for the Chancellor to find additional money to support hospices, because it is some of our most vulnerable people who need their support. They are literally at the end of their lives, and hospices have no other way to receive funding. I urge the Minister—though it may not be up to him; it may be down to the Chancellor—to find the additional funding.

Before I close, I thank Hospice UK and Marie Curie for the excellent briefings they have provided for today’s debate. It is a shame that more Members are not present. I know that if the debate had taken place at another time, it would have been very well attended. I will leave it there, and I look forward to hearing from the Minister. I may have to leave before the end of the debate, so I apologise for that in advance, Mr Paisley.

13:48

[Munira Wilson (Twickenham) (LD)]

I confess that I had planned to make a couple of interventions, as opposed to a speech, but given that more hon. Members could not be present, I will try to add a bit more to what I was going to say. Forgive me if I am a little rusty and not very well prepared.

I thank the hon. Member for North Ayrshire and Arran (Patricia Gibson) for securing this really important debate. I have a particular interest in children’s hospices, because there happens to be a Shooting Star children’s hospice in Hampton, in my constituency. It is a much-loved institution in the area that serves children not just from my constituency, but from right across London and Surrey, and well beyond. It looks after children with life-limiting conditions and those who, sadly, have terminal conditions, and it provides respite care as well as ongoing care, particularly at the end of life. The hospice is therefore highly valued by the families it has served, and they were keen for me to make representations to Ministers.

I am fond of the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), but I am disappointed that there is not a Treasury Minister present, given that the debate is about fiscal support for the hospice sector and hon. Members will be largely talking about funding streams. I know it is the job of the Department of Health and Social Care to advocate for them, but at the end of day it is a Treasury decision. We therefore call on the Chancellor and his Ministers to think about funding for hospices.

Demand has been rising, particularly in the children’s hospice sector; it rose about 40% between 2009-10 and 2017-18. At the same time, as we have heard, costs, including staff costs, are rising across the sector. From visiting Shooting Star, I know hospices are constantly trying to compete with the NHS and the rest of the social care sector, which are increasingly going after the same staff. The staff shortages across the sector are well documented. The hon. Member for North Ayrshire and Arran mentioned energy costs, but I will give a specific example from Shooting Star. It is paying £90,000 per year in energy costs. That is predicted to skyrocket to £230,000 per year by the end of September 2023—about two and a half times the current spend. That £140,000 increase is equal to the cost of covering the hospice’s family support line for three years, or the salary of three nurses.

As the hon. Member laid out, hospices have not been classified as an energy-intensive industry, whereas many other places—including even botanical gardens, I think—have been. Hospices are therefore not getting the additional support, yet supporting care for those with very serious conditions is an energy-intensive task. Hon. Members who have visited hospices will have seen the paraphernalia and the equipment, and children and their families also have to be kept warm. It is absurd. I plead with the Minister to make strong representations to his colleagues in the Treasury to ensure hospices are reclassified as energy intensive. Earlier this week in departmental questions, my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) asked the Secretary of State for Energy Security and Net Zero to consider a specific fund to support hospices with their energy costs. The Secretary of State said he would look at those concerns. I therefore task the Minister with speaking to both the Secretary of State and colleagues at the Treasury to see what can be done to support Shooting Star and many other hospices.

We have heard that food and other supply costs are rising, which brings me to funding streams. We know that hospices are heavily reliant on fundraising, and in recent years, children’s hospices have been receiving a children’s hospice grant from NHS England, which they are grateful for. In 2023-24, that funding is due to rise to £25 million. I recognise and welcome that, and I thank the Department of Health and Social Care for making the grant available. However—and this is an important “however”—beyond 2023-24, there is no guarantee that that funding will continue. The grant represents about £1 in every £6 that children’s hospices spend. Another important point is there is no commitment that NHS England will continue to deliver it as a ringfenced grant. If it is not directly distributed to children’s hospices as a ringfenced grant from NHS England centrally, but is instead devolved down to integrated care boards, some of which are already projecting deficits, there is concern that the grant may go to plug black holes in ICB budgets. When the Minister rises to speak, will he first give some sort of commitment on funding continuing between 2023 and 2024? Clearly the quantum cannot be specified while discussions are ongoing with the Treasury, but will he give some reassurance to the children’s hospice sector that that money will continue beyond 2023-24, and that it will be centrally administered as a ringfenced grant rather than going via ICBs?

Together for Short Lives says that if that grant were to be cut, nearly one in five children’s hospices would cut end of life care, over a quarter would cut symptom management services and nearly two thirds would cut short breaks for respite. Children who are critically ill and very sick deserve better, so I implore the Minister to provide those assurances to Shooting Star in my constituency and all the children’s hospices across the country that provide such vital support and care.

13:54

[Patrick Grady (Glasgow North) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I warmly congratulate my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) on securing today’s very important debate and on her powerful opening speech.

The debate is particularly timely as yesterday Marie Curie launched its annual great daffodil appeal and, as my hon. Friend said, the all-party party parliamentary group on hospice and end of life care launched its significant report, “The Lasting Impact of Covid-19 on Death, Dying and Bereavement”. I particularly congratulate the hon. Member for Darlington (Peter Gibson) and Baroness Finlay of Llandaff on their work in producing that report. I note that the report is dedicated to the memory of the late member for Birmingham, Erdington, Jack Dromey, who chaired the APPG for many years with great passion, but did not live to see the report published.

Death is a fact of life; the mortality rate of the human race is 100%. More people are living longer, which means more people are dying later in life, and they are dying of more complicated and longer term conditions, which require more intensive care and support. That is often where the hospice movement comes into its own, because it provides a range of services to people, including respite care and wider support not just for residents, but for their families and friends. As the hon. Member for Twickenham (Munira Wilson) noted, the increasing complication in medical conditions is also true for those who lead shorter lives, and the children’s hospice movement does incredibly important work. As she said, children’s hospices are experiencing many of the challenges outlined today.

We have heard a number of moving stories and testimonies that speak to the value of the hospice movement today. Almost everybody will know somebody who has spent time, and perhaps passed away, in a hospice. I think of the late Liz Quinn, a tireless activist for the Scottish National party in Glasgow and real mentor to me over the years, who spent her final weeks, just before the 2017 election, in the care of the Marie Curie centre in Glasgow. Another close friend, Melanie, whose experiences I have shared in this house before and who has advocated for Marie Curie’s #DyingInPoverty campaign, has been living with terminal cancer and is now in the incredibly wonderful, compassionate care of the Highland Hospice in Inverness. I cannot speak highly enough of the support the hospice provides, not just to her but to her family and friends, such as myself.

I have not yet had the privilege of visiting the new Prince and Princess of Wales Hospice in Bellahouston Park in Glasgow, but a few years ago I visited its old facility on Carlton Place. The sense of peace, care and compassion was almost tangible. Many people in the west of Scotland also know the dedication of staff and volunteers at the St Margaret of Scotland Hospice in Clydebank. All this work builds on a tradition that dates back to the pioneering work of Dame Cicely Saunders in the 1960s, further to the work of Jeanne Garnier in 19th century France.

The specialist services provided by hospices come with specialist and specific costs. As everyone who has spoken already has said, energy is the first and foremost of those costs. Medical equipment needs to run 24 hours a day, seven days a week, and residents need to be kept warm and comfortable—that is one of the key aspects of palliative care. The steep increases in energy prices are having an immediate and significant impact. The Hospice UK briefing speaks of some hospices facing up to fivefold increases in energy bills.

Wider inflationary pressures are also having an impact. Food and nutrition are crucial in providing holistic care, helping people to maintain their strength as they live through what is often their final illness. Hospices need to be able to provide residents with nutritious meals of the best possible quality, but those costs are spiralling as well, potentially costing the sector as much as £100 million a year extra. On top of that, staff have to be properly remunerated. Hospice UK estimates that 71% of costs are related to staff. Every staff member will be feeling the individual and household pressures of the cost of living, and organisations want to be able to pay their staff a fair and decent wage. At the same time, as the hon. Member for Enfield, Southgate (Bambos Charalambous) drew out, there is a risk of a squeeze on fundraising and traditional sources of donations because of the financial pressures that many people are experiencing.

My hon. Friend the Member for North Ayrshire and Arran was not wrong to say that this is becoming an existential issue for many hospices around the country. If hospices cannot provide the service that they do, the cost will be borne elsewhere. It will have to be borne by the NHS more directly—people staying in hospital for longer, and patients not getting through as quickly as they might—or local care services will have to provide more intensive support for people in their own homes. Of course people should be supported to die in their home if that is what they want, but that is not done without cost, and that cost has to be met from somewhere. If it is not met by the local authority, the NHS or the hospice sector, it will be met by households, which in turn will lead to a further spiral.

Even when there are pressures on funding, we must think about the preventive elements of spending efficiently and effectively, whether it is the Department of Health and Social Care or the Treasury. The Treasury ultimately holds the purse strings, and Members were right to say that it would have been useful to hear from the Treasury, but I am sure that the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O'Brien), is capable. The Government speak with one voice, and I am sure he will pass all this on.

There has to be a recognition of the stark financial situation and action to address it. As others have said, hospices are not pubs or restaurants—they do not pass their costs on to customers. The next phase of the energy bills discount scheme has to recognise that and provide targeted support for organisations that need it most. The hon. Member for Twickenham is right: zoos, museums and botanic gardens play incredibly valuable and important roles for society and the economy, but it seems incongruous to say the least that they should qualify for more support than the hospice sector does under the Government schemes.

The Government must also think about how they can address staff and skill shortages. They do not like to hear it, but the reality is that Brexit has caused a black hole in labour supply in the United Kingdom. The Government have to invest both in medium and long-term training and skills development, so that hospices provide attractive careers for people who already live in the United Kingdom. It is inspiring to see the care that is provided in the hospice sector, and people should want to make that a career. It is a privilege to support people at the very end of their lives, but we cannot expect people to do that for free. They have to be rewarded, have their skills recognised, be paid a decent wage and be trained to an appropriate level, so the Government must invest in that area.

The Government also have to address short-term challenges, which means they have to be far more generous with their visa regime. They might even think about some of the asylum seekers, who may or may not have come here on small boats, who are currently sitting in cramped and crowded hotel rooms, playing cards and watching TV, who have qualifications and training in nursing and medicine. They want help the country that they have come to. They have fled persecution and want to make their homes here. I meet such people all the time, not just in my constituency but around the country. Perhaps the Government should think about allowing those people to contribute to our society, particularly the hospice sector.

The Government should think about what lessons they can learn from the Scottish Government’s approach. My hon. Friend the Member for North Ayrshire and Arran spoke about the investment that they are making in the hospice sector. They had a strategic framework for action and are now developing a strategy on palliative and end of life care. They are also providing £7 million a year to the Children’s Hospices Across Scotland movement. Parking places at hospices will be exempt from workplace parking levies, and there is an ambition to create a national care service that will ensure consistency and fairness at national level with services that are designed and delivered locally.

I want to end on the note of consensus that has come through in the debate so far by paying tribute to the incredible work of the hospice movement, which supports people through some of the most difficult times of their lives. I recognise that hospices are experiencing their own difficult times, so we have to do everything we possibly can to support them.

14:04

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Paisley. I pay tribute to and thank the hon. Member for North Ayrshire and Arran (Patricia Gibson), who secured this important debate. I also praise the important contributions from my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), who is no longer in his seat, the hon. Member for Twickenham (Munira Wilson), and the SNP spokesperson, the hon. Member for Glasgow North (Patrick Grady).

I pay tribute to the vital role that the hospice movement plays in the UK. I particularly want to mention Hospice UK and Marie Curie, who do so much in this area. The palliative care and services that hospices deliver is crucial to improving the quality of life for people with terminal illnesses. They are vital to a dignified, comfortable and compassionate end of life. Hospices serve a huge number of our communities. As we heard today, in the UK in 2020-21 more than 300,000 people received care from hospices; that is against a backdrop of more than 650,000 deaths in the UK in 2021. Hospices also work across the system to reduce the pressure on the NHS and to train and support health and care workers.

Hospices care for some of the most vulnerable people in our society. As we have heard today, the majority of hospices rely on charitable funding for a significant amount of the funding they use to deliver services. Prior to the pandemic, an average of 34% of adult hospice funding and 18% of children’s hospice funding came from the Government, but now many are struggling to pay the rising costs of energy, food and staff. Hospices face additional costs of around £100 million a year. Those who run them worry about the future of their services and the level of service that they will be able to provide, but reducing energy consumption in hospices, as we have heard, is not an option. They need to keep medical machines running and the in-patient units warm for those receiving care.

I am sure the Minister will point us towards the energy bills discount scheme, but, as we have heard today, under that scheme hospices will be eligible for the same reduced level of support as pubs and restaurants, and even less support than a zoo or a museum. I appreciate this is not in the Minister’s brief, but I would be grateful if he set out the rationale for that and whether the Government have a plan to reassess and address that in the coming Budget. Although NHS services may have their energy bills paid for by the Government, hospices will be expected to raise money to pay the astronomical bills that they will receive after April.

How do the Government expect already struggling communities to keep hospices running? I am sure the Minister agrees with me about how unfair that is, and I am sure he also agrees with the praise for the hospice sector we have heard this afternoon. In February, a written question in the House of Lords asked the Government what assessment they had made of the impact of the increased cost of living and energy costs on hospices in England. Sadly, the answer was:

“No assessment has been made.”

I would be grateful if the Minister gave a commitment to carry out such an assessment.

The NHS long-term plan includes a welcome ambition to improve end-of-life care. I struggle to see how that ambition will be met, in the light of hospices being under such fiscal pressure. It feels like Government support of the sector is lacking. So many of us will, at some point, rely on hospices to take care of us or our loved ones. Following the pandemic, we see even more referrals to hospices. I will be interested to hear from the Minister what assessments have been made of the ambition to improve end-of-life care in the light of the compelling arguments that Members have set out this afternoon.

Yesterday, the APPG for hospice and end of life care released its report, “The Lasting Impact of COVID-19 on Death, Dying and Bereavement”. One of its recommendations is that the Government should conduct a review of hospice funding in England. I would be grateful if the Minister could tell us whether the Government will be considering those recommendations and when we are likely to hear the response. Hospices do such fantastic work, in providing care in the most unimaginable of circumstances. We need to ensure that they continue to do so.

14:12

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Mr Paisley. I congratulate the hon. Member for North Ayrshire and Arran (Patricia Gibson) on securing this debate and thank her for the support that she gives to the palliative, end-of-life care and bereavement sectors. The Minister for Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), is unfortunately unable to be here today, so I am here to represent the Government. I extend my gratitude to all Members here today for their contributions, which I have heard and learned from. I pay tribute to my own local hospices in Leicestershire, LOROS—the Leicestershire and Rutland Organisation for the Relief of Suffering—and Rainbows, for the work that they do.

The Government are acutely aware of the pressures and challenges posed by the rising costs that have been mentioned in today’s debate. While they affect us all in every sector, the impact on the hospice sector has rightly been raised for debate. Everyone here recognises the incredible importance of palliative and end-of-life care services, and the invaluable work that hospices, charities and the people who support them do to ensure that dignity, care and compassion are present in our lives when we need them most.

The efforts of organisations such as Hospice UK and Together for Short Lives play a vital role in ensuring that we as a nation provide world-leading palliative and end-of-life care. Like pretty much everyone in the country, I thank them. I take this opportunity to say thank you for everything that they do.

The hospice sector supports more than 200,000 people with life-limiting conditions in the UK each year, as well as tens of thousands of family members with bereavement support. We know we have an ageing population presenting with more complex health needs for more years of life. On average, about 600,000 people die every year in the UK, and that number is expected to increase. With that expected increase, the number of people needing palliative care is also likely to rise. Health is of course a devolved policy area, so in terms of direct hospice policy, I can only speak to the English experience, although I will of course talk about some UK-wide areas that are highly relevant, such as energy policy.

While so much palliative and end-of-life care is provided by NHS staff and services, hospices also provide significant support to people at the end of their life and to those important to them. They are mainly independent charitable organisations that receive funding from a mix of public sources and charitable donations. The sense of purpose that is shared with the community—the community cares for the hospice and the hospice cares for the community—is something that we should cherish. I see that strongly in my constituency. It is emblematic of the incredible rallying of compassion and care that we see around hospices all over the country. We should also note the important role that hospices played at the height of the covid pandemic when considering their important place in their communities.

In England, integrated care boards are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local populations. In the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission. That will ensure a more consistent national approach and support commissioners in prioritising end-of-life and palliative care, as hon. Members have called for. In July 2022, NHS England published new statutory guidance on palliative and end-of-life care to support commissioners with that new duty. It includes specific reference to ensuring the sufficient provision of specialist palliative care services and hospice beds, and ensuring their future financial sustainability.

I recognise the importance of quality palliative and end-of-life care for children and young people. NHS England is investing £23 million via the children’s hospice grant by March 2023, rising to £25 million by 2023-24, in order to provide care close to home for seriously ill children when they need it.

On the question that the hon. Member for Twickenham (Munira Wilson) asked, although we only set out funding to date in the spending review, that does not mean that all funding will be cut off at that point. We are exploring exactly how that funding will be provided in the future. Furthermore, this financial year, NHS England has made £5 million of match funding available to ICBs for local children’s palliative and end-of-life care services. That will rise to £7 million in 2023-24, demonstrating the value of those services.

The funding of hospices and the sector is indicative of the Government’s commitment to their work and the vital societal role that they play. We recognise, however, that hospices, like every other organisation and household across the country, are having to contend with a range of budgetary pressures, including huge energy costs following the Russian invasion of Ukraine.

[Munira Wilson]

I thank the Minister for addressing one of my key questions about the children’s hospice grant. I am sure the sector will be grateful to hear that it is expected to continue. Although hospices will understand that he cannot commit to that at this stage, the problem is that if they do not know what they will get for the next three to four years, how can they make plans for their workforces and services? Will he say anything more than that something will continue? I do not know whether he is coming to this, but will he also say something about the ringfenced grant being administered directly, rather than via ICBs?

[Neil O’Brien]

Those are both really important points. The hon. Lady knows that it is not for me to set out the future of funding, but I hear the points she makes about ensuring that funding flows to hospices and that they are prioritised by ICBs, and about providing as much certainty as quickly as possible. Both those points have landed with me.

To meet the energy pressures, the UK Government’s energy bill relief scheme provides a price reduction in wholesale gas and electricity prices for all UK businesses and all other non-domestic customers. That means that they will pay wholesale energy costs below half of the expected prices this winter. A new scheme—the energy bills discount scheme, which has been mentioned— was announced in January, ahead of the current scheme ending in March. It is intended to help hospices’ budgetary planning into the future and provide certainty. That follows a Treasury-led review of the energy bill relief scheme some months ago.

The energy bills discount scheme will provide all eligible non-domestic energy users, such as hospices, with a discount on high energy bills until March 2024. It will apply to all UK domestic energy users in the voluntary and public sector, including hospices. We will invest up to £5.5 billion to support those non-domestic users. Furthermore, hospices may also be entitled to a reduction in VAT from 20% to 5% and exclusion from the main rates of the climate change levy on the energy they use for non-business purposes, as long as they meet the criteria in the scheme.

In addition to those two specifically energy-focused interventions, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflationary pressures, with local ICBs deciding how best to distribute that funding according to local need, including to palliative and end-of-life care providers such as hospices. I have previously mentioned the steps we have already taken in legislation and guidance to ensure that hospices are prioritised by ICBs.

A large part of hospice activity—probably the majority—actually takes place in people’s homes. That is why we are also taking action on domestic energy pressures. In fact, this winter we are spending a total of £55 billion to help households and businesses with their energy bills. That is among the largest support packages in Europe. A typical household will save about £900 this winter under the energy price guarantee, in addition to the £400 energy bill support scheme for households. On top of that, we are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making people’s homes easier and cheaper to heat.

To help with some of the other cost of living pressures on households—which is the last thing people need when they are in need of hospice care—we are taking measures such as the extra £900 cost of living payment for 8 million poorer households, the largest ever increase to the national living wage for 2 million workers, and a total of £26 billion for cost of living support next year. I hope some of these supportive measures will reassure Members about the Government’s commitment to the sustainability of the hospice sector, particularly during this challenging fiscal period. I understand that the rising cost of living has caused all kinds of uncertainties, and we continue to engage proactively with the sector to try to understand the issues it faces.

[Munira Wilson]

Will the Minister give way?

[Neil O’Brien]

I will close my speech by again expressing my thanks to those who have attended the debate—including the hon. Lady, to whom I now give way.

[Munira Wilson]

I thank the Minister for giving way again. On his point about the energy bill relief scheme, will he at least acknowledge the absurdity of leaving hospices out of the energy-intensive grouping, while botanical gardens, zoos and museums, deserving though they are, have been included? Does he not recognise that that is utterly absurd, given the sort of services that hospices are delivering?

[Neil O’Brien]

Although this is not my policy area, as I understand it, this applies to the energy-intensive and the traded sectors, so organisations need to pass through two different filters to qualify: they have to be very energy intensive and in the traded sector. That would explain the organisations that are chosen or not chosen, but as I said earlier, I absolutely hear the point that the hon. Lady is making.

I pay tribute to all those working in and supporting the palliative and end-of-life care sector and providing essential support to those who need it. I hope I have reassured Members of the Government’s commitment to supporting these invaluable services.

14:23

[Patricia Gibson]

I thank everybody who has turned up to participate in this important debate and made important contributions from various parts of the UK about the challenges in their constituencies. I thank the Minister for coming along; I know that this is not his exact portfolio area, but I thank him for his answers.

We have heard from across the House about the invaluable support that hospices provide in helping our loved ones pass away free from pain and suffering, the importance of that for those left behind—the bereaved—and the intensity of the grief they suffer. It was remiss of me not to say this in my opening speech, but I specifically requested, as did the hospice sector, that a Treasury Minister respond to this debate. Despite that request—this does not reflect on the Minister who turned out—my debate was immediately passed to the Department of Health and Social Care. Given that the motion refers to “fiscal support”, that was disappointing, and I am sure that the hospice sector will share my disappointment. That is no meant as any disrespect to the Minister who has turned up. The reason why it was important for a Treasury Minister to be here is that we are on the verge of the spring Budget, and it was hoped that this would be a good time to catch their ear.

We have heard from every speaker today about concerns that the hospice sector has been classified in the same category as botanical gardens, pubs and restaurants for energy support from 1 April. The Minister said that that is because the businesses receiving additional support are energy-intensive and in the traded sector. The common-sense response to that is that we therefore need a specific sector for hospices. If they do not fit into the sectors to which additional support can be given, they deserve to be made a special case. I know that the Minister cannot speak on behalf of the Treasury, but I am concerned that the call for additional energy support for hospices does not appear to have made any progress. I am sure that everybody who participated in this debate will want to continue to pursue that.

I hope that the Minister will feed back to his colleagues in the Department for Health and Social Care that there is no denying that, whatever progress we make or do not make on energy bills, we need a more sustainable, long-term, comprehensive funding plan for hospices. They are struggling to survive. I mentioned the comment from the chief executive of Sue Ryder about hospices relying for essential income on bake sales, selling second-hand clothes and sponsored walks. All those things are very worthy, and they make a valuable contribution, but by themselves they inherently mean that the financial stability of hospices is undermined. As the hon. Member for Twickenham (Munira Wilson) said, long-term planning for the hospice sector is important.

I hope that the Minister will agree with the need for a long-term plan, and that he has paid close attention to the representations made across the Chamber today. No Government want to preside over the demise and loss of our hospice sector, and I am sure that the current Government do not want to be in that position. That is why we need urgent action now to save our hospices.

Question put and agreed to.

Resolved,

That this House has considered fiscal support to the hospice sector and increases in the cost of living.

14:27

Sitting adjourned.