Hospice Services: Support

Debate between Caroline Nokes and Tim Farron

Wednesday 14th June 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Nokes. I pay tribute to the hon. Member for Eastleigh (Paul Holmes) for securing this important debate.

St Mary’s Hospice at Ulverston, St John’s Hospice at Lancaster and the Eden Valley Hospice at Carlisle provide tender, professional and specialist care for people with life-limiting conditions and their loved ones—something we are so grateful for. They prove that life has dignity from beginning to end. Hospitals, however marvellous they are, do not have the resources to replicate the care that is provided by hospices.

The costs of running a hospice have gone through the roof in recent times. Val Stangoe, the chief executive of St Mary’s, one of our three local hospices, said to me:

“The recent settlement by the NHS Lancashire South Cumbria ICB of 0.0%”—

as pointed out by the hon. Member for Lancaster and Fleetwood (Cat Smith)—

“has left our hospices in a state of financial deficit, with potential loss of hospice beds and services.”

She went on:

“Your local hospices”—

our hospices—

“are now operating on a deficit budget, have received the lowest settlements in England. The proposed 0.0% uplift equates to almost 10% in cuts, significantly impacting delivery of services. This stands in contrast to other regions, where hospices have received an average uplift of 2.7%”—

which is not enough. She continued:

“The disproportionate treatment faced by hospices in Lancashire South Cumbria is unfair and must be addressed.”

My fundamental ask of the Minister is this: will she directly involve herself in that situation to stop our hospices in Cumbria suffering? I have been asking the Government for months to come up with a scheme to help hospices that are struggling with their energy costs, which have gone up three times in recent months. There are lots of promises and no action.

There is a cost to meeting the NHS pay settlement. There is a cost to ensuring that hospices are paid properly so that they can pay their staff, keep them, and recruit them in the first place, and so that they can pay their energy bills. But the cost of not doing that is far greater, not only in terms of the health damage and people’s pain and suffering, but for the hospitals that have to pick up the pieces when hospices are not able to meet people’s needs.

[Caroline Nokes (in the Chair)]

Because one speaker has dropped out, I am going to increase the time limit back to three minutes.

Eating Disorders Awareness Week

Debate between Caroline Nokes and Tim Farron

Tuesday 28th February 2023 Westminster Hall

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

It is a genuine pleasure to serve under your guidance this morning, Ms Harris. I congratulate my hon. Friend the Member for Bath (Wera Hobhouse) on securing this debate, which she has led very well. It has been a helpful debate, and I associate myself with the comments that everyone has made. I also add my thanks to Beat, Hope Virgo and all the others leading the campaign to increase awareness and improve provision for people suffering with eating disorders.

Eating disorders are, of course, a range of mental health conditions that have a physical consequence, with maybe two thirds of those suffering from them having a physical illness as a consequence of their mental health condition. It is a privilege, and deeply moving, to work alongside, support and serve sufferers and their families in my communities in Cumbria. I feel deeply affected by not just their struggle with their condition but, sometimes, their struggle to access the services they need.

As has been mentioned, covid has had an impact on the prevalence of eating disorders, with something like a 55% increase in referrals during that period, and an increase of more than 80% in the number of hospital admissions, and I want to remark on what we do in response to those admissions. In our communities in Westmorland, anybody needing tier 4 hospitalisation for an eating disorder will be placed in a bed in Manchester, Edinburgh or Darlington if they are lucky and there are sufficient beds in those places. In many cases, as the hon. Member for Sheffield, Hallam (Olivia Blake) mentioned, people—often young people—end up hospitalised on the wrong kind of wards, where they are supported by lovely, wonderful people who are just not trained to support them. Therefore, the experience not just of that person in their suffering, but of the people caring for them and the other people—often young people—on those wards, is harrowing, deeply distressing and inappropriate.

As has also been noted, it is worth mentioning that the use of BMI as a measure to decide whether someone can access services is dangerous and foolish. We would not say to a person with cancer, “Come back when you have more cancer”—we would treat them.

[Caroline Nokes]

This will be a very brief intervention. The hon. Gentleman is absolutely right about BMI—we really have to move away from it. It gives a misleading impression of wellbeing. Can we please remember that it is designed for a Caucasian male’s body type? We know that the majority of sufferers of eating disorders are women.

[Tim Farron]

I am grateful to the right hon. Lady for a helpful intervention. That is absolutely true. We would not say to a person who presented with cancer, “Come back when your tumours have spread.” If someone is presenting with an eating disorder, we need to believe them and allow them to access the right support immediately. That needs to be changed urgently.

At the other end of the spectrum, at tier 1, and particularly for young people, what are we doing to build resilience so that people do not develop eating disorders in the first place? In Cumbria, there is nearly nothing in terms of provision for adults, while we spend a grand total, through our public health, of 75p per child and young person on tier 1 resilience support, and that is for all mental health conditions, not just eating disorders. We need to prevent people from getting into these circumstances in the first place—for their sake and for everyone else’s.

Let us be positive: it is important to welcome the access waiting time standards. They are a good thing. However, they are mostly not being met. In north Cumbria, 26% of routine referrals of young people and 11% of urgent referrals of young people are not being treated in that timescale. In south Cumbria, 23% of routine referrals are not being seen within the four-week standard. While there is better news for those meeting the standards for urgent referrals, the total declared for Morecambe Bay hospitals trust is 12 individuals with an urgent eating disorder need. That is baloney. I personally know more people than that who are struggling, which tells us either that the data is faulty or that it is hard to get into the system because BMI is used as a gateway to access those services.

More generally, this speaks of a lack of parity when it comes to care, treatment and taking seriously issues relating to mental health, particularly where young people and eating disorders are concerned. If one of our young people were to break their leg on a football pitch on a Saturday afternoon, they would be straight into hospital and the healing process would begin that day. If something invisible in them breaks, it could be weeks or months before they get support, or it could never come. It may come dangerously, or even fatally, too late, and that is wrong.

What are our collective asks? We need increased awareness. It is right that we focus on men, who are less likely to come forward and yet make up a huge proportion of those in need, but help should be there for everyone, and I urge people to come forward and access it. We also need more support for families, who are massively hit by the consequences of eating disorders for their loved ones.

We mentioned the waiting time standards for young people and children—I am glad we have them, although I wish we met them—but there are no standards for adults, and it is about time that there were. Research funding needs to be increased so that we can understand the causes and cures and tackle this range of diseases head on. We need to be utterly intolerant of dangerous images and things that lead people into this dangerous area and cause such ill health.

Medical training needs to be improved so that we can refer our referred accurately. We need to tackle the BMI gateway. When tackling obesity, for example, we need to remember that there is a danger of things such as like calorie references being well-intentioned but counter- productive. We need to ensure that money allocated to integrated care boards for eating disorder support is actually spent on that. Finally, services must be commissioned adequately and close to home.