Hospice Funding

Edward Timpson Excerpts

Monday 22nd April 2024 Commons Chamber

[Edward Timpson (Eddisbury) (Con)]

Thank you very much, Mr Deputy Speaker, not least for enabling me to reassure myself that I can still get out of my seat, despite my London marathon legs from yesterday—I had to find a way to get that in!

May I start with some positives? I do not want to steal the Minister’s thunder, but there has been some really good support for hospices in recent times. We heard about the covid support. The Government gave around £400 million to increase capacity and to enable patients to be discharged from hospital. We saw hospices benefiting from the Government’s energy bill relief scheme until April last year and, since then, the discount scheme until March this year. As we heard earlier, there has been an increase in the NHS England children’s hospice grant from £12 million in 2019-20 to £25 million in 2023-24. I believe that that has, since July last year, been committed through to 2024-25, albeit it is now allocated through ICBs rather than directly.

So why are hospices struggling? I think that the answer is best encapsulated in a recent report from the Health and Social Care Committee, which stated that funding for specialist palliative and end of life care was “insufficient and unsustainable” and was creating

“inequality in access to and quality of care.”

What does that mean for hospices in my constituency and across Cheshire? Let us take the Hospice of the Good Shepherd in Chester, which is just outside my constituency but serves many of my constituents. As its chief executive, Rhian Edwards, informed me, last year it delivered more than 2,000 hours of direct care per week, supporting 476 patients and their families. To do so, it used £4 million of its own charitable funds, with the ICB contributing £1 million. Over three years the ICB contribution has fallen from 22% to 20%, and is expected to fall further to 16% in the next financial year.

This is against a backdrop of running costs—80% of which are staff costs—shooting up, mainly as a consequence of the requirement to match pay awards for medics and nursing staff, welcome as they are for those workers. The impact is a forecast operating loss of just under £1 million for 2024-25, and there is a similar scenario in nine out of 10 hospices in the country. Rhian told me:

“although we’ve always struggled to balance our books, this level of deficit is feeling very different.”

Another example is St Luke’s hospice in Winsford, which has been providing palliative care since 1988. It has 162 members of staff, and 95% of the workforce live and work in Cheshire. It has 700 volunteers and 10 charity shops. At the heart of this incredible organisation is a charitable purpose, and it does amazing work, but only 12% of its income is received through the NHS and the ICB, one of the lowest percentages in support packages of this kind across the country. It costs £5 million to run St Luke’s, so it has to raise—I have worked this out—£8 a minute to keep its services going. Within the Cheshire and Merseyside region, it receives about £1 million less grant funding than a hospice of a similar size in Merseyside dealing with the same end of life care.

Welcome though the extra funding was during covid, the fundamental financial issues facing hospices have not gone away; they have simply been postponed. This financial year, for example, will see a £350,000 black hole in the finances of St Luke’s, not helped by a staggering 60% increase in its utility costs. Neil Wright, its chief executive, explained to me:

“As a charity, we have a fiduciary duty to balance the books. This means that without progressive investment of sustainable funding, hospices will have to reduce and eventually stop services over the coming years. This will then place 100% of the financial burden of EoL”

—end of life—

“care back onto the already overstretched NHS”.

So what can be done? Hospices such as St Luke’s are not looking for, or expecting, 100% funding; they just want a sensible, sustainable funding formula. At present, however, ICB funding does not reflect the true cost of clinical care. When it comes to sustainability, as other Members have said, we need multi-year contracts to give hospices the confidence to deliver their services and invest, grow and develop to meet the needs of their communities. We have the NHS long-term workforce plan, which is hugely welcome and, I believe, provides a real opportunity to assess—fully and rigorously—and deliver the palliative and end of life care services that are necessary to meet the growing demand over the coming years and decades.

It is also worth remembering that some people face greater barriers in accessing palliative care, including those who live alone, in poverty or with dementia, as well as those with learning disabilities. In the end, if we do not secure the long-term future of hospices, we will have created a false economy and a false reality. If we do, we will not only reduce pressure on NHS services and have fewer unplanned and potentially avoidable hospital admissions, but will ensure that we can deliver compassionate care for those coming to the end of their lives and for their families and loved ones, thus demonstrating that we are a society that values both a good life and a good end of life.