Ageing and End-of-life Care

Luke Evans Excerpts

Thursday 30th October 2025 Commons Chamber

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

I yet again thank the hon. Member for Strangford (Jim Shannon). He should be proud of Mona Shannon, and she will be proud of him not just for raising this topic today, but for all the work he does across this House talking about health, because he is assiduous and dedicated to timely health interventions, and that should be applauded across the House and this nation. I am indebted to him for securing this debate.

In the hon. Member’s speech, he mentioned who he had spoken to. I, too, have met the organisations Sue Ryder and Marie Curie, including at party conference, and I have met many other organisations, including LOROS and Rainbows, that cover my area. When I saw the title “Ageing Community” for this debate, I must admit that I thought the hon. Member should have applied for a five-day debate, considering what we could cover. I also notice the expertise in this debate. We have a secondary care surgeon, someone with public health experience at the back and me as a GP. It is turning into a multidisciplinary team, and there is a lot to unpack, whether it is prevention, mitigation, healthy lifestyles or looking at the best examples across the world. I recently travelled to Japan and Korea and saw how they look after their elderly and their approach to the lifestyle of the elderly. There is a lot to be learned out there, as across the world we all grapple with an ageing population.

There are other topics that we could talk about, and some were touched on. On social care, it is a shame that there has been a change from cross-party talks to an independent commission. I note that Baroness Casey is being taken back to the Home Office, which means she is spread thinly. There is a wider debate to be had on social care, which is: what do the British public actually want? Often we look at the Scandinavian model, but say that we do not want to pay the taxes for it. We want the household or family approach, like the Bangladeshi or Pakistani model, but we certainly do not actually want grandma or grandpa coming to stay with us and we want to stay working. Therein lies the problem in British culture. We are not 100% sure what we want when we cross over from the NHS into social care, and we are not sure how to provide it.

Some hard evidence of policies on an ageing community has been talked about, and unfortunately I have to raise the issue of winter fuel. In the Government’s analysis when they took away winter fuel payments—despite all the warnings—they knew that it would put 50,000 people into absolute poverty and 100,000 people into relative poverty. We can contrast that with the Opposition and our recent announcement on stamp duty. Jackson-Stops estimates that in the first year alone, up to 500,000 people above the age of 55 would consider downsizing because of that policy. I do not call that downsizing, as we heard in the debate on stamp duty—it is right-sizing, because it gives a real chance not only for more families to go upwards, but for people to move into more appropriate accommodation as they age.

There is a lot to be said in the debate about an ageing population, as the hon. Member for Shipley (Anna Dixon) pointed out, but I will focus my comments on the three questions that I think I caught from the hon. Member for Strangford: the assessment of the need for a national strategy for palliative care; what the Government are doing to ensure that palliative care is included in neighbourhood health centres; and the progress being made on 24-hour support.

I will start with the national strategy and funding, and let us give credit to the Government where it is due. When it comes to children’s hospice funding, they have continued the payment and extended it, which is welcome, although it does not offer enough mitigation for national insurance contributions. The Government will say that when it comes to adult funding, they have given £100 million. That is capital funding, though, and as one hospice worker put it to me, there is no point in having new curtains and a lick of paint if there are no staff.

As the Liberal Democrats pointed out, the National Audit Office report on the hospice sector that came out only yesterday states:

“DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector”,

or what the real impact of Government funding is. It continues:

“In 2024-25, 11 independent adult hospices in England reported service reductions or staff redundancies, and other hospices announced plans to reduce services, in response to reduced income or increased costs. Cuts appear to be across all types of services offered by hospices. Most hospices reported the increase in the costs of service delivery within the palliative and end-of-life care sector as being the primary reason for service reductions…Six hospices have been designated by ICBs as ‘commissioner requested services’, a mechanism to forewarn ICBs of potential difficulties with services that, should they discontinue, would have significant impact on the local population”.

Hospice UK responded to that, saying:

“unfortunately the whole hospice sector is…struggling, just as demand for their services is rising. Surging costs mean 2 in 5 English hospices are planning cuts this year, and 20% ended last year with a deficit of over £1m.”

What does that actually look like in real life? In my area, LOROS is facing a deficit of £2 million. It has already had to reduce its in-patient capacity from 31 to 20 beds, and it is reducing its day therapy and cutting its physiotherapy, occupational therapy, social work, chaplaincy and complementary therapies, and closing the volunteer home-visiting service.

It is not just my region that is affected: a cursory look at Hansard will show that the Kirkwood hospice in Kirklees has made 19 redundancies; the Ashgate hospice in Derbyshire has 52 jobs at risk, with beds cut from 21 to 15; St Catherine’s hospice in West Sussex is looking at 40 job cuts, with half of its new rooms being mothballed; Weston Hospicecare—highlighted both here today by the hon. Member for Weston-super-Mare (Dan Aldridge), and by others, including my hon. Friend the Member for Bridgwater (Sir Ashley Fox) at other times—faces an increased national insurance bill of £139,000; the Arthur Rank hospice in Cambridgeshire is losing £829,000, which is forcing the closure of nine beds, 40% of its capacity; and Marie Curie has pointed out that its national insurance contribution costs have risen by £2.9 million.

Through all this, we have still never heard whether the Health team knew that this was going to happen and chose to push it through, or whether it was simply an oversight when it came to challenging the Treasury. Ever since the Budget, we have never heard an answer to that. At the time of the Budget, the CEO of Marie Curie, Matthew Reed, said:

“The Health Secretary himself has acknowledged that palliative and end of life care is not good enough, so we are shocked by the lack of measures in the budget to fix it. Palliative care needs are projected to rise by 25% over the next 25 years, around 147,000 more people each year, yet this government lacks a strategy to tackle the magnitude of this challenge.”

Have the Government made an assessment of how much the NICs increase has impacted the hospice sector? As has been mentioned, Together for Short Lives estimates that the average hospice is facing a bill of about £133,000.

I raised a lot of these questions in a debate in January, and the Minister for Care kindly wrote to me in response. It is not just about the financial side; we are looking at the structural aspect too. He wrote:

“As you are aware, integrated care boards…are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. In addition, the National Institute for Health and Care Excellence…has published quality standards and guidelines to support commissioners to carry out this duty. While the NICE guidelines are not legally binding, they act as a regulatory benchmark for best practice in palliative and end-of-life care…Whilst the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.”

So there is a grey area about where hospices are covered, and that fits in with the NAO report.

[Anna Dixon]

As the hon. Member rightly says, ICBs are under a legal duty to commission palliative care services. Does he not recognise that the problems we are having, not just with hospice care but with the lack of availability of palliative and end-of-life care, often come down to poor commissioning—ICBs failing to commission in line with that statutory guidance—and the confusion that arises between charitable donations and that which should be commissioned by the NHS?

[Dr Evans]

The hon. Lady is spot on; that is exactly the point that I was getting at. While there is a legal duty in terms of palliation, what that palliation looks like is important. Her question was also raised by the hon. Member for Strangford, who asked whether it is now time to have a strategy dedicated to palliative care, given the rise in demand.

The letter goes on to say:

“Charitable hospices are autonomous organisations that provide a range of services that go beyond that which statutory services are legally required to provide. Consequently, the funding arrangements reflect this.”

We are in a grey area, and a palliative care strategy could well be a way to unlock this problem. I will be interested to hear what the Government have to say on this issue.

However, it is not just about finances and commissioning; it is also about the workforce. That is partly addressed in the letter:

“As set out above, we have committed to develop a ten-year plan to deliver an NHS fit for the future. This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”

By my calculations, we are coming up to Halloween and even bonfire night, and we still have not seen a workforce plan. My question to the Government is: when are we likely to see that?

That leads me on to my next point: how do the Government intend to ensure that palliative care specialists are included in neighbourhood health centres? The 10-year plan is laudable, and I think there is agreement across the political spectrum on its contents, but the one thing it is missing is a delivery chapter. How are we going to do it? The shift is correct, but we do not know how we are going to get there, so I would be grateful if the Minister could address that. The 10-year plan explicitly talks about public-private partnerships, and there is concern on both sides of the House that we could see PFI mark 2. If Members need to have their memory jogged, private finance initiatives brought in £13 billion to build hospitals and services, but at a cost of £80 billion to taxpayers.

Why does this all matter? In my last few moments, I will turn to the final question that was posed by the hon. Member for Strangford, which was about access to 24-hour support. I will quickly read out a couple of comments from one of my constituents, whose husband Mat sadly passed away from a brain tumour. She highlights this issue:

“During the day, the support was outstanding because I could call the community nurses and the palliative nurses, and they would always call me straight back. They would visit Mat daily to administer the medications needed in his syringe drivers. They were kind, caring and so supportive to us and our family.

The night times were different and frightening. Often during the night when I was trying to get support, he could see how scared and stressed I was, which made him more scared, often telling me he was okay just to try and not make me worry. Every night I used to be thinking what might happen tonight—will Mat have another seizure? Will he be in so much pain again? Will they call me back if I need support? How long will it take to get help to arrive?”

Marie Curie points out that only seven of the 42 ICBs in England have a single point of access. I raised this issue with the Minister in a letter in August, and he kindly responded in September. He pointed out that integrated care boards must commission on this basis. There is NICE guidance on “End of life care for adults”, under quality standard 13, and on “End of life care for adults: service delivery”, under NICE guideline 142, which talks about the fact that there should be some form of 24-hour care, but at no point did the letter address the issue of the phoneline. When I asked the Department about data, I was told in a letter:

“Regarding data about palliative care helplines, such as average waiting/response times, the Department does not collect or hold this information.”

Will the Minister look at that and consider whether the Department should hold such information?

The letter went on to say:

“We recognise that more could be done to support the palliative and end-of-life care sector. I have tasked officials within the Department and at NHS England to look at how improving the access, quality and sustainability of all-age palliative and end-of-life care to ensure that their proposals are in line with the ten-year plan.”

I would be grateful if the Minister could ask the Minister responsible whether there is indeed an update and what that looks like. At the end of the day, we are concerned not necessarily about inputs, but much more about outputs.

We know that death is certain for us all; only our willingness to face it seems optional. This is very much a British mentality, and I believe we need to change that when it comes to talking about death and our mortality. We need to speak more openly and candidly about what an ageing population looks like, for that is what we are. That is why the hon. Member for Strangford brought forward this debate, and he reminds us that we chase the days ahead while never quite noticing how swiftly they turn into years behind us. That leads me to reflect on the fact that, as politicians and as a society, we build a world to live longer, yet we all too easily forget to ask: how do we want to grow old?

--- Later in debate ---

[Dr Ahmed]

I am very concerned to hear what my hon. Friend has reported to the House. Clearly, coercion is unacceptable in all forms. Safeguarding is taken very seriously by the national health service and by the Department of Health and Social Care, and as the Minister with responsibility for patient safety, I am very happy to look into that further and to take it up with him after the debate.

As set out in the 10-year health plan, we are going to shift more care out of hospitals and into communities, and make care more personalised. If there is anywhere where that is most important it is palliative care and end-of-life care. Palliative care and end-of-life care, including hospices, have a big role to play in that shift, and they were highlighted in the 10-year plan as an integral component of neighbourhood health teams.

In England, integrated care boards are responsible for the commissioning of palliative care and end-of-life care to meet the needs of the local population. To support ICBs in this duty, NHS England has produced statutory guidance. That includes the need for 24/7 access to palliative care and advice, and a palliative care and end-of-life care dashboard that brings together all relevant data in one place. The dashboard helps commissioners understand the palliative care needs of the local population. Of course, the majority of palliative care and end-of-life care is provided by NHS staff and NHS services, and that has benefited from the record funding in the NHS that the Chancellor delivered in the last Budget.

I will not be able to address all the points made by the hon. Member for Hinckley and Bosworth (Dr Evans), as he was in a typically verbose mood, but if he wills the ends, he must will the means, and if he does not agree with the means, he must present his thesis as to the alternative model of funding that he wishes to see. Otherwise, it is a case of cutting services.

However, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at the end of their lives and to their loved ones. In recognition of that, £100 million of capital funding has been made available to hospices in England to ensure that they have the best physical environment for caring. That includes helping hospices to provide the best end-of-life care to patients and their families in a supportive and dignified environment. It includes funding to deliver IT systems and provide refurbishments and facilities for patients and visitors, so that they can see their family members at the end of their lives in a dignified environment—much more than just a lick of paint.

[Dr Evans]

Given the recent National Audit Office report and the fact that the tax increase to national insurance contributions has had the biggest impact on the voluntary sector, has an impact assessment been carried out into how much the cost has gone up for hospices in England to provide their services? If not, will the Minister consider it?

[Dr Ahmed]

The hon. Gentleman knows that the NAO report covers a period both when his party was in government and beyond. I go back to the point about NICs. If he wills the end, he must understand the means. I am very happy to have that conversation with him at length after the debate, respecting the confines of the time that I have—I do not want to test your patience, Madam Deputy Speaker.

I am delighted that the first £25 million of the £100 million fund has been passed to Hospice UK and has been spent on capital projects already. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), visited Katharine House hospice earlier this year, Wigan and Leigh hospice in July, and Noah’s Ark children’s hospice earlier this month to see directly for himself how that record investment is making a meaningful impact on the ground. We can confirm that the Department of Health and Social Care has now transferred the rest of the £75 million to Hospice UK for onward spending in 2025-26. We are also providing £26 million of revenue funding to support children and young people’s hospices. This is a continuation of the funding that, up until recently, was known as the children’s hospice grant. That funding will see circa £26 million allocated to children and young people’s hospices in England each year via local integrated care boards on behalf of NHS England. This amounts in total to £80 million of hospice funding over the next three years.

For many of us who are in good health, managing complexity and ageing seems a distant idea. The Government recognise that the number of people with palliative care and ageing needs is projected to rise significantly over the next quarter of a century. That is why we are shifting more healthcare out of hospital and into communities through our plan for change. That is why we are investing, through the National Institute for Health and Care Research, over £3 million in a policy research unit in palliative and end-of-life care. The unit launched in January 2024 and is building the evidence base on palliative care and end-of-life care.

Earlier this year the Minister of State for Care and, more recently, the Secretary of State met key palliative care and end-of-life care and hospice stakeholders at dedicated roundtables, and focused that discussion on long-term sector sustainability within the context of the 10-year plan. Following the recent publication of the plan, the Minister of State for Care tasked officials to work at speed to generate proposals to improve the access, quality and sustainability of all-age palliative care and end-of-life care as we start to implement the plan.

In closing, I hope that those measures assure the hon. Member for Strangford of the Government’s seriousness to build a sustainable palliative care and end-of-life care sector for the long term.

[Dr Evans]

Will the Minister give way?

[Dr Ahmed]

I will not, in the interests of time.

I reiterate my thanks to the hon. Member for Strangford for bringing forward this vital issue, and I thank all hon. Members who have spoken today. He can be assured that he has raised the voice of those who deserve dignity at the end of their lives, and that his call has been well and truly heard by the Government.