World Stroke Day

Munira Wilson Excerpts

Tuesday 28th October 2025 Westminster Hall

[Munira Wilson (Twickenham) (LD)]

I beg to move,

That this House has considered World Stroke Day 2025.

It is a pleasure to serve under your chairmanship, Ms Vaz. I thank all the hon. Members who have come to Westminster Hall today to mark World Stroke Day, which is tomorrow. This year, recovery is in the spotlight, and this debate provides a timely opportunity to consider the life-changing impact a stroke can have both on a survivor and their loved ones and how the NHS can better support patients’ recovery beyond the acute phase of treatment in the early days following a stroke.

Every day in the UK, another 240 people wake up to the catastrophic impact of a stroke. There are currently more than 1.4 million stroke survivors in the UK. On 9 May this year, my mother was one of those people, and that is the primary reason why I secured this debate. Her experiences over the past six months are still too raw and too devastating for us as a family for me to talk about today. Sadly, too many stories shared with me in recent weeks reflect exactly what my mum has been through and is still going through.

I will endeavour to use the short time available to highlight some of those stories and to call on the Minister to prioritise stroke rehabilitation in particular. Not only is that the right thing to do for the patient and for their family, but it makes a lot of financial sense. Ultimately, it would save the taxpayer money in healthcare and social care costs and enable those of working age to continue to work and to be active in their communities.

The Stroke Association estimates that, without Government action, stroke is expected to cost £75 billion by 2035. Approximately 100,000 people have a stroke each year in the UK, with 59% of them occurring in older generations. There are 38,000 stroke-related deaths every year, which makes it the fourth single leading cause of death in the UK. It is also the leading cause of complex adult disability in the UK, with around 60% of stroke patients leaving hospital with a disability. Stroke causes brain damage and can leave survivors unable to move, see, speak or even swallow. It can leave people doubly incontinent and lead to personality changes as well as depression. The NHS is rightly lauded for the care it provides, particularly in hospital, often delivering world-class support to those who need it when the unexpected happens.

[Afzal Khan (Manchester Rusholme) (Lab)]

In my constituency, Manchester royal infirmary’s ward 31 provides outstanding acute and rehabilitative stroke care, supported by dedicated community health champions who promote prevention and early intervention to reduce the risk of stroke. Will the hon. Member join me in thanking both our dedicated hospital staff and community health champions, and support sustained investment in prevention, staffing and rehabilitation so that we can save lives and help survivors recover fully?

[Munira Wilson]

Of course I am very happy to congratulate the staff in the hon. Gentleman’s local hospital. Through my personal experience with my mother, I have seen how amazing hospital staff are, and where community services are available, I am sure those staff are brilliant, but the crux of my speech is about how poor the rehab services are in some parts of the country and how we really need to staff and boost them if we want to help people to have a good quality of life.

I have heard time and again from those who have lived experience that support for community rehabilitation is simply not good enough and often collapses six weeks post discharge from hospital. In some cases, support even six weeks post discharge is not available, depending on which integrated care board or local authority is responsible.

[Steve Darling (Torbay) (LD)]

In Torbay, in Devon, we have the third highest prevalence of strokes in the United Kingdom, and yet, within the last 12 months, we have seen cuts to support for the local stroke association. That has left people who are suffering from strokes feeling isolated and abandoned. Does my hon. Friend agree that we need to see more investment at the grassroots to support sufferers of strokes?

[Munira Wilson]

I 100% agree. The post-stroke support is critical, and I will share some stories about people who have felt abandoned and isolated in exactly the way that my hon. Friend describes.

Despite guidelines from the National Institute for Health and Care Excellence, the Chartered Society of Physiotherapy says that 20% of people do not receive the minimum specialist rehabilitation required in the first five days following a stroke, and 68% do not have an assessment for rehabilitation, which is required after discharge. The reality is that those who want to regain a level of independence need to be able to fund support privately.

I pay tribute to Richard Sealy, who runs the Neuro Rehab Practice in Hampton, which is in my constituency. He and his whole team are doing brilliant work in trying to fill that gap. Over the summer, I had the privilege of visiting the practice and speaking to stroke survivors and their carers about their experiences. What runs through so many of their stories—I am sure Members will have heard similar—is the cliff edge that people fall off when they leave hospital, and the devastating knock-on impact that can have.

I would like to share some of their testimonies. One stroke survivor said:

“I felt lost, like I had been thrown out of the boat, not knowing what to do or where to find help”.

Another survivor’s family member said:

“Although the NHS took care of her while she was in hospital, we felt that after the six weeks had finished, it was very much goodbye. You’re now on your own”.

Another, when asked what happened when the NHS rehab ended and whether they were given any further options, simply replied, “Nothing.”

Those survivor stories are far from unique, and that is unacceptable. According to the Stroke Association, only 17% of community-based rehab services have appropriate access to each core therapy—physiotherapy, speech and language therapy and occupational therapy. The Right to Rehab campaign argues for the simple idea that rehabilitation should be accessible to everyone who needs it, for as long as they need it.

We know that stroke survivors continue to make incremental improvements over many months, even years, so I welcome the Government’s ambition to rebuild our NHS through transitioning care from hospital to the community, and to improve integration of rehabilitation. While the Government target to reduce stroke and heart attack deaths by a quarter in the next 10 years is also welcome, given the devastating impact that stroke can have and the struggle to recover faced by many, the scope of that target must be widened to also reducing disability.

Take Miriam, a resident of Twickenham, who at just 21 years old suffered a stroke only three months after graduating with a BA in music. After spending four days in hospital without diagnosis or treatment, where she suffered two more strokes, she was unable to play an instrument or even grasp a pencil. She suffered significant challenges, including depression and isolation, but through therapy and determination, she was able to rebuild her life. Miriam is now a neurological music therapist, working with children and adults with learning disabilities, and I believe she is here, watching today’s debate.

Chris Stirling, who suffered a stroke in his 60s, was told by doctors after six months in hospital that he should go into a care home. He left hospital in a wheelchair, unable to shower. Thanks to privately funded neuro physiotherapy and the support of his family, he is now able to play golf, one-handed. Not everyone is as lucky as Chris to have both the means and the family support.

Miriam and Chris’s stories, and the testimonies I shared earlier in my speech, show just how important it is to get both stroke diagnosis and rehabilitation right.

[Carla Lockhart (Upper Bann) (DUP)]

The hon. Member is making a powerful speech. Family friend Hannah Garrity, who is now in her 20s, took her stroke at the age of eight. She was a little girl, who woke up one day and took a severe headache, and out of that, she had a very severe stroke. She is an inspiration. She is now teaching art in schools. She is a Sunday school teacher in her local church, and she gives so much back to society. Would the hon. Member agree that more research is needed, particularly in relation to strokes in young people and children, given the increase in the number of them who are taking strokes?

[Munira Wilson]

Absolutely. I am sure that in stroke, as in so many other areas of medicine, more research would be welcome, particularly into how we can prevent stroke in younger people. It is shocking to hear that a child so young suffered a stroke.

The stories that I have shared today demonstrate the impact that good care and rehab can have on quality of life, regaining independence and restoring people’s identity. The moral, social, health and economic cases for better rehab support are overwhelming. Will the Minister therefore commit to expanding the Government target to cut deaths caused by stroke and heart attack to include reducing disability? With stoke and cardiovascular disease a trailblazer for the modern service framework, what discussions is he having in the Department and with the Treasury to resource implementation and ensure there is a lead in the Department on this area? With 40% of physiotherapists saying that insufficient staffing is leading to their patients experiencing increased levels of pain and ill health, what work is he undertaking to expand the physio workforce? Will he look at ensuring that integrated care boards’ data plans capture and report on performance and rehabilitation, including in relation to populations who are not accessing rehabilitation?

On this World Stroke Day, stroke survivors and their carers are not asking for the impossible: a concrete plan to make stroke rehabilitation accessible across the country, no matter what someone earns or where they live. As the Secretary of State himself said only at the start of this year,

“Whether in the NHS or in social care, we definitely need to do more on rehabilitation, because rehabilitation is often secondary prevention.”—[Official Report, 6 January 2025; Vol. 759, c. 608.]

He was right, and now that needs to be delivered. I look forward to the Minister’s response. I would welcome the opportunity to meet him to discuss these issues alongside patient groups and representatives.

--- Later in debate ---

[Munira Wilson]

I thank all hon. Members who have taken part in the debate, particularly the hon. Members for Stratford and Bow (Uma Kumaran), for Strangford (Jim Shannon) and for South West Norfolk (Terry Jermy), for sharing their personal stories. I also thank everyone for their good wishes for my mum, which I will pass on when I speak to her next.

I am grateful for the Minister’s response. I am encouraged by what he said about data, prevention, the digital tools that will come into play, and the fact that we are trying to make thrombectomies universal during that acute phase when somebody is blue lighted somewhere. However, I come back to one of my key asks, which was to widen the target for stroke and cardiovascular disease to prevent disability, not just to save lives.

Of course, saving lives is crucial. Thanks to those interventions, many lives are saved, but the disability that goes with that is incredible. Yes, we can use robots and all sorts of other new technology, but, ultimately, physios, occupational therapists and speech and language therapists are desperately needed. Frankly, community-based rehab is withering on the vine, and I have been personally quite shocked by how patchy it is. My plea is for the Minister to take the need to build up those services to the public health Minister, and I hope that she will be willing to meet me, as well as patient groups and patients.

Question put and agreed to.

Resolved,

That this House has considered World Stroke Day 2025.

Terminally Ill Adults (End of Life) Bill

Munira Wilson Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)]

I am almost in my 13th hour of trying to speak on this topic, so I hope Members will understand that I am not going to take any interventions. I rise to speak in support of new clause 4, tabled by my hon. Friend the Member for Peterborough (Andrew Pakes); amendment (b) to new clause 14, tabled by my hon. Friend the Member for Rochdale (Paul Waugh); and amendment 13, tabled by my hon. Friend the Member for Glasgow West (Patricia Ferguson).

Let me start by saying that ending suffering is a shared goal of all Members across this House. No one has a monopoly on wanting to end suffering; the question is how best we do it. As a former aid worker and someone who has risked my own life in order to alleviate the suffering of total strangers in war zones, I promise the House that I am motivated to end suffering at least as much as the next Member. It is worth the House knowing, too, that my darling dad died of terminal cancer in a hospice that was run and funded by a charity, because the NHS does not have that provision.

New clause 4 matters, because we do not live in an equal society, although many of us—particularly on the Labour Benches—seek to bring one about. This is a deeply flawed Bill, and the truth is that in seeking to give choice to some, it risks causing new harm to a much larger, vulnerable group of our citizens. The safeguards, which were watered down in Committee, will not prevent this. Indeed, this week, we have seen a letter from over 1,000 doctors saying that the Bill will “widen inequalities” and that it is “simply not safe”. Earlier, we heard a powerful speech from my hon. Friend the Member for Rochdale about the impact of advertising on the most vulnerable. New clause 4 would increase the collection of data about the impact on the most vulnerable and bring in proper oversight from the chief medical officer, including in relation to those with protected characteristics.

Last time we debated the Bill, we heard from my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis). We are in the shared situation of having close and dearly loved family members who have complex disabilities. My hon. Friend and our families know how it is to have to struggle—to fight every week for the access to basic state services that our loved one is entitled to but cannot access. Those services and precious state resources would increase their equality and ability to live well, but were stretched beyond breaking point by successive Tory Governments. It is that experience that brought me into politics and into the Labour party, and to this day—away from my day job as a Member of this House—I still have to fight on behalf of my loved one, who has significant physical impairments as well as learning difficulties, for them to access the healthcare and support that they desperately need.

Vulnerable people do not always make decisions in their own best interests, and I also know from my family experience that they can be highly susceptible to pressure from others who do not have their best interests at heart. That is why the transparency created by new clause 4 matters. I remind the House, too, that the Royal College of Psychiatrists has described the so-called safeguards in the Bill as “inadequate”, and that in Washington state, almost two thirds of those who had an assisted death in the last year for which data is available cited fear of being a burden on their family, friends or caregivers as a reason for doing so. I do not want that to happen in our country. Over 350 disability rights organisations oppose the Bill as it stands, and one of my constituents has told me that the Bill contributes to a sense among disabled people that “We are disposable.”

Amendment 13 and new clause 4 both make important changes to the role of the voluntary assisted dying commissioner. I ask my hon. Friends on the Labour Benches whether they have questioned the wisdom of the Prime Minister himself having to personally appoint the death tsar—as the media have christened that role—shortly before the next general election.

Finally, earlier this week, I heard an hon. Member say that he believes the Bill is flawed, but plans to vote for it anyway so that it becomes law and we would have to sort out the problems later—we have heard more of that today. The hon. Member did not specify how he thought this would happen, or when. He is right that the Bill is flawed, but he is wrong that we can ignore those problems. To do so would be to fail in our job as legislators. Being in favour of these amendments and against the Bill does not mean accepting the status quo, as some have tried to suggest. It means that we choose, instead, to protect the NHS and to work, to fight and to battle for a palliative care system that is worthy of those we represent, rather than diverting time and energy into helping people to kill themselves.

[Munira Wilson (Twickenham) (LD)]

Even though I am not opposed to the principle of assisted dying, I have a number of deep concerns about the content of the Bill, the process by which we are legislating for such a monumental change and, importantly, the context in which it would be enacted, given the numerous challenges facing our health and care services. That is why I have tabled amendment 21 relating to palliative care and end-of-life needs, which has attracted cross-party support.

I am grateful to the hon. Member for Spen Valley (Kim Leadbeater) for supporting the amendment. I want to pay tribute to her today for kick-starting a debate about dying well and, in particular, about palliative care—a topic that has been neglected by many of us, myself included, for far too long.

Amendment 21 would require the Secretary of State to lay a report before Parliament a year after the Act has passed detailing the availability, quality and distribution of health services to those with palliative and end-of-life needs. Marie Curie estimates that one in four people who could benefit from specialist palliative end-of-life care do not receive it. People who are poorer, less educated and, yes, non-white are even less likely to receive it.

I was horrified, if I am honest, by the earlier speech from the hon. Member for Loughborough (Dr Sandher). All the data shows us that people from minority ethnic communities are less likely to access the healthcare services they deserve, in particular palliative care. There is a deep distrust of health services, and those of us who were in this place during the covid pandemic saw that played out in real time in hospitals and care settings up and down the country, with far more people from minority ethnic communities losing their lives and far more healthcare professionals from ethnic minorities not protected in the way that they should have been. If those people from minority ethnic and disadvantaged communities are less likely to access palliative care as a result of the Bill being passed, contrary to what its supporters say, my fear is that more people—rather than fewer—will die a terrible, horrendous, traumatic and painful death and they will be disproportionately from those communities.

[Dr Sandher]

The hon. Member raises a powerful and excellent point about the people from ethnic minorities who died during covid and their access to healthcare. As she will understand, that is of deep importance to me too. She is right about the need for greater palliative care and I am glad, as she says, that we are having that discussion.

If we look at assisted dying around the world and concern around ethnic minorities being more likely to access it, the stats show that it is the other way around and they are less likely to access it. However, that point is neither here nor there; rather, given that the safeguards are in place, the question is: is the process working well? Those are where the stats are going forward. I believe that the hon. Member raises the matter in good faith, and I thank her for doing so.

[Munira Wilson]

I actually think the stats the hon. Member cited undermine his own argument, because all the data shows us that the members of the communities I am talking about are less likely to access the healthcare services they need and therefore, less likely to end up accessing assisted dying. The hon. Member for Stroud (Dr Opher) gave the game away—he is acknowledging it—that wealthier people tend to access assisted dying more because they have the choice, as well as the services to have that meaningful choice. Those inequalities deeply concern me.

My grave concerns about the Bill becoming law are that the people I am talking about do not have the loudest voices or well-funded campaigns to support them. This whole debate about inequalities in access to palliative care should be the topic of a debate on a separate day and I hope there is the chance to have that debate.

Marie Curie also warns that there is

“no realistic national or local plan to address the scale of this challenge”,

and that the whole system is in “a perilous state” due to a

“lack of sustainable funding…and limited prioritisation of…end of life care”.

A 2023 survey of integrated care boards found that half had no plans to invest capital in palliative care services and 40% admitted that their services were inadequate for the needs of their population.

--- Later in debate ---

[Mr Lee Dillon (Newbury) (LD)]

I hear the argument from hon. Members on both sides of the Chamber about palliative care in this country not being at the level that we would expect, and I accept that. What I do not hear from those who oppose the Bill is exactly what level we need so that assisted dying can go hand in hand with it as a genuine option.

[Munira Wilson]

I note that the Health and Social Care Committee and the hon. Member for York Central (Rachael Maskell) have undertaken a report, so they will advise us on that issue. [Interruption.] I am aware that I need to finish, so I urge hon. Members to support the amendments of my hon. Friends the Members for Wimbledon (Mr Kohler) and for Richmond Park (Sarah Olney) to ensure that we do not allow the Bill to implement sweeping Henry VIII powers on such a sensitive and important issue, and to ensure that we collect, through new schedule 2, important monitoring data on how any assisted dying or death service will operate. We need transparency.

[Lloyd Hatton (South Dorset) (Lab)]

I rise to speak in support of new clause 15 and amendment 54, and against new clause 5. As right hon. and hon. Members will be aware, new clause 15 would not classify a death under the Bill as suspicious or unexpected, so a full coroner’s inquest would not be needed.

If the Bill becomes law, assisted dying would be a legal, strictly regulated and well monitored choice made freely by the individual concerned. To be absolutely clear to hon. Members, it is not assisted suicide. The Bill concerns people who want to live but who, faced with an inevitable, irreversible and terminal diagnosis, want choice over the manner of their death. That is an important choice that removes some of the trauma and anxiety for not only the patients but their family and loved ones. New clause 15 and its consequential amendment 54 will ensure that families who are naturally grieving the loss of their loved one are not needlessly subjected to an invasive coroner’s investigation.

Oral Answers to Questions

Munira Wilson Excerpts

Tuesday 11th February 2025 Commons Chamber

[Ashley Dalton]

Yes, I would be more than happy to support that. That is part and parcel of this Government’s aim to shift the NHS from hospitals to community.

[Munira Wilson (Twickenham) (LD)]

2. What steps his Department is taking to improve access to mental health services.

[The Minister for Care (Stephen Kinnock)]

After 14 years of Tory neglect and incompetence, we inherited a broken NHS, and nowhere is that more apparent than in our mental health services. Too many people are waiting too long to access the care they need. To fix that, we will recruit 8,500 more mental health workers; provide access to specialist mental health professionals in every school, as the hon. Member has called for; roll out Young Futures hubs in communities; and modernise the Mental Health Act 1983.

[Munira Wilson]

With the Terminally Ill Adults (End of Life) Bill being amended to include a panel that will involve psychiatrists who will determine whether a request for assisted dying should be granted, as well as a number of cross-party amendments rightly calling for the involvement of mental health professionals earlier in the process, what assessment have Ministers made of whether there is sufficient capacity in mental health services, which the Minister has just noted are overstretched, to meet those demands, and on the potential knock-on impact on both waiting times and treatments for those with mental health conditions?

[Stephen Kinnock]

The hon. Lady will know that the Government’s position on the Terminally Ill Adults (End of Life) Bill is one of neutrality. I am on the Bill Committee simply to speak about the Government’s position on the workability and operationalisation of the Bill. We look forward to seeing the amendment that will be brought forward by my hon. Friend the Member for Spen Valley (Kim Leadbeater). Any comment we make or position we take will be based on the operationalisation of that amendment, should it become part of the Bill and, ultimately, should the Bill gain Royal Assent.

Hospice and Palliative Care

Munira Wilson Excerpts

Monday 13th January 2025 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

I pay tribute to my hon. Friend the Member for Wimbledon (Mr Kohler) for securing this debate and I thank the Backbench Business Committee for granting it. As he stated, the debate has taken on an added salience since the hon. Member for Spen Valley (Kim Leadbeater) brought forward her Terminally Ill Adults (End of Life) Bill on assisted dying. I hope we can all agree that regardless of what happens to the passage of the Bill, there is an urgent need to address hospice and palliative care. I want to touch briefly on two points: on children’s hospice funding and support; and, more broadly, on inequalities in access to palliative care, which relate to the concerns many of us have about that Bill.

On children’s hospices, I am very proud to have Shooting Star children’s hospice in my constituency in Hampton, to which my hon. Friend the Member for Wimbledon referred. As he stated, as well as serving children and young people and their families in my constituency, it actually serves a very wide area of south-west London, west London and all of Surrey. It provides care and support to children with life-limiting conditions, respite care, family support and, importantly, a bereavement service. From talking to the mother of a teenager who died very unexpectedly from an asthma attack in my constituency, I know that her young teenage friends have been very well supported by Shooting Star as they have been grieving their friend who so unexpectedly and tragically lost her life. I want to take this opportunity to pay tribute to Shooting Star for its incredible work.

Like other hospices, Shooting Star relies on the goodwill and generosity of so many in our community and beyond, skydiving, running, donating clothes and toys to its shops. As my hon. Friend pointed out, it now faces a £200,000 bill as a result of the employers’ national insurance rise. While I welcome the Health Secretary’s announcement prior to Christmas to renew the children’s hospice grant, I reiterate its question which was echoed by my hon. Friend: is this a long-term commitment and not just for the next financial year, and will it be ringfenced? It has told me time and again that it cannot plan for the future if it is living hand to mouth, year to year in terms of recruiting staff and putting services in place.

Hospice funding is so variable. As we have heard, Together for Short Lives reports that NHS funding in 2022-23 for children varied by as much as £483 per child. Hospice UK made a freedom of information request which found, shockingly, that 40% of ICBs have absolutely no idea how much they are spending on children’s palliative care. We need to hold our ICBs much more accountable for children’s and adult palliative care. Together for Short Lives also highlights a £295 million spending gap in NHS spending on children’s palliative care, when compared against National Institute for Health and Care Excellence standards.

That brings me to my second substantive point, on the variability of palliative care with particular regard to how it compares to national standards. Marie Curie estimates that one in four people who could benefit from specialist palliative end of life care do not receive it. People are more likely to get good palliative care, frankly, if they are richer, more educated, white and younger. The inequalities across our society in access to palliative care are growing and demand is growing, too. I had a number of conversations with the hon. Member for Spen Valley. These inequalities are one of many reasons why I really struggled and could not support her Bill on Second Reading. They really, really concern me. Back in 2011—getting on for 14 years ago—NICE recommended that there should be a designated palliative care advice line out of hours implemented in every area of the country, but only one in three areas offers that service. That shows us just how poor we are at putting in place what we have already been told needs to be provided so that people can die a good death. If that happened in any other area of care, particularly in cancer, there would, rightly, be outrage that we were not implementing NICE recommendations.

The 2024 Marie Curie “Better End of Life” report said that large numbers of people were struggling to access services. There was late recognition of their needs and poor communication. It found that the impact on carers of poor end of life care was profound. The physical and emotional toll that it took on carers left one carer saying:

“The overall experience is that no one really cares.”

When we are at our most vulnerable at end of life and our loved ones are also struggling, we deserve so much better. We need far greater investment in palliative care and hospice care. I urge the Minister to take genuine action to address both the geographic disparities and the deep inequalities that exist in accessing palliative care. We have a moral imperative, particularly if the assisted dying Bill makes progress. We cannot be in a position where assisted death is available universally on the NHS to those identified in the Bill, but access to good palliative care is not. That is what grated with me most and why I could not walk through the Aye Lobby that day. I urge the Minister and the Bill Committee to ensure that duties are written into law so that there is genuine choice at the end of life. Whether the Bill passes or not, we need to see much greater action on good palliative care.

--- Later in debate ---

[Munira Wilson]

On the children’s hospice grant, will the Minister confirm that it will be ringfenced, and that it will go beyond the one-year settlement?

[Stephen Kinnock]

Again, that is on the agenda for discussion with officials. Having inherited a disastrous situation, we are using 2025-26 to stabilise and to try to enable the sector to survive. The hon. Lady will understand that as well as doing that, we are looking at long-term reform solutions, but when we came into power on 4 July, it was one minute to midnight, and we had to rescue the sector. That is what we are doing, and we will look at the long-term issues in due course.

A number of Members have raised the concern around employers’ national insurance contributions. Since we came to office in July, we have been completely focused on repairing the catastrophic legacy of 14 years of Conservative neglect and incompetence. The first step was to fix the foundations of the public finances at the autumn Budget, and that enabled the spending review settlement of a £22.6 billion increase in resource spending for our health and care system. Our approach to ENIC exemptions has been consistent with the Office for National Statistics definition and the approach taken by previous Governments. It does not include an exemption for independent contractors, including charities like hospices, although December’s record funding announcement was a clear recognition of our commitment to financially supporting this vital sector more broadly.

I ask Opposition Members from all parties who luxuriate in criticising the means by which we have raised the record funding for hospices what they would do. How would they have raised the £22 billion that our autumn Budget delivered? Which taxes would they raise? Which public services would they cut? Answer comes there none. The Government recognise the need to protect the smallest businesses and charities, such as hospices, which is why we have more than doubled the employment allowance to £10,500, meaning that more than half of businesses and charities with ENIC liabilities either gain or see no change next year.

While the debate is not about assisted dying, I want to say a word on the matter. My hon. Friend the Member for Spen Valley (Kim Leadbeater) put forward her Bill, and it has received its Second Reading. It is vital that our approach to end of life care and patient choice is holistic and driven by an in-depth understanding of patient need.

I thank everybody across the House for this excellent debate. Actions speak louder than words. This Government have acted to deliver the biggest financial contribution to hospices in a generation.

National Insurance Contributions: Healthcare

Munira Wilson Excerpts

Thursday 14th November 2024 Commons Chamber

[Karin Smyth]

My hon. Friend makes an excellent point. We have still not heard from the Opposition whether they agree with the extra investment that has gone into the sector or with Lord Darzi’s report that diagnosed their legacy, including why they left that legacy and the serious issues we now have to address.

[Munira Wilson (Twickenham) (LD)]

Shooting Star children’s hospice in Hampton serves children with life-limiting conditions and supports their families not just in my constituency but across south-west London and Surrey. With the national insurance hike, it faces a bill of £200,000, on top of all the inflationary costs that it has had to absorb. It is also waiting for confirmation as to whether the children’s hospice grant, which this year provided it with £1.8 million, will continue beyond April 2025. Will the Minister commit to making hospices exempt from the NI rise, not just for nursing staff but for all staff, and when will she be able to give Shooting Star and other children’s hospices confirmation on whether the children’s hospice grant will continue? They need to plan now.

[Karin Smyth]

I commend the hon. Lady for raising the great work done by hospices. We understand the pressures and the precarious situation that many have been left in after 14 years of the last Government. We are willing and keen to talk to representatives from all types of hospice, and others. We are going through the process of the allocations and we will be able to get back to them as soon as possible.

Access to Primary Healthcare

Munira Wilson Excerpts

Wednesday 16th October 2024 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

As well as needing more GPs, our GPs need decent premises from which to deliver high-quality care to patients. Park Road surgery in my constituency has been looking for new premises for more than a decade—it serves 13,000 patients out of an old Victorian house—but there simply is not the budget, and the processes are too complex. Will the Minister commit to both looking at the bureaucracy and pressing the Chancellor for more capital investment in primary care?

[Stephen Kinnock]

As the Darzi review shows, one of the most egregious examples of the neglect and incompetence of the past 14 years is the underspend on capital. We are clear that a number of premises across the country can be repurposed, and that the bureaucracy needs to be cleared out of its way. As the Prime Minister said earlier this week, we will have a mission about smart regulation and clearing the bureaucratic barriers to change.

We are also cutting red tape so that GPs spend less time pushing paper and more time face-to-face with the patients they serve. We are working to bring back the family doctors and to end the 8 am scramble. We have done more for primary care in the last 14 weeks than that lot did in the last 14 years.

On dentistry, we will introduce supervised tooth brushing for three to five-year-olds in deprived areas, ending the national scandal of tooth decay. And we are rebuilding the bridges that the Conservatives burned with the British Dental Association. I have already met the BDA, and we will deliver a rescue plan that gets NHS dentistry back on its feet, with 700,000 additional urgent appointments, starting as soon as possible, in those parts of our country that need them most.

Oral Answers to Questions

Munira Wilson Excerpts

Tuesday 15th October 2024 Commons Chamber

[Stephen Kinnock]

I thank the hon. Gentleman for that question and the passion with which he put it. We are committed to rolling out Young Futures hubs across the country and, of course, we need to prioritise areas of particular need. I would be happy to meet him to discuss that further.

[Munira Wilson (Twickenham) (LD)]

A recent review of children’s mental health services in my local authority, the London borough of Richmond, found that, staggeringly, children with mild to moderate needs in tier 2 waited on average 15 months before receiving treatment, and those with more severe needs waited on average nine months. The Minister does not need me to tell him that during that time, children’s conditions get worse; they need greater treatment and, sadly, too many present at A&E self-harming and attempting to take their own life. As well as committing to mental health professionals in every school, will he put some money into acute provision, so that children do not end up in A&E?

[Stephen Kinnock]

We are absolutely committed to the three shifts: from hospital to community, from sickness to prevention and from analogue to digital. The sickness to prevention aspect is important in the question that the hon. Member raises. Treatable mental health conditions such as anxiety and depression should be identified early to prevent them from developing into something more serious and into a crisis, so I absolutely share the sentiment behind her question. They will be at the heart of our 10-year strategy for the future of our health.

NHS Performance: Darzi Investigation

Munira Wilson Excerpts

Monday 7th October 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

I beg to move,

That this House has considered Lord Darzi’s independent investigation into NHS performance.

I am pleased to have the opportunity to open this debate on Lord Darzi’s investigation into the national health service, not just so that we can debate the past and what went so badly wrong, but so that the House can also debate the future of our NHS, how it needs to change and the many reasons to be optimistic about what our health service can be.

We have to start with honesty. For too long, Conservative Governments swept problems under the carpet, more interested in scapegoats than solutions. [Interruption.] I know; it is terrible. That is why I asked Lord Darzi to conduct an independent investigation into our national health service. He is an eminent cancer surgeon, with 30 years’ experience in the NHS, yet what he found shocked even him: some 100,000 toddlers and babies were left waiting for six hours in A&E last year; more than one in 10 hospital beds are taken up by patients who do not need to be there; children are less healthy today than they were a decade ago; adults are living longer but getting sicker sooner; conditions such as diabetes and high blood pressure are rising relentlessly; mortality from preventable causes is far higher than in other advanced countries; almost 3 million people are off work sick; and waiting lists are at record highs while patient satisfaction is at a record low.

The fundamental promise of the NHS—that it will be there for us when we need it—has been broken for a decade. Why? Because of four knock-out blows. First, a decade of under-investment means NHS staff are forced to use pagers and fax machines, with fewer cancer scanners than Greece and buildings literally crumbling. That is not to mention the disgrace that the previous Government’s new hospitals programme was written according to fictitious timetables, with the funding running out this coming March.

Secondly, there was Andrew Lansley’s disastrous 2012 top-down reorganisation that nobody voted for, cost billions and took years. It was an enormous waste of time, talent and money that should have been spent on caring for patients.

Thirdly, there was a failure to reform. The reforms made by the last Labour Government, which delivered the shortest waiting times and highest patient satisfaction in history, were ditched—a golden inheritance squandered.

Fourthly, there was coronavirus. Lord Darzi found that the NHS was hit harder than any other comparable healthcare system because of the damage the Tories had already done. It is not just that they did not fix the roof when the sun was shining; they doused the house in petrol, left the gas on and covid just lit the match. That is why millions are stuck on waiting lists, ambulances do not arrive on time and people cannot see their GP. Never forgive, never forget and never let the Tories do it again.

[Munira Wilson (Twickenham) (LD)]

Lord Darzi’s report was utterly damning about the treatment of children in our health system. He said that too many children were being let down, and pointed out that they account for 24% of the population, but only 11% of NHS expenditure, and that over 100,000 children wait for over a year to be assessed for mental health treatment. He said we must do better, so will the Secretary of State commit to putting children front and centre of the 10-year plan, and to making them a priority, because for a decade, the Tories let our children down?

[Wes Streeting]

I strongly agree with the hon. Member. I will talk about the 10-year plan shortly, but I can guarantee that children and paediatric care will be front and centre of that plan. We can do much more to shine a spotlight on paediatric waiting lists, as well as doing much more in practice. She mentioned children and young people’s mental health, on which our parties strongly agree. We will deliver our manifesto commitment to put mental health support in every primary and secondary school in the country, as well as providing walk-in services in every community, so that young people receive the mental health and wellbeing support that they need and do not get to the crisis point reached by far too many of our children.

The hon. Member’s intervention is an example of why I am looking forward to the debate. I hope to listen to contributions and to challenge from all sides of the House. Before I take any interventions from Conservative Members, I advise them that if they want to get a hearing on the NHS ever again, then the first word that should pass their lips is, “Sorry”. Only last week, at the Conservative party conference, we did not see a single shred of remorse or contrition for their appalling record. Indeed, when it comes to the shadow Secretary of State and her party, it seems that sorry is the hardest word.

The NHS is broken. NHS staff do not want to accept that, but it is. According to YouGov, that is what the vast majority of patients say. It is also what staff tell me every time I am on the frontline, but I understand why some people find the word difficult. In the past few weeks, I have met some of the NHS team who happened to be on duty on Monday 29 July. I have listened to paramedics describe the scene they walked into at the community centre in Southport. Children and adults who had been dancing to Taylor Swift were lying bleeding and, in some cases, tragically dying as a result of an unimaginable, senseless, mindless attack. Those paramedics had to make split-second decisions about who to treat and in what order to give the injured the best chance of survival. Security teams cleared busy hospital corridors to shield as many people as possible from the horror. Lab teams mobilised blood supplies. Receptionists fielded calls from panic-stricken patients. Surgical teams across multiple hospitals worked together, fighting to save those young lives. Even now, months later, mental health staff are picking up the pieces for families who are either grieving or going through the unimaginable challenge of supporting their children through what they witnessed.

On that day, those NHS responders—the whole team involved—were the best of humanity confronting the worst. That is who NHS staff are. That is what they do. Let me be clear: the NHS may be broken, but NHS staff did not break it. I want to be clear about this too: what is broken can be fixed. While the NHS may be in the midst of the worst crisis in its history, the biggest asset that we have is the people who work in it. They are up for the challenge, and up for change. The NHS is broken, but it is not beaten. Together with the 1.5 million people working in the health service, this Government will turn our NHS around, get it back on its feet, and make it fit for the future.

Pharmacy Provision: Hampton

Munira Wilson Excerpts

Friday 26th July 2024 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

May I start by congratulating you, Madam Deputy Speaker, on your election? It is a pleasure to see you in the Chair. I also congratulate the Minister on his appointment. We have worked closely together in recent years in the all-party parliamentary group on kinship care, so I have no doubt that he will do an excellent job. I suspect that young Lyle is very proud of his granddad right now.

I am delighted to have secured this Adjournment debate. You might be surprised to learn, Madam Deputy Speaker, that this is the first I have managed to secure since my election in 2019, so I want to use this exciting opportunity to bring to the Minister’s attention the impact of pharmacy closures on the local community in the Hampton area of my constituency, as well as the immense financial challenges facing community pharmacy right across England. I will also raise concerns about the impenetrable bureaucratic processes, which need overhauling, in new pharmacy licence applications and pharmacy closures.

Let me set the scene. Last autumn, two Boots pharmacies in the Hampton area were closed. One of those pharmacies was in the Hampton North ward, one of three wards of relative deprivation in the London borough of Richmond upon Thames. The west of the ward is within the 20% most deprived areas of the country; it is densely populated with a significant amount of social housing. As a result of that closure in Tangley Park, the entire ward is now without a community pharmacy.

Hampton North is poorly served by public transport: there is no station, and the two bus routes serving the area are notoriously unreliable. The nearest pharmacy is now a mile away on foot, a distance that is difficult to cover for the elderly and those with mobility issues. It is certainly more than a 20-minute walk away, which is the measure that previous Ministers liked to use to highlight pharmacy accessibility. Predictably, those closures have put a lot of pressure on the nearest remaining pharmacies, which face queues and stock issues. Again, that is not exactly convenient or practical for elderly and vulnerable patients.

At this point, I pay tribute to Mike Derry and Healthwatch Richmond for their brilliant work championing local patients and giving them a voice. Healthwatch undertook a survey of some 700 residents in the Hampton area at the start of the year to demonstrate the impact of the closures. One person said:

“I have gone without medication as I can’t stand very long. There are queues—I have waited over half an hour.”

Healthwatch England highlighted the plight of 87-year-old Gill. She used to just about be able to get across the road from her house to the Tangley Park pharmacy. Now the nearest pharmacy is over a mile away, and Gill, who does not drive, cannot access that service because of the distance that she would have to walk to get there. She even paid the nearest pharmacy to deliver her medicines to her home each month, but in the eight months since she purchased the delivery service, it has shown up only twice. Her carer has to travel to collect the medication in person for her.

Hampton is not unusual in losing pharmacy provision. I am sure that the Minister is aware of the crisis facing the community pharmacy sector. Data from the Community Chemists’ Association shows that there has been a net loss of over 1,200 pharmacies—1402 closures and only 179 openings—since 2015. More than a third of those losses have been in the most deprived areas of the country. The National Pharmacy Association reports that the number of pharmacies that have closed so far this calendar year—the equivalent of 10 pharmacies a week—is nearly 50% higher compared with the same point in 2023. As well as independent pharmacies, big chains such as Lloyds Pharmacy and Boots have significantly accelerated closure numbers over the past 18 months. A big driver of these closures is a significant real-terms reduction in funding for pharmacy; that funding has dropped by around 30% since 2015.

[James MacCleary (Lewes) (LD)]

Is my hon. Friend aware of the issue of overwhelmed surgeries referring increasing numbers of patients to local pharmacists? I have seen it in my Lewes constituency. Does she agree that this will only contribute further to closures?

[Munira Wilson]

I thank my hon. Friend for his intervention, and I congratulate him on his excellent maiden speech. I completely agree with him. We want doctors to use community pharmacy more to alleviate the pressure on other parts of the health service, but frankly, if the pharmacies are not there, the remaining ones will be overwhelmed. I talked to local GPs in the Hampton area following these closures, and they were desperate to see more provision. They thought about trying to set up their own community pharmacy provision, but they just could not make the numbers add up because of the funding shortfall.

The Company Chemists’ Association estimates an average funding shortfall of £67,000 per pharmacy. That is based on an analysis of data published by the Department of Health and Social Care in a written parliamentary answer at the beginning of last year. Many pharmacists are left out of pocket, as they are reimbursed less for a number of medications than the price they pay, and there are stories of some using credit cards and overdrafts to purchase medication.

These funding pressures are coupled with major workforce challenges. When I met Boots following the news that it is closing two branches in Hampton, it cited a lack of pharmacists as a major reason for closing some 300 pharmacies across the UK, although commercial pressures were clearly the main driver. Layered on top of these issues are regular medicine supply shortages, which add more work and create more stress for already overstretched pharmacists. Community Pharmacy England reported last year that 92% of pharmacies were having to manage supply issues daily.

It is a perfect storm for community pharmacy at a time when we need preventive healthcare and self-care more than ever. The potential of community pharmacies to improve patient health and reduce the pressure on NHS hospitals and GPs is immense, yet they are closing in their hundreds every year. We should be relying on pharmacies even more to keep the nation healthy. The previous Conservative Government’s announcement of the Pharmacy First initiative was very welcome in its ambition, but if pharmacies are not even funded for the basics right now, with big gaps in provision opening up all over the country, it is hard to see how Pharmacy First’s ambitions will be achieved.

The Liberal Democrats would like to see the Government building on the Pharmacy First principle and giving pharmacists more prescribing rights and public health responsibilities. As in so many areas of public health, the “invest to save” argument is compelling, and I look forward to hearing the Minister’s comments on what the new Labour Government will do on funding to enable community pharmacy to not just survive, but thrive and grow as an essential part of our primary care infrastructure.

Having addressed the causes of these closures, I will spend some time exploring the processes involved in local communities being informed of pharmacy closures, and their input, or lack thereof, in them, as well as discussing the complete lack of transparency or accountability in relation to applications for new pharmacy licences. For starters, only those organisations designated as “interested parties” in the regulations are informed of new applications, and only their feedback has to be taken into account. Anyone else who is interested, such as me as a local MP, needs to make a freedom of information request, unless someone in the local health community passes on the information. My views, and the views of other people in the community, can be ignored.

To describe the bureaucratic process that sits around new applications as byzantine would be generous. I hope the Minister, Madam Deputy Speaker and other hon. Members will bear with me while I try to explain what happened in Hampton. We are part of the South West London Integrated Care Board, but NHS England has delegated the pharmacy market entry function for the whole of London to the North East London ICB, which is on completely the opposite side of the city. Officials have no local knowledge of our area, no understanding of local transport links and no relationships with the local health system.

Let me start with the closures. The Minister will be aware of the statutory three-month notice period for pharmacy closures; last August, Boots would have had to give NHS England three months’ notice of its intentions in Hampton. That information was not passed by NHSE to the Richmond health and wellbeing board. I find that utterly staggering. The first that local councillors, the local health community in the area and I as the MP knew about the planned closures was when Boots placed signs in its windows to inform customers, and concerned constituents started to contact me about the likely impact of the closures.

At the end of August 2023, while this was going on and we were all in the dark, the local health and wellbeing board published a pharmaceutical needs assessment, but it was inaccurate and failed to identify an imminent future gap in need in the Hampton North area because it had not been notified of the closures. The Tangley Park Boots subsequently closed in late October. The Priory Road Boots, which was directly opposite a busy GP surgery, closed in early November.

In November, an application was received for a new independent pharmacy licence on the Tangley Park Boots site. Once again, the local health and wellbeing board was not notified of the application—this time, for two whole months. During this period of complete silence, the health and wellbeing board issued a supplementary statement to the local pharmaceutical needs assessment, which identified the gap in Hampton. However, because the application for a new pharmacy was made in November, and it referred to the original needs assessment that was made before the supplementary statement was published, it was rejected, even though the application itself identified the gap, which was officially made clear in the supplementary statement subsequently published in December. Not only that, but it took the North East London ICB a full eight months to issue the rejection; tht happened earlier this month, even though the decision used evidence received in December to justify the rejection.

Madam Deputy Speaker, if you and other hon. Members are still managing to follow this sorry story, I hope you will agree that this decision is utterly perverse. It is also utterly unreasonable that timely applications to open pharmacies in response to multiple closures should be inherently prevented in this way. The delays in sharing information with the local health and wellbeing board and the delays in decision making are unforgivable. During the lengthy delay, the local authority received a planning application to change the Tangley Park pharmacy site into a fast food outlet. Thankfully, that was rejected earlier this month after representations from the public health team and councillors, but I am sure the public health Minister will agree that it would be unfortunate, to put it mildly, if a pharmacy were replaced with a fast food outlet.

One local official told me yesterday that the systems architecture is too complicated, and that there is a need for clearer responsibilities and accountability. Amen to that, I say. Healthwatch Richmond has demanded answers from the North East London ICB, but it has received a frankly woeful response that does not address the substantive question of why the application was so badly handled. The response passes the buck and blames regulations. To be clear, Healthwatch and I are not qualified to comment on the merits of an application; what we are doing is challenging the unfathomable process.

I say to the Minister that the huge funding challenges facing community pharmacy are pressing. I appreciate that they may be extremely difficult for him to address, given that the Chancellor has an iron fist as far as any additional public spending is concerned, but the Minister must wage a campaign to improve the funding situation. It makes financial sense. We will not grow the economy without improving the nation’s health. In that campaign, he will have cross-party support from Members on the Opposition Benches.

Revisiting the regulations and how NHS England is implementing them will cost next to nothing. There should be proper consultation with and involvement from the local community on closure notices, and changes in the process for new licences could ensure that we can quickly plug pharmacy gaps when they open up in areas such as Hampton. Crucially, those powers need to be delegated to the local ICB, with full involvement from the local health and wellbeing board. They know their communities and their geography best—trust them.

Finally, if the Minister could step in on the specific issues in my constituency—the application that has been rejected and is going NHS Resolution on appeal—simply to ensure a common-sense approach, the residents of Hampton North and I would be very grateful. We desperately need a new pharmacy for our community. I look forward to his response.

[Madam Deputy Speaker (Judith Cummins)]

I call the Minister.

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

May I start by welcoming you to the Chair, Madam Deputy Speaker? I congratulate you on your election earlier this week. I also congratulate the hon. Member for Twickenham (Munira Wilson) on securing a debate that is absolutely crucial, not just given the specifics of the case in her constituency, but for the precedent that it sets as we plan community pharmacy provision across England. I assure her that although Lyle missed out on his week in London for Whitsun half-term, because somebody called a general election, he is on his way to London as I speak, with Allison, so that we can do London as tourists this weekend.

I am responding on behalf of the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), who leads in this area. I start by paying tribute to pharmacists. It is a credit to them that surveys show that nine in 10 people who visit pharmacies feel positive about their experience. Colleagues appreciate how accessible pharmacies in towns and villages across our country are, but for too long, Governments have failed to recognise their essential role in safeguarding the nation’s health, not least in my constituency of Gorton and Denton. This Government know that people who work in pharmacies are highly trained specialists, and we are committed to helping pharmacists and pharmacy technicians reach their full potential.

Pharmacies already provide vital advice on prescriptions, over-the-counter medicines and minor ailments, but they do not just dispense medicines and proffer advice, important though that is; they must do much more than that. Many already offer blood-pressure checks, flu and covid-19 vaccinations, contraception consultations and treatment for the seven conditions covered by the Pharmacy First service. I supported Pharmacy First when I was in opposition, as I think the hon. Lady did, and my party pledged to build on the programme by making prescribing an integral part of the services delivered by community pharmacies. For that reason, in the next two years, we will ensure that every newly qualified pharmacist has a prescribing qualification, while we train up the existing workforce.

This year, NHS England is working closely with all integrated care boards on pilots to test how prescribing can work in community pharmacy, because like the hon. Lady, we want pharmacies delivering services that help patients to access advice, prevention and treatment more easily; services that ease the pressure on general practice and in other areas in the NHS; and services that unlock the knowledge and expertise that our pharmacists have to offer. This Government take the view that pharmacies can and should play an even greater role in providing healthcare on the high street. That is why we stood on a manifesto that promised to shift resources to primary care and to community services over time. Community pharmacies will play an important part in moving our health service from hospital to community, from analogue to digital, and from sickness to prevention. But we have only been in office for three weeks; this cannot happen overnight, and colleagues have been absolutely right to raise concerns with Ministers about the closure of pharmacies.

As we speak, well over 10,000 pharmacies in England are dispensing medicines, offering advice and delivering care, and despite closures, access to pharmacies remains good across most of the country. Four out of five people live within a 20-minute walk of their local pharmacy, but as we have heard in this really important debate, that is not the case everywhere in the country. I know, having listened to the hon. Lady, that in Twickenham it is higher than four in five, but in other parts of the country it is below one in two. In the most deprived parts of England there are almost twice as many pharmacies—a good thing—than in the least deprived, but we need better access across the country. To take the example of my own constituency, where access to pharmacies is fairly good, almost the entire population is within a 20-minute walk from a pharmacy. However, in certain rural areas, and in a growing number of urban areas because of the closure programme, that is not the case. In those rural areas, there are dispensing doctors who can supply medicines to patients, and patients across the country can access around 400 distance-selling pharmacies that deliver medicines to patients’ homes free of charge. It is true that experiences vary depending on where people live, but I am aware of the specific problem in Hampton following the closure of the two Boots pharmacies that she described.

[Munira Wilson]

On the point about the 20-minute walk and the four in five statistic, does the Minister recognise that a 20-minute walk for me or him is actually much longer for an elderly person or somebody with multiple health conditions or mobility issues? We have to work out what measure we are using. Yes, the Twickenham constituency may have many pharmacies, but we must look at that highly localised level. That is why we need the local authority and local health boards to be involved, because actually in Hampton, as a community, the transport links are terrible.

[Andrew Gwynne]

I completely understand the case the hon. Lady is making. I ask her please to understand that she is pushing on a bit of an open door. It is a completely different subject, but I have had exactly the same arguments about bank closures in my constituency. I am told that as long as the nearest bank branch is half an hour away by public transport, that is acceptable. Unfortunately, computer says no when it is two buses that do not meet up in between. I agree with her that there are complexities around drawing up arbitrary limits, but generally access to pharmacies is good. We need to maximise the use of the pharmacy network so that we get more pharmacists coming in.

Hospice Funding

Munira Wilson Excerpts

Monday 22nd April 2024 Commons Chamber

[Sally-Ann Hart]

I do, and I will be coming to that a little later.

The future of end of life care is uncertain, as increasing costs and demands are putting huge pressures on hospices and care providers. When it comes to the debate on assisted suicide, it is important that people feel confident that their end of life care will protect them from pain and suffering.

Certainly, we need increased funding. More resources are needed for end of life care services, including hospices, home care and palliative care teams. St Michael’s Hospice, for example, costs around £7 million a year to run and it receives about £2 million a year from the integrated care board and the remaining £5 million comes from the community in various forms. Like all hospices, St Michael’s is heavily dependent on the generosity of local individuals, companies, groups and trusts. This funding model is uncertain and unsustainable and places hospices under considerable strain.

[Munira Wilson (Twickenham) (LD)]

I thank the hon. Lady for giving way and congratulate her on this important debate. On the point that the hon. Member for Brent North (Barry Gardiner) made about children’s hospices, I have the fantastic Shooting Star children’s hospice in Hampton in my constituency, which serves a wide catchment area. The hon. Lady mentioned the statutory duty, introduced by the Government, on ICBs to commission and fund palliative care, but the problem is that there is such huge variability. Surrey Heartlands, which is one of the ICBs that Shooting Star serves, spends only a paltry £39 per child, even though the average should be about £151, and other ICBs will not even disclose the amount. Does she agree that we need multi-year contracts with ICBs to serve these hospices?

[Sally-Ann Hart]

I agree, and will come to that later in my speech.

Demelza receives just 10% of its income from the children’s hospice grant, which ends in March 2025, and just 4% of its income from spot purchases, so 86% of its income must come from fundraising. I am concerned that neither the UK Government nor NHS England has set out whether the children’s hospice grant, which is worth £25 million, will continue beyond 2024-25. The grant is a vital source of funding for children’s hospices. Dependence on the generosity of members of the public to pay for vital healthcare would not be tolerated in other core areas of healthcare such as maternity services, cancer care or A&E. Hospices are the only statutory service that relies on fundraising to keep going, despite end of life care being an essential service that so many of us will need.

--- Later in debate ---

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

I thank the hon. Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this important debate.

Hospices do incredible work. In communities across the country, they hundreds of thousands of people every year with essential palliative and end of life care. The services that hospices deliver are absolutely crucial to improving the quality of life for people in their final weeks and days, helping to provide a dignified, comfortable and compassionate end of life. That support is vital not just to people at the end of their lives, but to their family and friends. End of life care impacts not just the patient but all their loved ones, and the specialist support that hospices provide patients in their final stages of life, and their families who are watching them pass away without suffering or pain, is immeasurable. It is why hospices are so important.

In my Enfield, Southgate constituency, we are lucky to have a facility of the incredible North London Hospice, which has been caring for people since 1984. Its health and wellbeing centre in Barrowell Green helps to enable the best of life at the end of life for people across the boroughs of Enfield, Haringey and Barnet, providing tailored care, including physical, emotional, spiritual, wellbeing and bereavement support for patients, friends, carers and loved ones. I must also mention those in the wonderful North London Hospice photography club, who support each other and take amazing pictures, which they sell to raise funds for the hospice.

I remember hearing from a constituent of mine, Joy Watkins, who was receiving care and support at the hospice. Joy has sadly now passed away, but her words about the importance of the hospice and the care that she received were incredibly moving. Joy spoke about going to something called a death café—an informal space for people to talk about end of life, share their concerns and listen of others express their thoughts, hopes and experiences of death. 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 viewed and handled the end of her life.

The way in which we talk about and approach dying matters, and Joy’s words have really stuck with me. Indeed, they were one of the reasons I introduced my private Member’s Bill—the Terminal Illness (Provision of Palliative Care and Support for Carers) Bill—back in 2018. Next month, Hospice UK will be promoting its campaign for Dying Matters Awareness Week, and I look forward to supporting its efforts on that important initiative. Honest and timely conversations about death and dying are essential to good end of life care, but barriers including lack of confidence, taboos around discussing death, and confusion about who should be having these conversations all too often mean that patients, carers and families may not understand what is happening or get all the information and support that they need. That is where hospices and their brilliant staff come in. More recently, a close family member of mine received support from North London Hospice, and although Gabby sadly passed away, I am so grateful for the hospice’s specialist care.

Yesterday I and about a dozen hon. Members ran the London marathon. I was proud to do so to raise money for North London Hospice. When pounding the streets of London in such a wonderful festival of community yesterday, I was struck by how many runners were, like me, raising money for their local hospices. That demonstrates the sad reality of inadequate central funding for hospices. I have been trying to bang the drum for North London Hospice since I was first elected, and although it took me a few years to muster the courage to put on the running vest and put my knees on the line, as each year passes it feels as if the challenges facing hospices grow greater and more acute.

As we know, hospices are an integral part of our health and social care system. They work in partnership with local health and care systems, helping to reduce the pressure on our NHS by caring for patients who would otherwise be directly supported by NHS services. As a community, we are reliant on hospices—they are important parts of the communities that they serve—but they are also reliant on us for support, through fundraising and donations, because they are largely charitably funded. On average, around two thirds of adult hospice income is raised through fundraising such as charity shops and marathons, and the figure is higher for children’s hospices, which must raise around four fifths of their income.

[Munira Wilson]

On children’s hospices, Shooting Star in my constituency, which I have already mentioned, is very grateful that the Minister has committed to the children’s hospice grant for 2024-25, which comes centrally from NHS England. The problem is that that is a year-to-year commitment, which does not help hospices such as Shooting Star to plan for the long term. Does the hon. Gentleman agree that a ringfence should be placed around that funding and that it should be pegged to inflation year on year so that children’s hospices can plan properly?

[Bambos Charalambous]

The hon. Member makes an excellent point. Long-term funding is absolutely essential if hospices, particularly children’s hospices, are to be able to plan ahead.

North London Hospice is reliant on donations from the community each year to fill its £10 million funding gap, as only a small proportion of its costs are funded by the NHS. Of course, the cost of living crisis continues to eat away at people’s finances, which directly impacts on our communities’ ability to provide the vital charitable support that hospices rely on. The reality of the current state of funding is that hospices are struggling to keep up with inflation and rising costs, which is leading to services being cut. However, demand for palliative care continues to grow—for North London Hospice, it has grown at a rate of 5% year on year. The costs of running hospice services, including energy bills and the cost of paying staff a fair wage, also continue to rise rapidly.

Hospices recruit from a small pool of staff in the NHS and care sector, but they are not provided with the same Government funding to meet NHS pay levels, meaning that many hospice staff are doing the same job as their NHS colleagues but being paid less for it. As a result, Hospice UK’s figures suggest an 11% growth in payroll costs this year, which means around £130 million of additional spending that is not met by increased statutory funding. As I have mentioned, those costs are not met with additional uplifts from NHS funding or contracts, and despite a legal requirement for ICBs to commission palliative care services that meet the needs of the local population, the funding that hospices receive from ICBs varies significantly across the country and means that charitable donations make up much of their income.