Ageing and End-of-life Care

Sam Carling Excerpts

Thursday 30th October 2025 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this debate. The range of topics about which he is knowledgeable never ceases to surprise me. We are grateful for his contribution to this House, and I wish his mother well.

I am also grateful for the speech of my hon. Friend the Member for Shipley (Anna Dixon). She is too modest to say so, but she is indeed an expert in social care and ageing, and her calls for a national strategy for end-of-life care and ageing have been heard. I thank my hon. Friend the Member for Carlisle (Ms Minns) for sharing her powerful story about her mother—that cannot have been easy, so I am grateful for her bravery. Like my hon. Friend the Member for Weston-super-Mare (Dan Aldridge), I pay tribute to the hospice in Weston and the dedicated team there. I will be happy to pass on any correspondence required regarding the issues that the hon. Member for Epsom and Ewell (Helen Maguire) highlighted about the 111 service.

The planning, funding and delivery of health services are devolved matters, but I am delighted to answer on behalf of the Government on what we are doing to improve palliative care and end-of-life care in England. I would like to take this opportunity to thank all of those who work and volunteer in palliative care, both in the NHS and in our hospice sector, for the support they provide to patients, families and loved ones. It would be remiss of me not to mention the Prince & Princess of Wales hospice in my own constituency, which recently took such good care of my cousin as she passed away from breast cancer.

This Government want a society in which every person receives high-quality, compassionate care from diagnosis through to the end of their lives, irrespective of their age, condition or geographical region. As the hon. Member for Strangford has adumbrated, end-of-life care and palliative care is much more than cancer care; it is about ageing and ageing well. We recognise that there are currently a high number of hospital admissions and bed days at the end of people’s lives, and the last year of people’s lives accounts for 15% of emergency admissions and approximately a third of all bed days.

[Sam Carling (North West Cambridgeshire) (Lab)]

I am passionate about ensuring that older people in medical settings are not subjected to coercion over their medical decisions. I have recently been contacted by a whistleblower from the Jehovah’s Witnesses, who has expressed concern that some of the religious assistants who come in to support patients with their decisions are actually coercing them. Will he offer any thoughts, more broadly, on how we can ensure that people are not being subjected to coercion in older care settings?

[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.

Oral Answers to Questions

Sam Carling Excerpts

Tuesday 19th November 2024 Commons Chamber

[Chris Vince (Harlow) (Lab/Co-op)]

8. What assessment his Department has made of the adequacy of patient access to primary care services.

[Sam Carling (North West Cambridgeshire) (Lab)]

21. What assessment his Department has made of the adequacy of patient access to primary care services.

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

Mr Speaker, I associate myself with your remarks about the war in Ukraine. I know the whole House stands with Ukraine as it defends its freedom and democracy. This is precisely why the Prime Minister’s leadership at the G20, and in other international fora, is vital in standing up not just for our national interests but for our values across the world.

Over the past decade, the Conservatives’ mismanagement has left the NHS with 1,400 fewer full-time equivalent GPs than in 2015, hundreds of practice closures, the loss of over 1,000 community pharmacies, and NHS dentistry a distant memory, which is why this Government took immediate action to employ 1,000 more GPs. Through the additional roles reimbursement scheme, through the Chancellor’s Budget measures and through our 10-year plan, we will shift the focus of healthcare out of hospitals and into the community.

--- Later in debate ---

[Wes Streeting]

My hon. Friend is right that many of the pressures on our hospitals, such as the Princess Alexandra in Harlow, are a result of pressures in other parts of the health and social care system. It is outrageous that the biggest reason for five to nine-year-olds presenting to hospital is tooth decay, which is why we need to get NHS dentistry back on its feet, along with the rest of the NHS.

My hon. Friend the Minister for Care and I have regularly met the British Dental Association since the general election to consider how the dental contract can be reformed to retain dentists and rebuild NHS dental services.

[Sam Carling]

In my local area of Cambridgeshire and Peterborough, GPs are reporting feeling increasingly burnt out, with working conditions becoming more extreme. The number of patients per fully qualified GP in my area has increased by nearly 400 since December 2016, a higher increase than the national average. Can the Secretary of State tell me what his Department is doing to make the situation more sustainable while improving access to primary care?

[Wes Streeting]

General practice is a valued part of the NHS, and GPs are a vital part of our NHS family. In fact, they are delivering more appointments than ever before, and we recognise the significant pressures they face. At the same time, we know that patients are struggling to see their GP, which is why we have invested an additional £82 million into the ARRS to recruit 1,000 more newly qualified GPs this year. This will take pressure off general practice, and we will be announcing further budget allocations in the not-too-distant future to set out what further support we will provide for general practice.

Healthcare Provision: East of England

Sam Carling Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Sam Carling (North West Cambridgeshire) (Lab)]

I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing this important debate.

Following the election, some of the earliest emails I received were from NHS staff from a variety of disciplines who feel deeply undervalued, under-appreciated and overworked. In May of this year, GPs in Cambridgeshire carried out 547,804 appointments, 62.5% of which were face to face. That is the equivalent of 64% of the county in just one month.

There are more patients per fully qualified GP in the east of England than the ratio for England as a whole. It is the same for my region of Cambridgeshire and Peterborough, and in my constituency of North West Cambridgeshire there are fewer fully qualified GPs than in 2017. Local practices simply do not have the funding to hire more GPs, so we find ourselves looking at a ridiculous situation where we invest as a nation in world-class training for new GPs, through six years of medical school followed by foundation years and more, but once they qualify they often cannot find work.

It is not just about putting more funding into the system as a whole; allocation is not working fairly either. As the hon. Member for South Cambridgeshire (Pippa Heylings) just mentioned, the funding formula used for the general medical services contracts, under which most GP surgeries operate, is based in part on data originating before 2000. Leading GPs I have spoken to expressed a firm view that it discriminates against not just some of the areas the hon. Member for South Cambridgeshire mentioned, but urban settings with younger patients, despite significant health needs in those areas. I represent a significant part of urban Peterborough, which last year was ranked as the least healthy place in the entirety of Britain. This must be seriously examined, with changes made.

GMS contracts are held by practices in perpetuity, but a number have had to hand back their contracts to local NHS commissioners, which leads to their practices being put under time-limited commercial contracts called APMS contracts—alternative provider medical services contracts. That occurs when practices just cannot cope financially any more, and the rate in our region is truly shocking. Nationally, around 1% of GP practices are on APMS contracts. In Cambridgeshire and Peterborough, it is 12.5%, or one in eight, with many more on the edge.

These contracts are held by private companies whose loyalties lie with their shareholders. The stealth privatisation of our regional services is an appalling legacy of the last Government’s 14 years of failure. Not only are these private contracts bad for patients, with continuity of care poorer due to a higher proportion of locum staff employed, but they are far more expensive for the taxpayer. I know of one practice in the region that is being given £40 of additional funding per patient under an APMS contract, when ironically even half of that extra funding added to the GMS contract they handed back would probably have solved the problem. That makes me even more pleased and proud that this new Government are taking immediate steps to address the situation, with a 7.4% increase to the global funding sum for GP practices announced for 2024-25. We will fix this mess, but it is going to take time.

Healthcare needs have become greater over time. This is particularly acute in the east, the fastest-growing region in the UK in the 2010s, where the population grew by 8.1% between 2011 and 2021. Like much of the UK, the east is ageing. As people live longer, their healthcare needs become more complex and challenging, and a thriving workforce is needed to address those appropriately. If those needs are left unaddressed, NHS England warns of a shortfall of between 260,000 and 360,000 staff by 2036-37, with patient demand increasing across the board.

In my maiden speech, I highlighted the dental desert that we face in Peterborough; others have mentioned their areas. Some people have to travel as far as Stevenage and Kettering to receive treatment because, in our city, there are no adult dental clinics accepting new NHS patients. The British Dental Association has warned that unmet need for NHS dentistry in the UK is at an all-time high, and the Government will need our support to bring that down.

Of course healthcare is a joined-up issue affected by several other policy areas. The crisis in social care, for example, has exacerbated many of the issues faced by the health sector. Some in our eastern region have championed innovative methods to tackle that, such as models using virtual beds—of which there are 190 in Cambridgeshire and Peterborough; feedback has been really positive there. We need to support that kind of innovation to make our NHS fit for the future, as I know the Government will.

However, the issues in healthcare seem never ending: RAAC-ridden hospitals are having to be replaced; GPs and NHS workers are burnt out; recruitment and retention are difficult yet, simultaneously, some cannot find work; access to dental care is non-existent for some; healthcare inequalities persist; and patient demand is growing and growing.

Dealing with all of that is a huge undertaking, and the Government have been left with a terrible inheritance. Addressing it will require a deftness, competency and compassion that we have not seen for 14 years. But the Government have started well, and I have every confidence that the east, and those in my constituency of North West Cambridgeshire, will benefit from this Labour Government’s approach and see a better experience for staff and patients alike.