Hospice Sector: Fiscal Support and Cost of Living

In my constituency, North London Hospice now faces an energy bill of more than £460,000 in 2023-24—an increase of £280,000. That is a huge amount of money, and it is more that can be bridged by any additional fundraising efforts. Although the energy bills discount scheme is welcome, it needs to be extended because, as I mentioned earlier, hospices do not have any other means of finding extra money. Fundraising is already very tight for hospices, so we need to make sure that we ask the Government for this funding. The Budget is only a couple of weeks away, and I hope that the Chancellor listens to our request.

There is also a wider argument, which I am not proposing to make today, about the funding for hospices generally. The service they provide should not just be a voluntary service that is topped up by whatever fundraising available. Hospices actually help the NHS by providing additional assistance. There should not be a postcode lottery whereby clinical commissioning groups choose to give hospices funding according to how they are prioritised in their areas. We need to look at the funding model for hospices.

Today, however, we are asking, in these very unusual and extreme circumstances, for the Chancellor to find additional money to support hospices, because it is some of our most vulnerable people who need their support. They are literally at the end of their lives, and hospices have no other way to receive funding. I urge the Minister—though it may not be up to him; it may be down to the Chancellor—to find the additional funding.

Before I close, I thank Hospice UK and Marie Curie for the excellent briefings they have provided for today’s debate. It is a shame that more Members are not present. I know that if the debate had taken place at another time, it would have been very well attended. I will leave it there, and I look forward to hearing from the Minister. I may have to leave before the end of the debate, so I apologise for that in advance, Mr Paisley.

As the hon. Member laid out, hospices have not been classified as an energy-intensive industry, whereas many other places—including even botanical gardens, I think—have been. Hospices are therefore not getting the additional support, yet supporting care for those with very serious conditions is an energy-intensive task. Hon. Members who have visited hospices will have seen the paraphernalia and the equipment, and children and their families also have to be kept warm. It is absurd. I plead with the Minister to make strong representations to his colleagues in the Treasury to ensure hospices are reclassified as energy intensive. Earlier this week in departmental questions, my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) asked the Secretary of State for Energy Security and Net Zero to consider a specific fund to support hospices with their energy costs. The Secretary of State said he would look at those concerns. I therefore task the Minister with speaking to both the Secretary of State and colleagues at the Treasury to see what can be done to support Shooting Star and many other hospices.

We have heard that food and other supply costs are rising, which brings me to funding streams. We know that hospices are heavily reliant on fundraising, and in recent years, children’s hospices have been receiving a children’s hospice grant from NHS England, which they are grateful for. In 2023-24, that funding is due to rise to £25 million. I recognise and welcome that, and I thank the Department of Health and Social Care for making the grant available. However—and this is an important “however”—beyond 2023-24, there is no guarantee that that funding will continue. The grant represents about £1 in every £6 that children’s hospices spend. Another important point is there is no commitment that NHS England will continue to deliver it as a ringfenced grant. If it is not directly distributed to children’s hospices as a ringfenced grant from NHS England centrally, but is instead devolved down to integrated care boards, some of which are already projecting deficits, there is concern that the grant may go to plug black holes in ICB budgets. When the Minister rises to speak, will he first give some sort of commitment on funding continuing between 2023 and 2024? Clearly the quantum cannot be specified while discussions are ongoing with the Treasury, but will he give some reassurance to the children’s hospice sector that that money will continue beyond 2023-24, and that it will be centrally administered as a ringfenced grant rather than going via ICBs?

Together for Short Lives says that if that grant were to be cut, nearly one in five children’s hospices would cut end of life care, over a quarter would cut symptom management services and nearly two thirds would cut short breaks for respite. Children who are critically ill and very sick deserve better, so I implore the Minister to provide those assurances to Shooting Star in my constituency and all the children’s hospices across the country that provide such vital support and care.

I have not yet had the privilege of visiting the new Prince and Princess of Wales Hospice in Bellahouston Park in Glasgow, but a few years ago I visited its old facility on Carlton Place. The sense of peace, care and compassion was almost tangible. Many people in the west of Scotland also know the dedication of staff and volunteers at the St Margaret of Scotland Hospice in Clydebank. All this work builds on a tradition that dates back to the pioneering work of Dame Cicely Saunders in the 1960s, further to the work of Jeanne Garnier in 19th century France.

The specialist services provided by hospices come with specialist and specific costs. As everyone who has spoken already has said, energy is the first and foremost of those costs. Medical equipment needs to run 24 hours a day, seven days a week, and residents need to be kept warm and comfortable—that is one of the key aspects of palliative care. The steep increases in energy prices are having an immediate and significant impact. The Hospice UK briefing speaks of some hospices facing up to fivefold increases in energy bills.

Wider inflationary pressures are also having an impact. Food and nutrition are crucial in providing holistic care, helping people to maintain their strength as they live through what is often their final illness. Hospices need to be able to provide residents with nutritious meals of the best possible quality, but those costs are spiralling as well, potentially costing the sector as much as £100 million a year extra. On top of that, staff have to be properly remunerated. Hospice UK estimates that 71% of costs are related to staff. Every staff member will be feeling the individual and household pressures of the cost of living, and organisations want to be able to pay their staff a fair and decent wage. At the same time, as the hon. Member for Enfield, Southgate (Bambos Charalambous) drew out, there is a risk of a squeeze on fundraising and traditional sources of donations because of the financial pressures that many people are experiencing.

My hon. Friend the Member for North Ayrshire and Arran was not wrong to say that this is becoming an existential issue for many hospices around the country. If hospices cannot provide the service that they do, the cost will be borne elsewhere. It will have to be borne by the NHS more directly—people staying in hospital for longer, and patients not getting through as quickly as they might—or local care services will have to provide more intensive support for people in their own homes. Of course people should be supported to die in their home if that is what they want, but that is not done without cost, and that cost has to be met from somewhere. If it is not met by the local authority, the NHS or the hospice sector, it will be met by households, which in turn will lead to a further spiral.

Even when there are pressures on funding, we must think about the preventive elements of spending efficiently and effectively, whether it is the Department of Health and Social Care or the Treasury. The Treasury ultimately holds the purse strings, and Members were right to say that it would have been useful to hear from the Treasury, but I am sure that the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O'Brien), is capable. The Government speak with one voice, and I am sure he will pass all this on.

There has to be a recognition of the stark financial situation and action to address it. As others have said, hospices are not pubs or restaurants—they do not pass their costs on to customers. The next phase of the energy bills discount scheme has to recognise that and provide targeted support for organisations that need it most. The hon. Member for Twickenham is right: zoos, museums and botanic gardens play incredibly valuable and important roles for society and the economy, but it seems incongruous to say the least that they should qualify for more support than the hospice sector does under the Government schemes.

The Government must also think about how they can address staff and skill shortages. They do not like to hear it, but the reality is that Brexit has caused a black hole in labour supply in the United Kingdom. The Government have to invest both in medium and long-term training and skills development, so that hospices provide attractive careers for people who already live in the United Kingdom. It is inspiring to see the care that is provided in the hospice sector, and people should want to make that a career. It is a privilege to support people at the very end of their lives, but we cannot expect people to do that for free. They have to be rewarded, have their skills recognised, be paid a decent wage and be trained to an appropriate level, so the Government must invest in that area.

The Government also have to address short-term challenges, which means they have to be far more generous with their visa regime. They might even think about some of the asylum seekers, who may or may not have come here on small boats, who are currently sitting in cramped and crowded hotel rooms, playing cards and watching TV, who have qualifications and training in nursing and medicine. They want help the country that they have come to. They have fled persecution and want to make their homes here. I meet such people all the time, not just in my constituency but around the country. Perhaps the Government should think about allowing those people to contribute to our society, particularly the hospice sector.

The Government should think about what lessons they can learn from the Scottish Government’s approach. My hon. Friend the Member for North Ayrshire and Arran spoke about the investment that they are making in the hospice sector. They had a strategic framework for action and are now developing a strategy on palliative and end of life care. They are also providing £7 million a year to the Children’s Hospices Across Scotland movement. Parking places at hospices will be exempt from workplace parking levies, and there is an ambition to create a national care service that will ensure consistency and fairness at national level with services that are designed and delivered locally.

I want to end on the note of consensus that has come through in the debate so far by paying tribute to the incredible work of the hospice movement, which supports people through some of the most difficult times of their lives. I recognise that hospices are experiencing their own difficult times, so we have to do everything we possibly can to support them.

I am sure the Minister will point us towards the energy bills discount scheme, but, as we have heard today, under that scheme hospices will be eligible for the same reduced level of support as pubs and restaurants, and even less support than a zoo or a museum. I appreciate this is not in the Minister’s brief, but I would be grateful if he set out the rationale for that and whether the Government have a plan to reassess and address that in the coming Budget. Although NHS services may have their energy bills paid for by the Government, hospices will be expected to raise money to pay the astronomical bills that they will receive after April.

How do the Government expect already struggling communities to keep hospices running? I am sure the Minister agrees with me about how unfair that is, and I am sure he also agrees with the praise for the hospice sector we have heard this afternoon. In February, a written question in the House of Lords asked the Government what assessment they had made of the impact of the increased cost of living and energy costs on hospices in England. Sadly, the answer was:

“No assessment has been made.”

I would be grateful if the Minister gave a commitment to carry out such an assessment.

The NHS long-term plan includes a welcome ambition to improve end-of-life care. I struggle to see how that ambition will be met, in the light of hospices being under such fiscal pressure. It feels like Government support of the sector is lacking. So many of us will, at some point, rely on hospices to take care of us or our loved ones. Following the pandemic, we see even more referrals to hospices. I will be interested to hear from the Minister what assessments have been made of the ambition to improve end-of-life care in the light of the compelling arguments that Members have set out this afternoon.

Yesterday, the APPG for hospice and end of life care released its report, “The Lasting Impact of COVID-19 on Death, Dying and Bereavement”. One of its recommendations is that the Government should conduct a review of hospice funding in England. I would be grateful if the Minister could tell us whether the Government will be considering those recommendations and when we are likely to hear the response. Hospices do such fantastic work, in providing care in the most unimaginable of circumstances. We need to ensure that they continue to do so.

While so much palliative and end-of-life care is provided by NHS staff and services, hospices also provide significant support to people at the end of their life and to those important to them. They are mainly independent charitable organisations that receive funding from a mix of public sources and charitable donations. The sense of purpose that is shared with the community—the community cares for the hospice and the hospice cares for the community—is something that we should cherish. I see that strongly in my constituency. It is emblematic of the incredible rallying of compassion and care that we see around hospices all over the country. We should also note the important role that hospices played at the height of the covid pandemic when considering their important place in their communities.

In England, integrated care boards are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local populations. In the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission. That will ensure a more consistent national approach and support commissioners in prioritising end-of-life and palliative care, as hon. Members have called for. In July 2022, NHS England published new statutory guidance on palliative and end-of-life care to support commissioners with that new duty. It includes specific reference to ensuring the sufficient provision of specialist palliative care services and hospice beds, and ensuring their future financial sustainability.

I recognise the importance of quality palliative and end-of-life care for children and young people. NHS England is investing £23 million via the children’s hospice grant by March 2023, rising to £25 million by 2023-24, in order to provide care close to home for seriously ill children when they need it.

On the question that the hon. Member for Twickenham (Munira Wilson) asked, although we only set out funding to date in the spending review, that does not mean that all funding will be cut off at that point. We are exploring exactly how that funding will be provided in the future. Furthermore, this financial year, NHS England has made £5 million of match funding available to ICBs for local children’s palliative and end-of-life care services. That will rise to £7 million in 2023-24, demonstrating the value of those services.

The funding of hospices and the sector is indicative of the Government’s commitment to their work and the vital societal role that they play. We recognise, however, that hospices, like every other organisation and household across the country, are having to contend with a range of budgetary pressures, including huge energy costs following the Russian invasion of Ukraine.

A large part of hospice activity—probably the majority—actually takes place in people’s homes. That is why we are also taking action on domestic energy pressures. In fact, this winter we are spending a total of £55 billion to help households and businesses with their energy bills. That is among the largest support packages in Europe. A typical household will save about £900 this winter under the energy price guarantee, in addition to the £400 energy bill support scheme for households. On top of that, we are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making people’s homes easier and cheaper to heat.

To help with some of the other cost of living pressures on households—which is the last thing people need when they are in need of hospice care—we are taking measures such as the extra £900 cost of living payment for 8 million poorer households, the largest ever increase to the national living wage for 2 million workers, and a total of £26 billion for cost of living support next year. I hope some of these supportive measures will reassure Members about the Government’s commitment to the sustainability of the hospice sector, particularly during this challenging fiscal period. I understand that the rising cost of living has caused all kinds of uncertainties, and we continue to engage proactively with the sector to try to understand the issues it faces.

I hope that the Minister will feed back to his colleagues in the Department for Health and Social Care that there is no denying that, whatever progress we make or do not make on energy bills, we need a more sustainable, long-term, comprehensive funding plan for hospices. They are struggling to survive. I mentioned the comment from the chief executive of Sue Ryder about hospices relying for essential income on bake sales, selling second-hand clothes and sponsored walks. All those things are very worthy, and they make a valuable contribution, but by themselves they inherently mean that the financial stability of hospices is undermined. As the hon. Member for Twickenham (Munira Wilson) said, long-term planning for the hospice sector is important.

I hope that the Minister will agree with the need for a long-term plan, and that he has paid close attention to the representations made across the Chamber today. No Government want to preside over the demise and loss of our hospice sector, and I am sure that the current Government do not want to be in that position. That is why we need urgent action now to save our hospices.

That this House has considered fiscal support to the hospice sector and increases in the cost of living.