That this House has considered Ashgate Hospice and palliative care in north Derbyshire.
In late June of this year, my fiancé Amanda and I found ourselves, along with 3,000 others, dressed in bright-pink t-shirts, wearing flashy-pink bunny ears, setting out from Chesterfield football stadium on the annual Sparkle Night Walk, a fundraiser for Ashgate hospice in north Derbyshire. Fundraisers raised over £385,000 that night—another reminder of the precious place that Ashgate hospice has in the hearts of the people of north Derbyshire.
It is often said that everyone in north Derbyshire knows someone who has been helped by the hospice. It is impossible to overstate the affection for it, or the commitment that local people demonstrate to raising funds for it. Ashgate is a charitable hospice providing specialist palliative and end-of-life care for about 2,600 people each year across north Derbyshire. In October came the devastating announcement that Ashgate was consulting on making as many as 52 posts redundant, and planning to close 60% of its in-patient beds.
I have received so many emails from really concerned constituents about this issue. There was one that stuck out: it was from a serving member of the armed forces, who wrote to me about her elderly mother who recently passed away at Ashgate. She was stationed abroad, but flew home to be with her mum, and was able to spend five days and nights with her—her mother’s last moments. Does my hon. Friend agree that we should all be extremely thankful for the high-quality care that Ashgate hospice gives to our constituents and others, and that we should all be concerned about the reduction in beds and the loss of jobs?
My hon. Friend is absolutely right. There is a reason why Ashgate holds a dear place in people’s hearts. It is because at the lowest ebb, Ashgate has been there to provide love, care and support when all else is lost. This is a story that we hear so many times.
While the announcement caused shockwaves across the community, it did not entirely come as a surprise to Derbyshire MPs, who had for many weeks been attempting to get clarity between the then Derbyshire integrated care board and the hospice on a number of issues.
My hon. Friend mentioned other Derbyshire MPs. Many of my constituents have told me how Ashgate hospice has been there for them in their darkest moments. Paula Reeve told me that what Ashgate did for her mother, Joan Dempsey,
“felt nothing short of miraculous...That time was a very precious gift and my family remain in the debt of all the staff at Ashgate”.
Does my hon. Friend agree that we owe it to individuals like Paula to ensure that Ashgate hospice gets the funding it needs to continue these valued and vital services?
I absolutely agree with my hon. Friend. It is important to say that a half-hour debate is primarily an opportunity for a single Member to raise something with the Minister, and to get a ministerial response, but as my hon. Friends the Members for Derbyshire Dales (John Whitby) and for Bolsover (Natalie Fleet) made clear, it is an issue that is felt incredibly passionately right across the north Derbyshire community. My hon. Friend the Member for North East Derbyshire (Louise Sandher-Jones) would also have been here if she was not on Ministry of Defence duty in Gibraltar. It is an issue that many of us feel passionately about.
It is important to get across that, in those meetings, we wanted to establish what exactly the ICB’s current funding was paying for and how that benchmarked against the overall level of funding that hospices were receiving in other areas, and to get an agreement on an interim level of funding to enable the hospice to continue providing the current level of care while a more detailed investigation into the current cost of care was commissioned.
I commend the hon. Gentleman for securing this debate. I spoke to him beforehand to suggest a helpful intervention. He rightly said that fundraising is important for the hospice, but NHS funding never covers more than a fraction of the cost. There are four distinct hospices in Northern Ireland that provide instrumental support in terms of end-of-life care for those who require it. Does the hon. Gentleman agree that there must be a national minimum NHS funding level for hospice care to ensure that services across this whole nation are not depleting as a result of lack of funding?
I absolutely agree. One of the frustrations that many of us in Derbyshire have felt is that there is no clarity on what a reasonable level of funding is and what the expectation is. There are rumours flying left, right and centre. In the middle of all this, the staff, the patients and the fundraisers are left wondering who to believe and what the situation is. I hope that, when we hear from the Minister, we will learn more about that.
In the summer, the ICB produced a comparison with NHS-funded care in the south of the county in an effort to show MPs that Ashgate hospice was too expensive, but has now disowned that comparison. After several months of pretty unsatisfactory discussions at which the two sides never reached a settled position even on what was currently being spent, the move from Derbyshire to a three-county ICB model saw a sudden withdrawal by the ICB of any suggestion of interim funding, forcing the hospice to go ahead with plans to make redundancies.
Our hospices receive an average of just a third of their funding from Government via the NHS and are reliant on fundraising for the rest. The Government contribution fell dramatically under the 14 years of the previous Government, leaving the gap for charitable hospices to make up even larger. Year on year, hospices such as Ashgate have expended any fat in reserve and are now faced with intolerable financial pressures. In today’s debate, I am seeking to make the case for a more equitable funding settlement for all hospices to gain greater clarity about the particular situation in Derbyshire and see whether anything can be done to stave off these terrible service closures and nurse redundancies in an institution that provides outstanding palliative care.
Let me touch on the national context. Hospice UK published research last month showing that 57% of hospices ended the last financial year in deficit, with 20% recording a deficit of over £1 million. That is actually a slight improvement on the staggering 62% of hospices that recorded a deficit a year before, thanks to the emergency £100 million of additional funding provided by this Government. A health system that relies on a sector so chronically underfunded that 57% of hospices are in deficit to provide care is simply not functioning. The Government are right to make it a priority to assist hospices such as Ashgate to get back on their feet.
It is a real pleasure to serve under your chairship, Dr Huq, and I really thank my hon. Friend the Member for Chesterfield (Mr Perkins) for raising this important issue.
This year, I have seen at first hand—at the Wigan and Leigh hospice, the Noah’s Ark Children’s hospice in Barnet, and Katherine House hospice in Staffordshire—the vital role that hospices play in our communities, so I completely understand why my hon. Friend speaks so passionately about Ashgate hospice. And I will take a moment to thank everyone working or volunteering in the hospice care sector over Christmas, especially those who are spending Christmas day away from their own families just to bring a bit of joy to the people they care for.
This Government want a society where every person receives high-quality and compassionate care, from diagnosis through to the end of life. Hospices and wider palliative and end-of-life care services will play a key part in our efforts to shift more care out of hospitals and into the community. However, we inherited a palliative and end-of-life care system that is under pressure and we absolutely recognise the financial challenges that hospices face as a result of rising costs and reduced charitable income.
Let me echo what my hon. Friend said by also commending his constituents who came together to put their time, effort and money into fundraising. The fact that they managed to save two beds at Ashgate hospice from closing shows how important the hospice is to the wider community, even if challenges clearly remain.
Most hospices are charitable and independent organisations that receive some statutory funding for providing NHS services. The amount of funding that charitable hospices receive varies, both within and between ICB areas. Such variation can often be explained by the level of demand in a particular area, but it can also be explained by the totality and the type of provision from both NHS services and non-NHS services, including charitable hospices, within each ICB area.
I welcome tremendously what the Minister said. It is important to get on record the 55% increase since 2022 because many people contact me to say, “Why have you made cuts?”. Actually, though Ashgate has a £250,000 a month shortfall in what it is spending, there have not been any cuts—it is important that people understand that. I welcome the Minister’s intention to broker a discussion; I am keen to take him up on that offer. Neither staff nor fundraisers are sure of what they know on this issue. They would welcome someone independent coming in to provide that space between the ICB and the hospice. I welcome what the Minister said about the neighbourhood funding model and his recognition that the sector is in crisis, but right now we need, on a local basis, to address the matters that he has raised. I thank him for his commitment to do so.
We have a plan for next steps and I look forward to discussing those with him further.
Motion lapsed (Standing Order No. 10(6)).
11:30 am
Sitting suspended.
Although it is true that this crisis evolved under the previous Government and sat there on the ballooning list of things to do when this Government came to power, many hospices like Ashgate had spent year after year dipping into their reserves and had no fat left to cut when the Government’s welcome increase in funding was accompanied by the rising employer’s national insurance, the minimum wage increases and the NHS pay increase, which is obviously relevant to the wider health community. Many hospices are on the brink. I join the call of many other MPs from across the country for a more generous funding settlement that recognises the crucial role that hospices play in our health system.
Turning to the local situation, it is immensely frustrating to all the Derbyshire MPs, to staff, to unions and to local fundraisers that even at this stage there seems to be a lack of clarity about the current cost of care and how that benchmarks against hospices nationally. A letter I received yesterday from the ICB repeats the suggestion that it has offered to commission an independent review and provide some financial mitigation linked to specific and agreed service mitigations, funded up to £100,000. Indeed, the ICB repeats its view that those financial investigations will be necessary if sustainable solutions are to be found to funding palliative care. Ashgate’s view is that there is no lack of clarity about what money is being spent on, and that it demonstrated that to the ICB’s director of finance at a recent visit.
The situation seems largely unchanged since late October, but many staff face the threat of redundancy, and in the run-up to Christmas some have reluctantly and heartbreakingly chosen to leave the hospice. For any member of staff in any profession, a job being under threat before Christmas would be deeply worrying, but it is important to stress that nurses in the in-patient wards at Ashgate hospice are not just any members of staff. As we have heard from my hon. Friends the Members for Bolsover and for Derbyshire Dales, they provide support for patients and families at their very darkest hour, when all else is lost and all that remains is the comfort provided by the knowledge that a dying loved one is comfortable and cared for in a beautiful, high-quality and caring environment. The emotional strain on those nurses is huge, and the public empathy and affection for them is widely felt. Their professionalism and compassion is renowned, and the effect of the threatened job cuts on them has been devastating.
Although in-patient wards deal with far fewer patients than out-patient and at-home services, many see them as the front door of Ashgate hospice, but they face the biggest cuts: there is a plan to reduce palliative care beds from 15 to six. In response, there has been an outpouring of support for Ashgate hospice from the community. Nearly £250,000 was raised in just two weeks, including an incredible £50,000 from the owner of a Chesterfield-based business, Peter Kelsey. Those funds will allow the hospice to keep open two additional beds for another six months, and care for perhaps another 25 patients near the end of their lives.
Hundreds of my constituents have contacted me and my colleagues to voice their concerns about the situation at Ashgate hospice, and many have also written directly to the ICB to make the case. Despite the claims and counter-claims, there is now widespread distrust that urgently needs clearing up. The ICB continues to imply that Ashgate services are too expensive, although there has been no formal update following the director of finance’s visit to the hospice on 1 December. Staff and unions have been left confused and concerned about the implication that the finances are not straightforward, and remain frustrated about the process. They have questions about whether every step has been taken to reduce costs.
Staff at Ashgate have been alarmed at communications coming out of the ICB, which they believe undermine their reputation for professionalism and financial prudence. If trust in Ashgate’s ability to run its operations is diminished, it will have grave consequences for future fundraising.
What is not in question is that the care that Ashgate provides is outstanding and that, as of this new year, dozens of north Derbyshire’s most gravely ill patients, who would previously have been able to obtain a bed at Ashgate, will die either at home in less comfort, with family members put in intolerable situations, or in an acute bed in the local hospital sector, possibly at greater cost and in less comfort than was the case last year. I want all my constituents to receive the best end-of-life care possible, so it is hugely disappointing that palliative care patients in north Derbyshire will lose access to those beds, and that nurses at the hospices will be worrying about whether they still have a job.
I want to shed light on the distressing and unacceptable situation of service cuts and redundancies at Ashgate hospice, and I seek further clarity and transparency about the funding situation for palliative care in Derbyshire to see whether anything can be done to hold at bay cuts to services at Ashgate.
Although charitable income will always play a vital role in hospice care, allowing hospices to deliver holistic care that goes way beyond NHS provision, hospices need fair and consistent Government funding, which needs to be transparent and clearly linked to contracts. Crucially, it must reflect local need. Whether a person lives in Chesterfield, across wider north Derbyshire or elsewhere in the country, they and their family should have access to quality palliative care when they need it most. I would therefore appreciate hearing the Minister’s response on several points.
First, will he join me in lamenting the devastating cuts at Ashgate hospice? Does he agree that this situation, whereby in-patient palliative care services in north Derbyshire are being reduced, is unacceptable? Will he or his office intervene to ensure that Ashgate hospice and the local ICB reach a transparent and agreed position on the current funding situation, and examine how that position compares with national expectations about funding of palliative care?
More broadly, will the Minister set out the Government’s plans to ensure sufficient and sustainable funding for hospices in the future? Can he confirm whether he has any concerns about the cost of care at Ashgate hospice? If he cannot, will he get this matter on the public record, so that people across north Derbyshire can be confident that the money they have raised through fundraising—hard-earned money—is being prudently spent?
Does the Minister agree that, six months after the beginning of discussions locally, it is completely unacceptable that there is still a lack of agreement about exactly how much is being spent on care by the ICB and how much commissioned care the ICB is funding? Can he do anything to provide clarity about this situation?
Since 1988, Ashgate hospice has provided exemplary care to thousands of dying patients in north Derbyshire. It must go on. Its nurses deserve better than to lose their jobs and to worry about whether something else could have been done. I implore the Minister to ensure that the hospice sector is given the support it needs to play its crucial role, and that locally in north Derbyshire every avenue is explored to save jobs and beds at this wonderful institution.
Although the majority of palliative and end-of-life care is provided by NHS staff and services, of course voluntary sector organisations also play a vital part in supporting people at the end of their life. That is why a year ago, almost to the day, we announced a £100 million capital funding boost for adult hospices and children’s hospices, in order to ensure that they have the best physical environment in which to provide care.
Ashgate hospice is receiving over £845,000 of that money over the two years of funding and Blythe House hospice, another hospice in north Derbyshire, is receiving just under £160,000. All of this capital funding is a once in a generation investment into hospices in England, which will guarantee future savings by making them more sustainable, including by fixing draughty windows, repairing old boilers, installing solar panels, fixing roofs, etc.
We are also providing £26 million in revenue funding to support children and young people’s hospices that serve north Derbyshire. This year, Bluebell Wood children’s hospice is receiving £986,000, and Rainbows hospice for children and young people is receiving £1,462,000. Our priority was to protect children’s hospices from facing a cliff edge of yearly funding cycles through multi-year settlements, so we were delighted to confirm that this funding would be in place for the next three financial years. This money will be at least £26 million each year, adjusted for inflation, allocated via ICBs to children’s hospices in England, or around £80 million over the three years in total.
Having said all that, I do not for one second want to give the impression that I am downplaying the issues that my hon. Friend the Member for Chesterfield has raised, nor do I believe that this money is a silver bullet for all the issues we face. As he points out, integrated care boards are responsible for the commissioning of palliative care services to meet the needs of the people they serve. My understanding is that what NHS Derby and Derbyshire ICB calls its core contract value—the baseline funding in the contract with Ashgate hospice—has increased by 55% since 2022, which represents a higher share compared with uplifts the ICB has provided for other NHS services through its hospital trusts and other providers.
I am aware that the ICB has been working with the Ashgate team over several months to understand why their costs have risen significantly over the last financial year. It has also offered £100,000 towards an independent review, which would be linked to a future service specification—in other words, the way in which the ICB provides funding to the hospice in future. Derby and Derbyshire ICB has committed to develop a new service specification for palliative and end-of-life care to inform its contracting going into 2026-27, and to engage on a new model of palliative and end-of-life care across the ICB cluster, aligning to the three shifts set out in the 10-year plan and delivered through the neighbourhood health model of delivery.
However, it is clear from my hon. Friend’s speech that there are two sides to this story. It appears that there is a gulf in understanding between the ICB on the one hand and the management team of Ashgate and the community on the other—that is clear from everything my hon. Friend has said and from other interventions. I would therefore be more than happy to broker a discussion between the ICB, concerned Members of Parliament and the hospice to get to the bottom of what is going on, so that everyone is on the same page as to what is happening with the costs, where the problems lie in terms of provision and ensuring we do everything we can to retain this vital service. It feels like the dialogue between the ICB and the management team at the hospice is not working, and I am more than happy to intervene, to help to make that work. Perhaps I could sit down and discuss that further with my hon. Friend and other colleagues.
As I said earlier, the delivery of healthcare is largely devolved in England, and ICBs are responsible for the commissioning of palliative care services to meet the needs of local people. Beyond the £100 million of capital funding and the £80 million of revenue funding for children’s hospices, we are not able to offer additional funding from the centre as things stand, although we are looking at and exploring other opportunities. As I told the sector in a speech to the Hospice UK conference in Liverpool last month, I know that this is not the message the sector wants to hear, and it is certainly not the message that I want to deliver. But with the public finances in the state they are in—the state that we inherited them in—I have to recognise that the Chancellor has made some tough trade-offs to support our public services, especially the NHS, in the context of our debt interest payments surpassing the entirety of our education budget as things stand.
In these challenging circumstances, we are trying to support the sector in other ways. We are developing the first ever palliative care and end-of-life care modern service framework, or MSF, for England. That will be aligned with the ambitions set out in our 10-year health plan. We will closely monitor the shift towards strategic commissioning of palliative and end-of-life care services to ensure that services start bringing down variation in access and quality. While there is a lot of diversity in contracting models across the hospice sector, we will consider contracting and commissioning arrangements as part of this framework. In the long term, this will aid sustainability and help hospices to plan ahead.
The MSF will not just drive improvements to services that patients receive at the end of life; it will start helping ICBs to address challenges and variation in access, quality and sustainability. Further support is being provided to ICBs through the recent publication of NHS England’s strategic commissioning framework and medium-term planning guidance, which set out in black and white how ICBs should understand current and projected demand on services and associated costs, creating an overall plan to more effectively meet these needs through neighbourhood health. The medium-term planning guidance acknowledges the importance of high-quality palliative and end-of-life care. The guidance makes it clear that, from April next year, ICBs and providers must focus on reducing unnecessary non-elective admissions and bed days from high-priority cohorts—which include, importantly, people with palliative care and end-of-life care needs—and on enabling patients who require planned care to receive specialised support closer to home. That will be at the heart of the neighbourhood health service that we look to build. It is important to emphasise that the cohort of people who are reaching the end of life is a prioritised cohort within the framework of the shift to a neighbourhood health model.
I hope that those measures will reassure my hon. Friend the Member for Chesterfield of this Government’s commitment to the sustainability of the palliative and end-of-life care sector, including hospices such as Ashgate hospice. We will continue to work with NHS England in supporting ICBs to effectively commission the palliative and end-of-life care that is needed by their local populations. The work that our hospices do to support people in the sunset of their lives, to support families in their grief and to give such families bereavement counselling at their most vulnerable moments is utterly priceless. It is a sad reflection of the dire fiscal position that we inherited and the dire state of our public services in general that we cannot give more than the extra support that I have outlined, but we are doing everything that we can to support the sustainability of the sector in the long term while tackling inequalities and unwarranted variation in the quality and quantity of service provision.
To sum up, strategic commissioning of palliative and end-of-life care services is not working anything like as well as we want, frankly, across the country. It is clear that where there are gaps in an ICB’s understanding of the totality of the health and care needs of its population and in the capacity of partners and stakeholders in its ICB area to meet those needs, that process is not working as well as it needs to. That is what the modern service framework for palliative and end-of-life care seeks to address. We do not have many MSFs—we have commissioned, I think, three or four in total across the entirety of what the Department of Health and Social Care is doing—so that MSF reflects the importance that we attach to palliative and end-of-life care.
In the medium-term planning guidance, we have also emphasised that the palliative and end-of-life care cohort will be a top priority for our neighbourhood health strategy and the shift from hospital to community. That is what is happening at the strategic level, but I understand that at the constituency level, it also matters what is really happening for the community of my hon. Friend the Member for Chesterfield and the worrying issues around Ashgate hospice. On the detail of what is going on there, I would be very happy to work with him to see what we can do with the ICB and other key players and stakeholders to address the specifics of that issue. There is a strategic challenge, but also an opportunity, for us and a more specific issue on which I would be happy to work with him. Dr Huq, I am happy to give the floor back to my hon. Friend for any closing remarks he wishes to make.