Woodlands Hospice, Aintree
It is a pleasure to have an Adjournment debate on my local hospice, which is such an important topic. Many people think that a hospice is place where people go to die, but it is actually a place where people go to live. It would not be a debate on a hospice and end-of-life care without reminding ourselves of the words of Dame Cicely Saunders, who is widely acknowledged as the founder of the UK hospice movement:
“You matter because you are you, and you matter to the last moment of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”
When I recently visited Woodlands Hospice in my constituency, that is exactly what I found. Although it may sound counter-intuitive, it was a place brimming with life. Woodlands Hospice is an independent charity situated in the grounds of Aintree University Hospital. It covers a population of 330,000 in north Liverpool, south Sefton and Kirby and Knowsley. The hospice provides 15 in-patient beds with a purpose-built wing. Its wellbeing and support centre, which includes multi-professional assessment days, group therapies, outpatients, complementary therapies and a therapy-driven outreach service, provides services to enable people living with cancer and other life-limiting illnesses to live their lives in a positive and independent way.
I asked the hon. Gentleman beforehand whether he would give way, and he said he would. It is important to put this point on record. Does the hon. Gentleman agree that those who work in hospices, such as Woodlands and the Marie Curie Hospice in Northern Ireland, do tremendous work and are much to be thanked for the tremendous care that they provide, not just for patients, but for families?
I am delighted to agree. This is a great opportunity to thank all those staff and volunteers, wherever they are across the UK.
My hon. Friend was describing the excellent work that goes on at Woodlands Hospice, and my constituents benefit from that as well. In addition, the hospice provides “Hospice At Home”, helping people out in the community. The combination of services is vital to supporting the national health service. Does he agree that failing to support hospices, including Woodlands, is very damaging and undermines the national health service?
Absolutely, and I am coming to how the hospice sector is such a key part of our national health service.
It was a privilege to learn about the work of the wonderful staff and, importantly, the volunteers. More than 125,000 people give their time to volunteer for hospices each year. They are the lifeblood of the hospice sector. The Woodlands’ volunteer workforce of over 200 people from all walks of life and all ages add value to the patient experience, while the volunteers themselves get opportunities to develop their skills, avoid isolation and build a sense of community.
Woodlands Hospice must raise £1.3 million, which it tries to achieve with the help and support of communities in my constituency and beyond, but against the backdrop of financial uncertainty and squeezed living standards, that is no easy feat, particularly in more deprived communities such as mine, which have been hardest hit by austerity. I will return to the issue of funding later, but there are a number of ways our community supports Woodlands that do not involve straightforward cash donations: volunteering, undertaking challenge events for sponsorship, holding coffee mornings and—this year, I hope—becoming a friend of Woodlands via the new membership group scheme, which I will be taking up myself as soon as it is operational.
The support for Woodlands shown by my constituents illustrates how dearly we hold the care it provides. All Members here know how much their constituents value the care provided by hospices in their own local areas. That is what inspired me to call this debate tonight—to highlight the value of hospices as an essential part of the healthcare economy and to look at sustainable funding for hospices around the UK, particularly in the more deprived areas. It is right that those in more deprived areas, who will struggle to raise funds, receive more statutory funding.
I am grateful to my hon. Friend and neighbour for giving way. Like him, I recently visited Woodlands, and I congratulate him on securing this debate. Does he agree that the NHS funding that Woodlands receives is vital to its long-term sustainability and that we are seeking assurances from the Minister that at the very least it will be maintained in the future?
I absolutely agree. I hope that this debate will focus people’s eyes on the hospice sector across the UK and at Woodlands, where we need to ensure viable funding, and also funding that is longer term and better planned. Pressure needs to be taken off hospice managers as they plan the kind of care they provide for our constituents.
People who face progressive life-limiting illnesses require different levels of care. Apart from care and treatments specific to their conditions, they are likely to have what is often called palliative care, particularly as they approach the end of their lives. Death is a natural part of life. We will all die eventually, and most deaths—around three quarters—are expected, so the majority will require some form of palliative care, and everyone deserves to be able to end their life in comfort and dignity. That principle should be central to any civilised society.
There is, I am sure, agreement across the House on the importance of palliative care. It is not a bonus or extra, but an essential part of a good healthcare system. The hospice sector supports around 200,000 people with terminal and life-limiting conditions in the UK every year. This amounts to more than four in 10 of those estimated to need expert end-of-life care. Hospice care is free for everyone and provided for however long it is needed, be it days, weeks or even months. More than 40,000 people in the UK receive bereavement support from hospices each year.
Hospices support people with a wide range of conditions, including cancer, motor neurone disease, cardiovascular disease, dementia, multiple sclerosis and Parkinson’s disease—to name just a few—and they are increasingly supporting people with multiple life-limiting conditions. Most hospice care is provided while people are in their own home, but it can also be provided in a care home or at the hospice itself as an in-patient. It is a style of care rather than something that necessarily takes place just in one building. Hospices also aim to feel far more like a home than a hospital.
Outcomes are difficult to assess, and of course most patients do pass away, but it is worth remembering that many do not. A gentle, dignified, reflective and peaceful death with 24/7 expert care and surrounded by loved-ones is something that cannot be measured by traditional means, but we can measure the value in the appreciation and wellbeing of the patients and families helped through their bereavement. When I visited Woodlands, I was delighted to meet people who had long and happy associations with the hospice, had made friends there and still visited regularly for support with their health, but also to keep in touch with staff and friends.
It is also clear that NHS pressures mean increased pressures on hospices.
I thank my hon. Friend for giving way, and for outlining the work of the hospice movement. Does he agree that the values and ethos of the movement are deeply ingrained in communities throughout Merseyside? Willowbrook Hospice in St Helens, which is celebrating its 20th anniversary, is a good example. But hospices should not have to rely on the generosity of our constituents: they need statutory funding, because they are an integral part of social care.
I welcome my hon. Friend’s intervention.
Britain’s older population is set to increase sharply in the next few decades. The number of people aged 85 or over is expected to double in the next 20 years, and the number of people aged 100 or over is set to increase by more than eight times by 2035, to more than 100,000. The number of adults with life-limiting conditions is also on the rise. Everyone deserves high-quality, compassionate care at the end of their lives.
In recent months we have again witnessed the impact of severe winter pressures on the NHS, which has left hospitals buckling under unprecedented demand. Most people in the United Kingdom—just over half—currently die in hospital. Hospitals are amazing, life-saving places, and I pay tribute to all the staff who keep our NHS running at such difficult times. It is our country’s greatest achievement.
The hospice sector plays a vital role in providing care for those who no longer respond to curative treatment, so that patients who have no clinical need to be in a hospital bed can receive specialised and personalised care provided by a hospice multi-professional team. That also frees up hospital beds for those with acute care needs. A good hospice is a perfect example of good health and social care integration. We need a joined-up approach by the NHS, social care, the community and the voluntary sector. I welcome the Government’s decision to bring social care under a departmental umbrella, and I hope that the Minister will reassure me that hospices too will be recognised as a crucial part of the care system as a whole.
On average, adult hospices in the UK receive a third of their income from the Government, although the amount received by individual hospices varies widely. The rest comes from community fundraising, grant applications, hospice charity shops, lotteries and investments. According to Hospice UK, collectively charitable hospices in the UK need to raise about £1 billion a year from their local communities, which amounts to about £2.7 million per day. In a period of stagnant wages, and with national income distributed unevenly, that is a constant challenge, and the fact that it affects different areas and regions differently must be taken into account. Hospices rely on NHS funding contributions, and need assurances that those will continue even in the challenging financial climate that the NHS currently faces.
Some hospices have agreements in place for multi-year funding, but many are reliant on year-by-year decisions on funding levels, and that requires constant planning by hospice managers. NHS funding needs to be on a more committed and sustainable basis to allow for planning and development, and to enable staff to devote more of their time and energy to doing what needs to be done in relation to patient care. Of course, in more deprived areas, such as the communities in north Liverpool, the need for statutory funding is even greater. The fundraising opportunities that are available in the catchment areas of individual hospices can be very limited. Deprivation also means more complex health needs among the population that hospices serve. All too regularly, I see people dying younger, people dying from addictions, and people dying from diseases that are linked directly to poverty.
The complexity of funding for hospices creates further organisational difficulties for management and staff. Commissioning and contracting arrangements are still causing issues: nationally, a third of hospices are now working with four or more commissioners. Woodlands, for instance, covers a number of clinical commissioning groups, and requires each CCG to maintain or increase funding each year just to stand still. When funding decisions are made on a year-by-year basis, simply maintaining funding can take up much time and effort that should ideally be focused on patients and care.
I am sure I speak for the entire House when I say that we are all very grateful for the care that hospices deliver to people and communities across the country. They need ongoing recognition of the value that they provide to the healthcare economy as a whole. Specialist palliative care and end-of-life services need to be proactively included in transformation plans and service developments. The Government’s intentions were set out in July 2016, when they said that
“every person nearing the end of their life should receive attentive, high quality, compassionate care, so that their pain is eased, their spirits lifted and their wishes for their closing weeks, days and hours are respected.”
In order to realise those aims for every person in the UK, we must look at the funding framework as a whole to make it easier for hospices to receive sustainable NHS funding.
Can the Minister address two specific points: what guarantees are there that as pressures increase on NHS budgets, statutory funding to hospices, especially those in more deprived areas with the specific health problems affecting poorer communities, will be protected, and what is the Minister doing to encourage longer term funding models—multi-year agreements—so that hospices can plan better and care better? The people-centred care that responds to complex and changing needs provided by hospices like Woodlands is invaluable, and I believe every Member will want to do all we can to support the work they do across our constituencies.
I want to finish by paying tribute to the wonderful staff and amazing volunteers who make Woodlands the wonderful life-affirming place that it is, as well as thanking all those who give up their time to volunteer in hospices across the UK.
I thank the hon. Member for Liverpool, Walton (Dan Carden) for the way in which he has approached this debate. I commend him on making an excellent speech, as he could not have been better at articulating the positive contribution that hospices make. I do not think there was anything in his speech with which I disagreed, which is quite unusual.
I was struck by the hon. Gentleman’s description of hospices as places where people go to live. When I visit hospices, I am struck by the very real efforts that their staff go to to make them comforting places. It can be a more difficult time for the loved ones than it is for the person who is ending their life, but they really are comforting places, and the hon. Gentleman is right to pay tribute to all the staff who work in them.
The hon. Gentleman powerfully praised the efforts of his own hospice, Woodlands, which is clearly providing an excellent service. I am grateful that he has given me the opportunity to address some of the concerns and make clear how much we value the contribution that hospices make to the NHS.
It is testament to the excellence of our hospice sector that last October’s “State of Care” report by the Care Quality Commission showed that 70% of hospices are rated as good and 25% as outstanding. Those figures are higher than for any other secondary care service, which illustrates the significance of hospices’ contribution. Woodlands Hospice received a good rating in the CQC report. Like the hon. Gentleman, I congratulate its hard-working staff and volunteers on ensuring that patients get the personalised care and support that they need.
NHS England has advised that Liverpool clinical commissioning group, which is the main commissioner for the hospice—I hear what the hon. Gentleman says about there being more than one CCG, which probably adds to the strain on the hospice with regard to long-term funding—provides £900,000 of funding a year. Sefton also provides £240,000 per year, which brings the total amount provided to the hospice to over £1 million a year. As the hon. Gentleman outlined, the CCGs of Liverpool, South Sefton and Knowsley are in the process of reviewing their end-of-life care provision. They are taking into account population need, service demand, and all providers of that care, including Woodlands Hospice.
I am sure that the hon. Gentleman welcomes, as I do, the attention that local healthcare planners are giving to this important area of care. I suggest that the commissioners should pay close attention to what the hon. Gentleman and his colleagues have said tonight, speaking on behalf of their communities, about the value they place on this service. I hope that the commissioners will also take note of my comments when I say that the hospice sector, and this particular hospice, are making a very real contribution to people at the end of their life.
I know that many Members have hospices in their constituencies that they support and champion, so I thought that it might be helpful if I set out the broader position on hospice funding. As the hon. Gentleman outlined, the sector is characterised by strong voluntary contributions and philanthropic activity, which is to be celebrated.
We have 223 registered independent hospices and small number of public hospices that are run internally by NHS trusts. Around three quarters of hospices provide adult services, with the remainder caring for children and young people. The hospice movement was established from charitable and philanthropic donations, so the vast majority of hospices rely heavily on charitable income for the lion’s share of their budgets, but they do receive some statutory funding from CCGs and the Government for providing local services. As the hon. Gentleman suggested, the statutory funding varies from place to place for a wide number of reasons—he highlighted deprivation as one of them—but adult hospices receive an average of 30% of their overall funding from the NHS.
Funding remains a local decision, which I think is right, and the hon. Gentleman will be aware that we take deprivation into account when making our allocations to CCGs. He referred to long-term funding stability and the importance of knowing how much the Government will provide, and I will reflect on that important point. It would be good practice to give as much certainty as possible, which is a principle of our health funding more generally, so that will bear examination.
I am grateful that the Minister has committed to reflect on the thoughts of my hon. Friend the Member for Liverpool, Walton (Dan Carden) about a national framework, but the difficulty in having locally determined support from CCGs is that that will inevitably vary from place to place. Some CCGs are under much more financial pressure than others, which is why it is important that we have some kind of national framework.
I would not want to depart from the principle that this is for local decision makers, but that is not to say we do not make clear our expectations about what CCGs should be delivering as we develop our national policies on end of life, and support for hospices forms part of that. Given the number of people who pass away in hospices and the care that they receive, we would encourage CCGs to carefully consider the extent to which they support hospices.
In addition to NHS funding for locally commissioned services, children’s hospices receive £11 million through the children’s hospice grant, which is awarded annually and administered by the NHS. Children’s hospices tend to receive smaller amounts of statutory funding because of how they have developed and the services that they provide. Unlike adult hospices, which tend to be more focused on end-of-life care services, children’s hospices can provide support for much of a child’s life, and that can involve not only more clinical care, but much more support for families.
It is worth highlighting the point made by the hon. Member for Liverpool, Walton that philanthropic support does not just mean money. I pay tribute to all those involved in volunteering in hospices. That is a fantastic example of how communities come together to bring out the best in people, so I thank everyone involved in that work.
Members may be reassured to hear that, to improve commissioning arrangements, NHS England is making a new palliative care pricing system available in April. That should help local areas to plan services, and it will also encourage more consistency and, perhaps, transparency in how much CCGs are supporting the sector.
While hospices are, of course, an important feature of end-of-life care provision in this country, it is important to see them within the wider context of our ambitions for such care. As the hon. Gentleman mentioned, the Government have published the end-of-life care choice commitment, which is designed to transform end-of-life care, and the hospice sector is an important partner in that process. We are determined to significantly improve patient choice by enabling more people to die in the place of their choice, be that at home, in a hospice, in a care home or in hospital. Our commitment is to set out the further action that we will take to deliver high-quality, personalised end-of-life care for everyone, including by delivering advance care planning and ensuring that we have the necessary conversations earlier. I draw Members’ attention to the reference to hospice care at home, which is a significant aspect of the programme. We need to make sure that more people are aware of what their options are, and we need to encourage innovation in end-of-life care. In collaboration with partners from the voluntary sector, including key hospice and end-of-life charities, the Government and NHS England have been working to make sure that the quality and availability of end-of-life care services continue to improve and that our end-of-life care commitment is delivered.
As I have already mentioned, the Government believe it is right that CCGs have the autonomy to shape local services according to local need, but it is important that we do more to provide commissioners with the tools, evidence, support and guidance to demonstrate the benefits of delivering our vision for end-of-life care. A crucial part of that is strengthening the provision of end-of-life care services outside hospital and in the community so that people can make the choice of where they wish to end their life.
To deliver this, we are working with sustainability and transformation partnerships so that there is tailored information to assess where we need further investment, commissioning and intervention. NHS England is also a member of the national palliative and end-of-life care partnership, which is made up of charities and organisations from across the health and care system that have together developed a framework for improving end-of-life care at a local level. More guidance will be published through that body soon.
NHS England has also commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. I fully anticipate that could be a good news in support of the hon. Gentleman’s arguments. Although many such care models exist across England, there is poor data on what are the most effective approaches, which makes it rather more difficult for CCGs to confidently commission such services. The project will examine hospice-led initiatives that appear to be having a positive impact on where people are cared for, as well as on where they die. The Department and NHS England will pay close attention to the findings when they are made available, which should be next month.
We fully acknowledge that more needs to be done if we are to meet our ambition to reduce variations in end-of-life care and to ensure that the system works effectively to support more people to die in the place of their choice. However, I am confident that through NHS England’s programme board for end-of-life care, with all key system partners and stakeholders, including the hospice sector, we have the best opportunity to continue delivering the progress in end-of-life care that we all want, however and wherever it is provided. I cannot emphasise enough that hospices are central to our commitment. Local commissioners will wish to reflect on all the comments that were made in this evening’s debate when they come to make their allocations, and I wish Woodlands Hospice every success in the future.
Question put and agreed to.
Motion made, and Question proposed, That this House do now adjourn.—(Amanda Milling.)