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Hospice Funding and the NHS Pay Award

Volume 648: debated on Wednesday 31 October 2018

I beg to move,

That this House has considered hospice funding and the NHS pay award.

It is a pleasure to serve under your chairmanship, Mr Davies. I welcome everyone to the debate. It is half-past nine in the morning, and the good number of people attending highlights the importance of, and interest in, this subject. I am pleased to have been able to secure the debate.

When the Government announced that they would give our hardworking national health service staff a pay award that freed them from the constraints of the 1% public sector pay cap and was definitely higher than the pay freeze that many NHS staff have endured since 2010, I—like many MPs, I am sure—was very pleased for those staff, especially as I used to be one of them. When I worked as a clinical scientist in the NHS, I saw my take-home pay reduce year on year from 2010 to 2014, at which time I was elected to this place.

My message is certainly not that our hard-working NHS staff do not deserve this pay award; they deserve it, and more. The question is how the pay award will be funded by the charitable sector that is commissioned to provide NHS services. In April this year, I was contacted by the chief executive of my local hospice, Springhill, which provides end of life care to my constituents in Heywood and Middleton and to the wider borough of Rochdale. I am pleased to see my hon. Friend the Member for Rochdale (Tony Lloyd) in his place; while the hospice serves the whole borough, it is in his constituency, and I am sure he will have a useful contribution to make.

The chief executive of my local hospice raised three issues with me. The first was whether the Government have considered the impact of the increases in NHS pay on the hospice sector.

This is an incredibly important topic for debate, not least for Bolton Hospice, which is just outside my constituency. Does the hon. Lady agree that the pay increase causes problems not only in staff retention, but in the recruitment of new staff? We need very dedicated and skilled nurses to work in our hospices.

Of course I agree with the hon. Gentleman, and I will go on to talk about recruitment and retention and the problems that this issue is causing to our hospices in Bolton, in Rochdale and, I am sure, up and down the country.

The chief executive raised three issues with me; I have outlined the first, but the second was whether the effect of the pay increase on voluntary sector hospices had been calculated. The third point was whether voluntary hospices would be able to access additional Government funding to be able to afford the NHS pay increase.

Does my hon. Friend share my concern that these changes will only reinforce existing recruitment and retention pressures, and agree that the Government should ensure that they take steps to address staffing issues as well as pay changes?

There is a theme developing on recruitment and retention. We have shortages of particular groups of staff, and a two-tier pay arrangement for different NHS providers will only exacerbate those problems.

The points that colleagues have made seem to reflect the situation around the country. The hospice in my constituency, St Andrew’s, provides end of life and respite care for adults and children. The chief executive spoke to me when I went to the opening of its new garden, and expressed exactly the same concerns and fears about future staffing arrangements. The hospice has an incredibly dedicated team of staff, but fears losing them if they can get better pay elsewhere in the NHS.

My hon. Friend highlights the problems that hospices up and down the country are experiencing with the recruitment and retention of staff. I will explore those issues further in my speech.

Maybe the hon. Lady will come on to this in her speech, but has she looked at the different effects that the pay rise has on hospices for adults and hospices for children, and whether there is effectively a two-tier system in the way that those services are delivered?

That is an interesting question. In terms of hospice funding, children’s palliative care tends to receive less NHS funding, so I would imagine the problem is exacerbated for children’s hospices, because they will have to find proportionally more money to fund the pay award than adult hospices. It is an important point, and I hope the Minister will be able to shed some light on those issues when she sums up at the end.

As my hon. Friend says, we share a hospice. She said—I am not picking up on the phrase she used—that the hospice will need to raise more money. Raising money is the crux of this issue, because something like 70% of the funding for Springhill Hospice comes from charitable giving and less than 30% from public funds. Raising more money, unless the Government are prepared to put their hand into the taxpayer’s pocket, is nearly impossible. If the hospice cannot raise more money, the truth is that it will be a smaller service, and both those who are dying and their families will be unable to obtain this amazingly well-appreciated service.

My hon. Friend is absolutely right. This is the crux of the debate: a pay award has been decided on and agreed with the trade unions, but the Government do not seem able or willing to fund that pay award for non-NHS organisations.

I am lucky enough to have the renowned St Christopher’s Hospice in my constituency, and Demelza, which provides children’s hospice care, is also nearby and serves my community. Those hospices will have to find £200,000 a year each to fund the pay rise. Does my hon. Friend agree that the pay rise must be matched by central Government funds in order for our hospices to carry on providing their excellent services to our communities?

St Christopher’s Hospice got in touch with me about this debate, so I have had some communication with it about the problems it is experiencing. Sadly, those problems are replicated in hospices up and down the country, and it is important that we find a pot of funding to finance the NHS pay award.

Queenscourt Hospice serves my constituents and their families and carers. Like all hospices, it plays an incredibly important part in delivering NHS services, but it can only play a full part if it is fully funded. It faces a £250,000 increase in its wage bill in order to do just that. Is it not the point of this debate, which the Government have so far refused to engage with, that unless that money comes from central Government, those hospices, including Queenscourt, will not be able to continue to provide the vital services they provide now?

My hon. Friend makes an important point: hospices seem to be facing a choice of asking the community to give them extra money, or reducing the service they provide.

Am I incorrect in my understanding that hospices adopting the full Agenda for Change will receive Government assistance? Perhaps the Minister will clarify that. The difficulty for hospices in adopting it is that they lose control of their salary budget. The difficulty is in getting that balance right, and I hope that the Government will be able to help.

The right hon. Gentleman is absolutely right. I will explore the Agenda for Change later, because adopting it presents huge difficulties for non-NHS organisations.

The three points from the chief executive of Springhill Hospice were tabled as parliamentary questions. Sadly they received identical answers that included:

“We are considering carefully the impact of any agreement on non-NHS organisations such as hospices that may be affected by the proposed pay deal; however no decisions have been made. Staff in hospices do a fantastic job in delivering world-class care and the Department remains fully committed to improving palliative and end of life care.”

In July, I wrote to the Secretary of State for Health and Social Care, asking for an update on the issue. The response stated that he “understood concerns” that

“hospices may find recruitment and retention challenging if some of their staff choose to leave in favour of organisations that employ staff on the Agenda for Change contract”.

In summary, the Government will finance the pay award for non-statutory, non-NHS organisations only for organisations employing staff on the Agenda for Change contract, which is the nationally agreed set of terms and conditions for most NHS staff. The rationale for that was that:

“Additional funding relies on organisations employing staff on the Agenda for Change contract, because it is the Agenda for Change pay and non-pay reforms that together will help deliver the productivity improvements the Chancellor asked for in return for additional pay investment”.

What are the reforms that can only be made under Agenda for Change? On examination, it seems to be an emphasis on training and apprenticeships and a programme of appraisal and personal development. There is also a slightly vague statement on the improvement of the health and wellbeing of NHS staff, to improve levels of attendance, with a reference to

“positive management of sickness absence”,

whatever that may mean.

The response from Springhill Hospice was grim. The chief executive wrote to me:

“Very few charitable hospices employ their staff on Agenda for Change contracts, and as a result, Springhill Hospice, along with many other hospices, will miss out on the funding being set aside by the Government. This will place us at a considerable disadvantage in recruiting and retaining essential staff to deliver the services that we offer to people with life-limiting illness in this community, and will leave us with a significant additional cost.

Recruiting and retaining skilled staff is a critical challenge for us, and in order to remain competitive, we will have little choice but to increase pay for clinical staff. Over the course of the three-year NHS pay deal, we estimate that this will bring an additional cost to the hospice of in excess of £250,000. Without support from the Government, this extra cost can only be met by asking our communities to give more, or by reducing the services that we provide.

We are already asking our community for in excess of £2 million contribution each and every year, and in an area of high deprivation, I can only envisage that any additional ‘ask’ will not be able to be met by our community, so sadly we may have to look at service reduction, which in turn will place additional burden on an already stretched NHS.

NHS staff will start to see the pay increase reflected in their pay packets from this month onwards. Without government support, Springhill Hospice will see a significant additional cost fall to the charity as a consequence.”

My hon. Friend is being very generous with her time. Does she agree that one problem, shared by Longfield Hospice in my constituency, is the opaqueness about the money that the NHS puts into the hospice movement? It does not put much in, and it is unclear why it comes and what it should be used for.

I certainly agree with my hon. Friend. While preparing for the debate, I tried and failed to get clarity on how NHS funding is allocated to hospice services. I hope that the Minister will provide some clarity on that.

The chief executive of Springhill said that the Department’s response was unhelpful, and that if the hospice were to utilise Agenda for Change terms and conditions in full, it would have to go through a massive consultation with staff and would need to change everyone’s terms and conditions of employment, assuming that there was buy-in through the consultation process. In addition, it would have to employ a very bureaucratic appraisal system—it already has robust appraisal processes in place—while adopting the Agenda for Change process would necessitate a massive investment in staff training, which would again add to the cost burden.

The chief executive of a social enterprise that provides social care in my constituency under the Care Plus Group TUPE-ed out several staff in order to continue to provide those services. Those staff are on Agenda for Change contracts, but they will not receive the Government uplift in pay, because as the chief executive says:

“The plan is to fund only NHS trusts and foundation trusts, to pay the uplift directly to them.”

The issue goes much wider in the healthcare sector than hospices. It will affect providers of health and social care in our communities, as well as those staff contracted out from the NHS, including porters, orderlies and caterers. I know that Unison is campaigning for those staff who have been privatised within the NHS. Does my hon. Friend think that all those staff are integral to providing healthcare for all of us, and should be included in the uplift?

My hon. Friend is absolutely right: this goes wider than hospices. It applies to non-statutory, non-NHS organisations that provide essential services to the NHS. Staff being TUPE-ed out is difficult, and I hope the Minister will consider it in her remarks. The pay award has to be funded from somewhere, and it is extremely unfair if NHS staff are TUPE-ed out to a non-NHS provider and lose out on the pay award as a result.

The chief executive of Springhill talked to me about the role of the clinical commissioning group, saying she hoped that

“the CCG will recognise this significant additional burden when agreeing our annual contract”,

and that it will

“not be expecting us to reduce our costs this next financial year.”

I know, and the interventions I have taken show, that the problems experienced by Springhill Hospice are replicated up and down the country, and I am grateful to hon. Members for sharing their experiences from their own communities.

Hospice UK estimates that, over the course of the three-year NHS pay deal, charitable hospices will face an additional bill of between £60 million and £100 million. It says that the Department of Health and Social Care’s criteria for non-NHS providers to access the additional funding set aside to support the implementation of the NHS pay award exclude the majority of the country’s charitable hospices from that essential support. The Department itself has acknowledged that most charitable hospices do not employ staff on NHS terms and conditions, as the staff working in hospices are not NHS employees. However, as hospices recruit their staff from the same local pool as the NHS, they have little option but to mirror the pay award made to NHS staff in order to recruit and retain the staff they need. As a consequence, hospices face a difficult choice: they must either ask their local communities to donate more to fund the pay award or look at options to reduce services proportionately to cover the cost. Neither is a palatable option for the hospices or for the communities that they serve.

The Department maintains that hospices should look to their clinical commissioning groups for additional support, yet research by Hospice UK shows that in recent years two thirds of hospices in England have seen their NHS funding cut or frozen—in many instances, for several consecutive years. In the absence of tariffs reflecting the costs of care, the NHS currently makes a contribution towards the costs of providing hospice care. It is on average just 30% of the costs of providing adult hospice care services and just 15% for children’s hospice services, although that funding varies widely around the country.

Hospice UK has suggested a solution to the problem, which is to follow the precedent set in 2004, when the employer contribution to the NHS pension scheme was doubled from 7% to 14%. At the time, the Labour Government acknowledged that charitable hospices would face an additional cost that they could not recover from elsewhere, so they set aside a national pot of funding to be distributed centrally to mitigate the impact. That worked very well and is a model that would work well in relation to the NHS pay increase by recognising the unintended consequences for charitable hospices while maintaining the integrity of the deal negotiated and agreed with the NHS trade unions.

Additionally, I have been contacted by my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who tells me that he has secured an agreement for 3,000 healthcare workers in his constituency who work for a social enterprise to receive Government funding to finance the pay rise, so clearly a precedent has already been set. I would be interested to hear the Minister’s comments on that.

The pay deal that has been agreed is a pay deal for NHS staff and is welcomed. Since this debate was announced, I have also been contacted by the Chartered Society of Physiotherapy.

It has taken me a little while to catch up, but did my hon. Friend just say that a colleague has managed to secure an independent agreement that the pay deal will be honoured for some workers in a hospice setting? If so, how is it possible that one person can get such an agreement from Government but everyone in this Chamber who is raising issues cannot?

I thank my hon. Friend: that is exactly the point that I wanted to make. A deal has been done in Plymouth for a social enterprise provider that is not a hospice but a provider of mental health services. Obviously, smaller deals are being done. My hon. Friend the Member for Plymouth, Sutton and Devonport is not able to be with us today, but I was very interested in the evidence that he sent me. The Department of Health and Social Care needs to look at the smaller deals that have been done and ask itself what on earth is going on.

To return to the issue of physiotherapists, they are clinical staff whose role in hospice care is sometimes forgotten. The CSP told me that its members overwhelmingly backed the pay changes when consulted earlier this year. It pointed out to me the importance of the physiotherapist’s role in enabling people with a terminal illness to stay active as long as possible—a really important role—and went on to say that with the current shortage of physiotherapists, it is relatively easy for staff to change roles if they wish to do so, and that employers who cannot broadly match NHS pay rates will find it increasingly difficult to recruit staff.

There is clearly real concern that the NHS pay award will have an unforeseen but damaging impact on charitable hospices and other organisations that are already at a significant disadvantage compared with other non-NHS providers in not receiving reimbursement for the costs of the care that they provide to NHS patients. A sustainable hospice movement is an essential component of delivering the improvements in end of life care that the Government have rightly sought. The Government must look again at the conditions imposed on non-NHS providers and consider how funding may be made available to prevent a diminution of the end of life care service.

May I therefore, through the offices of the hon. Lady, put in my bid to the Minister for just such a local agreement for Naomi House and the Oakhaven Hospice in Hampshire?

I thank the right hon. Gentleman for that intervention, but we want a national agreement rather than a piecemeal set of local agreements. I hope that that will be addressed today.

I shall conclude by quoting NHS Employers:

“Patients are at the heart of everything the NHS does.”

How does that square with the Department of Health and Social Care’s refusal to finance the pay award for hospices, and how is that refusal putting terminally ill patients, at the time when they are most in need of care, at the heart of our NHS?

I thank the hon. Member for Heywood and Middleton (Liz McInnes) for securing the debate. “Fantastic” is probably the wrong word to use, but this is an important opportunity for us to speak about the great work that hospices do, the part that they play in all our local communities and how they help people and their families at the most difficult times of their lives. It is an honour to take part in the debate. I want to talk about the role of hospices, how they contribute to the desire to integrate health and social care and, as a result, how they must be funded to deliver the great work that they do.

This may seem a strange thing to say, but I have spent my most special moments at the bedside of someone in a hospice. Over the years and even as an MP, I have taken the opportunity to sit alongside people and their families in our local hospice, St Julia’s, which is just on the edge of my constituency, and I always leave with an incredible sense of gratitude for the work that the hospice does and how it helps people at that difficult time. It helps people to live and die well, which is what I am sure we would all love to be able to do when the time comes.

Let me explain what I have learned in recent years. Even now, the word “hospice” assumes that that is where we will die if we have—dare I say it—the right kind of illness to justify that, but I am learning that hospices are actually far from just places to die. People can go into one when they are very sick and come out a week or two later, having had various things done to help them, to get their body working again and to identify the right medicine. Hospices can give people time to work out what medicine or drug is really the right one for them. My mum was ill for a very long time. She was given a few weeks to live, but actually lived for more than a year. She spent 10 days in a hospice when we really thought it was the end and then she went on for a good six or seven months after that, simply because the hospice was able to correct her medication and—well, “flush her out” is probably the way to put it. It was lovely to come together as a family and sit alongside her, and to give my dad a break; he had about 10 days of really important respite. The hospice movement across the country, in my constituency and across Cornwall is fantastic. When I go there, it is a different experience from when I go to sit beside the bed of someone in an urgent care setting who is also reaching the end of their life.

In Cornwall, we are learning that hospices are not just about taking people in the closing days or months of their lives, but about alleviating pressure on urgent care by taking people out of a ward where it is not really appropriate for them to be in their last few days, and on community care. In response to trying to get the money it needs, our hospice has done a great bit of work by going out to homes and supporting people there in their last few days and weeks.

The point is that, by properly funding hospices and all the work they do, I am convinced that we would create a saving for the wider NHS as well as the beds that are needed for other people. That is important in my constituency, because our main hospital is in special measures—“requires improvement” is where we are at the moment—and one area of that is about palliative care. The frustration is that there is a desperate need for beds in the hospital, but in the hospice, beds are available all the time. It is simply about a lack of commissioning joined-up thinking and working together, and not having enough money in the hospice system.

Hon. Members have given various quotes about how much NHS funding hospices receive. Some time ago, my first question in Prime Minister’s questions, when the then Chancellor was replying, was about how little Cornish hospice care was funded. At that time, about 11% of the money came from the NHS. That is in a part of the world where there is a lot of deprivation and average earnings are low, so the rest of that money was being found by people who were not awash with cash. I do not know that it has improved much since; we are still one of the areas that receives the least money for our hospice care.

That is frustrating, because people are dying in the urgent care centre who should be in a hospice. Three weeks ago, I spent time with a family who were desperate to get their mum out of my local hospital, which is part of the urgent care set-up. I do not want to be unfair to the hospital team, but unfortunately, they were so keen to get the lady home that they waited for care packages that did not arrive, and she died in the hospital when she could have been in the hospice.

I thank the hon. Gentleman for making that important point, which raises an issue that I have had with a constituent. His wife was sent home supposedly well after going into hospital for urgent treatment but sadly she died two days later. Going to the local hospice, St Andrews, would probably have been a much better option for her, but it had not been thought of in that process.

The hon. Lady is absolutely right, and I have heard several stories where that has been the case. Separate to the debate, there is an obsession—I use that word because it might get the Minister’s attention, although it may be the wrong one—with getting people home at every possible opportunity. When I sit with those people, some of whom are desperately lonely, I ask whether that is right for them or whether hospices, community hospitals and other settings would be more appropriate. I want us, as leaders and politicians, to be careful not to create an assumption that home is always the best place, because I do not believe that. It certainly was not for my mum in the last days and weeks of her life.

Addressing some of the challenges requires an uplift in the funding available to hospices across the board, and we must pass on pay increases to nursing staff. I say again that when I go into my hospice, the working environment is very different from that in the urgent care centre, but I have already said that Cornwall is a low-wage area with a high cost of living due to the beautiful environment that we live in, which attracts people and pushes up the cost of housing. It is expensive to live in my part of the world, so nurses are not choosing to leave the hospice setting because they prefer urgent care—obviously, we need them there as well, so I am not trying to discourage that—but because they need the money to live. We should not be saying, at any stage, “It is okay, because hospices are a different environment to work in and they might prefer it there, so they will settle for lower wages.” I hope that we would never assume or expect that.

I met the chief executive of Cornwall Hospice Care soon after the pay award, and he expressed concern that the money being offered to NHS nurses and staff would have a negative impact on hospices and other parts of the system where people are not directly employed by the NHS. I agreed to raise that in the House at the first opportunity, which I have done, and I am grateful for this opportunity to do so as well.

I know that I am among friends when I say that the value of hospice care is not underestimated. The work that hospices do for children and adults is fantastic. They are an essential part of bringing health and social care together and ensuring that people are cared for in the right setting and as close to home as possible. We all know that it is better to be near our families, whatever our health situation, and certainly during the last moments of our life.

As I have said, people are dying in my urgent care centre, which has already been judged as poor for palliative care, when there are beds in the hospice not far away. That must be addressed, and I want the Minister to intervene to put pressure on the system—or systems, at the moment—on the question of why we cannot do more. There has been progress in the last three years towards working better together, but making the right decision is painfully slow for somebody who does not actually have the time for that decision to be made. There have been improvements in working together, and the managers in all the systems in Cornwall, including the hospices, have healthy relationships, but things seem to be getting stuck at ward level, so patients are potentially not getting the best care.

As I have said, hospices now do fantastic work in the community, which has been a response partly to funding but also to need. They are going out into people’s homes to help families and individuals to manage their care properly. I have made fairly clear the two things that are needed to help hospices to deliver that vital role. In the discussions around the NHS pay award, what engagement opportunities have the Minister and the Department had with hospices? Have they been included in discussions about how that can be addressed and passed on? I would love the Minister to look closely at the situation in Cornwall, which will be true elsewhere too, where the money available for hospices is not enough. That is a choice made at a local level by commissioners, not the Department.

We should also assess whether we are making full use of what is available in hospices. If there are 12 beds with people in who are being cared for in the right place, that care is far more cost-effective than if there are eight beds, as is the case in my local hospice. It is not just about throwing more money at hospices, but about making better use of resources. That will reduce the cost of care while ensuring that those people, who have such a challenge ahead of them in the days and weeks to come, are given the care, love and attention that they absolutely deserve and that we would expect in the great nation in which we live.

It is a pleasure to serve under your chairmanship, Mr Davies. I thank the hon. Member for Heywood and Middleton (Liz McInnes) for securing the debate and for her knowledgeable and informative speech. The hon. Member for St Ives (Derek Thomas) also made a sympathetic and informed contribution using personal and constituency examples, which we all benefit from.

There is little doubt that hospices play a vital role throughout the UK in providing palliative and end of life care, and that demand for care is increasing. We have heard that hospices face many of the same challenges as the NHS in terms of recruitment, and have to compete with pay levels to recruit and retain a good calibre of staff. Attracting and retaining the right people and raising the status and image of social care as a profession is key to delivering quality care.

In Scotland, health is devolved, and getting health and social care right for people is a key element of the Scottish Government’s health strategy. In 2015, the Scottish Government committed through the strategic framework for action on palliative and end of life care, or SFA, that by 2021 everyone in Scotland who needs palliative care will have access to it. Hospices play a vital role in meeting that aim and in ensuring that by 2021 all who would benefit from a key information summary will receive one. These summaries bring together important information, such as future care plans and end of life preferences, to support those with complex care needs or long-term conditions. The availability of care options will be improved by doubling the provision of palliative and end of life care in the community. That will result in fewer people dying in a hospital setting, which I am sure none of us would want to experience. As part of the Scottish Government’s 2016-17 budget, we have allocated a further £250 million to health and social care partnerships, to protect and grow social care services, and to deliver our shared priorities.

Historically, hospices have led the development and provision of palliative care. Their specialist expertise has often supported non-specialist services at the end of life and hospices can typically able t attract high numbers of volunteers and to generate significant levels of charitable income from within their communities.

In 2016-17, hospices in Scotland supported 19,000 people of all ages, ranging from newborn babies to centenarians. In the briefing sent round for today’s debate from Together for Short Lives, the UK’s charity for children’s palliative care, there was a request for parity in the contribution to charitable costs by children and adult hospices, and palliative care charities. That is a very reasonable and sensible suggestion, and the Scottish Government have committed to bring about such parity and to fund 50% of the agreed charitable costs of children’s hospices, in line with the adult provision.

During 2016-17, a total of 12,000 people in Scotland received hospice care in their homes. Over the past decade, a significant amount of work and investment has gone in to supporting older people and people with disabilities to live well in their own homes for longer. When hospice care is needed, the Scottish Government have clear standards that meet the needs of patients and respect their rights. And of course Scotland continues to be the only country in the UK that provides free personal care, benefiting over 76,000 older and vulnerable people. In addition, legislation has been approved to extend free personal care to under-65s, which will come into force from April next year.

Much of today’s debate focuses on NHS pay and its impact on the hospice sector. What does it mean for staff in Scotland? Staff on the Agenda for Change scale will benefit from an increase. Such staff include registered nurses, lead nurse managers, ward sisters, clinical nurse managers, clinical nurse specialists, senior nurses and nurse managers. The Scottish National party Government agreed a three-year pay deal linked to reform discussions that are due to be completed by December, meaning that most Agenda for Change staff will make more than their English equivalents.

For adult social care workers, the Scottish Government require all public sector employers to pay at least the Scottish living wage, so health and social care partnerships will have to pay the Scottish living wage, too. I stress that in Scotland we are committed to paying everyone in social care the living wage, and anything additional would be an arrangement agreed between the integration authorities and hospices. Those discussions are ongoing and I look forward to hearing their outcome.

It is a pleasure to serve under your chairmanship, Mr Davies.

I am grateful for the contributions by Members from both sides of the Chamber; they obviously all value the hospices in their constituencies. I pay particular tribute to my hon. Friend the Member for Heywood and Middleton (Liz McInnes) for securing this important debate and for outlining so clearly the dilemma facing hospices, citing the example of her own excellent hospice, Springhill. The dilemma is that the delivery of excellent services, by an excellent and qualified workforce, must be balanced against the funding to deliver those services continually.

We are all aware that the NHS is facing massive workforce issues and that recruitment of skilled people is an issue right across the NHS; there is a shortage of such people. We are also very much aware that if hospices are to compete for staff and to recruit and—crucially—retain staff, they must be able to make this pay award, which is extremely welcome. That is the essence of this debate.

Hon. Members made some really important points about the wider issues of funding, which are important, and about the lack of funding. I am grateful to the hon. Member for St Ives (Derek Thomas) for sharing a very personal family experience from his local hospice and for making the important point that hospices allow people to live and die well, which is absolutely crucial.

It is important to set this debate, which is essentially about funding, in a wider context, looking in the first instance at the vast array of services provided by hospices. The majority of hospices are charitable organisations, and provide absolutely tremendous support to the NHS but are not directly part of it. There are in the region of 3,000 in-patient hospice beds in the UK, where patients are helped to manage pain and other symptoms. Hospices also provide respite for carers; it is important not to overlook that.

However, hospices offer far more than an in-patient bed for those reaching the end of their life. In fact, the majority of hospice care is provided in people’s own homes. Hospice UK reports that, in 2016, 51,000 people accessed in-patient hospice care, while 179,000 people received the support of trained hospice staff at home. Many hospices also offer daycare, which gives people the chance to spend time in a hospice and use the majority of the services it offers, while still living at home. In 2017, 37,000 people used day hospice services.

The majority of hospices also offer bereavement counselling. Hospices help to mitigate negative outcomes of loss, helping people to manage what can be a hugely painful and isolating experience. One gentleman in my constituency told me that he did not know how he and his daughters would have coped without the excellent Pendleside Hospice when he lost his wife, and his daughters lost their mother.

It is clear that our hospices are doing a fantastic job supporting people when they need it most. It is difficult to measure the level of demand, but it is a fact that, in 2016, 597,000 people died in the UK, and Hospice UK estimates that 450,000 of them could potentially have benefited from hospice services. It is also clear that there is much unmet demand and that provision varies widely from town to town. Given the changing demographics, though, it is very likely that demand for hospice services will continue to rise.

Consequently, it is imperative that, at the very least, we protect the provision that already exists. As I have said, the majority of hospice services are provided by charitable hospices, which rely on donations from, and fundraising in, their local community to meet the majority of their costs. It is a fact that hospices have a combined revenue of £1.4 billion, and yet the NHS pays only £350 million towards hospices. The average NHS contribution to hospices equates to 30%, and that proportion is falling because there has not been an uplift in funding to hospices for many years. Ten years ago, my own hospice received 32% of its funding from the NHS. That has now fallen to 22%, and in common with other charitable hospices it is reliant on the generosity of local people and businesses. Each year, hospices must raise millions of pounds to run their services and pay their staff.

I will briefly mention children’s hospices. Last week, I met staff from Derian House, and I was shocked to learn that although this excellent hospice supports children and young people from 38 constituencies, only 10% of its funding comes from the NHS. There are 49,000 babies, children and young people in the UK with life-limiting or life-threatening conditions. That number is growing as a result of advances in medical technology, and it is vital that these children and their families have access to palliative care that meets their needs.

Austerity has made fundraising more challenging, as many new and worthy charities now compete for funds. It is a fact that in this economic environment the financial stability and sustainability of many hospices is at risk, and implementing the NHS pay award will add to the financial pressures they face. It is unthinkable that, in the face of increasing demand, they may be forced to reduce services or even close.

At this point, I want to join colleagues in paying tribute to the dedicated staff who are the lifeblood of our hospices. The majority of charitable hospices, although outside the NHS Agenda for Change, attempt to match NHS pay and conditions, ensuring that staff who do that amazing work are properly remunerated. It is essential that those hospices are able to match NHS levels of pay if they are to continue to recruit and retain the staff they need.

I welcome the recently negotiated NHS pay award. That award, which has been hard won and is long overdue, will be hugely welcomed by clinical and non-clinical staff throughout the NHS. Crucially, though, it will not be funded for the charitable sector, and hospices will need to raise additional funds. Coming on top of existing funding pressures, that is going to push our hospices to breaking point. Pendleside Hospice, which serves my constituency, will need to raise an additional £500,000 to fully fund that award. I am sure that the Department of Health and Social Care did not intend to disadvantage hospices in this way, and that this was an unintended consequence. I hope that, in the first instance, the Minister will take the opportunity to announce that the Government will fund the staff pay award in all hospices.

In conclusion, I hope that the Minister will go further to ensure that NHS England resumes its work on developing a specialist palliative care currency, to inform future CCG commissioning of hospice care. It is an inescapable fact that a mechanism to increase the proportion of NHS funding paid to hospices is urgently needed. In a world without hospices, that clinical care would have to be entirely provided directly by the NHS, and would add significantly to NHS costs.

As ever, it is a great pleasure to serve under your chairmanship, Mr Davies. I add my voice to those congratulating the hon. Member for Heywood and Middleton (Liz McInnes) on securing a debate on this important matter, and congratulate every Member who has been involved, either through a speech or an intervention. As MPs, we are all aware of the crucial role that hospices play in supporting and caring for our communities at a time of great need. I understand the concerns that have been raised, and have listened carefully to the strong arguments that have been made.

Hospices across England are delivering excellent end of life care and contributing to their local communities, as they have for many years. The Care Quality Commission’s “State of Care” report, published on 10 October, is testament to that. That report showed that hospices have continued to provide high-quality care at the end of people’s lives, even improving on their performance last year, which saw them rated as the highest performing secondary care servicer, with 27% of hospices—more than a quarter—rated as outstanding. I know that Springhill Hospice in the constituency of the hon. Member for Heywood and Middleton was rated as good overall in the CQC’s most recent assessment, but was rated as outstanding in the delivery of care and effective services, and people spoke highly of the kindness and caring attitude of staff. That is why the hon. Lady is right to raise this debate. I add my thanks to all those working and volunteering in the hon. Lady’s hospice, and in hospices up and down the country, for the quality of care that they offer.

We all know that palliative care can take many forms, whether at home, in a hospice, or in a hospital. There is never a more important time to make sure people get the right level of care. My hon. Friend the Member for St Ives (Derek Thomas) spoke about the immeasurable support that was given to his mum by his local hospice, and he rightly mentioned the crucial role of local commissioners in ensuring that hospices can do their amazing work, which I will speak more about in a moment. My mum was responsible for fundraising to build the Naomi House children’s hospice that my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) mentioned earlier.

Will the Minister address the question that was raised about local deals, and will she acknowledge the bid that I made?

Sadly, I cannot comment on individual cases. I am not aware of any individual deals being done with the Government, but of course, this could be a local arrangement. For 2019-20 and the remaining two years of the deal, funding will follow the usual route. It goes through CCGs, so I imagine that the instance that the hon. Lady mentioned is due to that, but I am keen to hear more.

Maybe the Minister would like to take the issue up with my hon. Friend the Member for Plymouth, Sutton and Devonport (Luke Pollard), who has informed me of an agreement that has been made in Plymouth regarding a social enterprise, with the support of the trade unions. That is an interesting example that we potentially should extend to the whole country.

I can only applaud the hon. Lady’s tenacity in continuing to make that case, and we will certainly look into the matter. As I say, I have no knowledge of that individual case, but I share the desire of my right hon. Friend the Member for New Forest West to ensure that hospices such as Naomi House and Jacksplace have the funding that is necessary to do their incredible work. My mum got the whole family involved in all manner of quite humiliating fundraising exercises back in the 1990s to build Naomi House children’s hospice, and I was delighted that my role as Minister took me back to Naomi House and, indeed, Jacksplace, which caters for young adults. I went there over the summer, and Mark Smith, its director of care, was kind enough to give me a tour of the facilities. We discussed some of the issues that have been raised today, as well as others, and my team has been looking carefully at what more we can do about some of those issues.

Since I was appointed Minister for Care in January, I have met with a range of charitable stakeholders from the end of life and palliative care sector, as well as the national clinical director for end of life care, Professor Bee Wee, who is quite incredible. Having met both system representatives and representatives of charities, I have been impressed by not only their incredible passion and commitment to see Government aims for end of life care delivered, but the shared consensus on what changes are needed to drive through the improvements that we would all like to see. Hospices are an incredibly important feature of end of life care provision, but we have to see them in the wider context of our ambitions in that area. In 2016, the Government published our end of life care choice commitment, which encompasses the whole system approach to transforming end of life care, placing patients and their choices, needs and preferences at the heart of planning. The NHS gets it right when choice is meaningful, personalised, and matched by healthcare services that can respond in an effective way that places patients, families and carers at the centre of the decision-making process. I know that parts of the country are delivering excellent palliative and end of life care for both adults and children.

The Minister’s reference to “parts of the country” is of concern to me. Does she agree that the amount of funding, and the capacity for particular communities to raise that funding, is still a postcode lottery? In more deprived areas, accessing the knowledge, skills and ability to raise that funding is more of a challenge. How would the Minister suggest that we create more equity and parity?

The hon. Lady makes an excellent point. She is right: there are services up and down the country delivering first-class care, but there are also areas where we know we need to do more. NHS England is firmly focused on providing both the support and the challenge to achieve that, and the hon. Lady is right to mention the incredible efforts of the imaginative and resourceful volunteers who do incredible work to raise much-needed funds for those vital hospices.

A key objective in delivering our commitment to strengthening the provision of end of life services out of hospital and in the community is that people should have that level of choice, and a quality choice, up and down the country. Work is ongoing nationally to provide sustainability and transformation partnerships with tailored information to assess and enhance end of life care services in their areas. We talked earlier about commissioning; NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. Historically, hospices have struggled to demonstrate strong evidence of the services they provide and the fabulous care that we all know they offer.

The hon. Member for Burnley (Julie Cooper) mentioned currency. NHS England is working to support local use of the specialist palliative care currency, which can help local areas to plan and deliver services, including hospice services. The currency can help local services better understand the complexity of palliative care and the investment needed to deliver it properly. It is also essential that we can assess how effectively commissioners are working to improve end of life care services. My hon. Friend the Member for St Ives hit the nail on the head when he spoke about that. This year we have a new indicator in place designed to help measure how well patients needing end of life care are supported in the community. Going forward, we are planning to do more work to develop indicators that will enable NHS England to further scrutinise the effectiveness of local health economies in delivering choice in end of life care and securing the progress we all want to see.

Can the Minister give some idea of the timescales? The point has been made that not only are these organisations at risk of closing, but the people who need the care have not got time. Timescales that indicate the urgency with which the Government are treating the matter would be welcome.

That is a very good point. NHS England will bring forward its report on hospice care very shortly, in November.

I want to talk about staff funding. In common with much of the sector, I know hospices have faced financial challenges. I recognise the concerns of hospices that the recently announced NHS pay rise is putting them under pressure to match the uplift awarded to staff employed on the Agenda for Change contract not only to retain the incredible staff they already have, but to attract the staff they need. We have agreed that for 2018-19, non-NHS organisations that employ existing and new staff on the Agenda for Change contract will be eligible to receive additional funding. Most hospices do not employ their staff on the Agenda for Change contract because of the cost that would entail and so are ineligible.

Is it possible for a hospice to employ some staff on those contracts and then achieve the benefit of doing so without handing over its entire employment budget and losing control over it?

That is a very good question, which I will drop my right hon. Friend a note to answer, if he does not mind, as we need to make a few more inquiries about that.

It is important to stress that the Agenda for Change pay deal does not seek to make any distinction between the value we place on staff working in NHS and non-NHS organisations. Staff work incredibly hard to provide services, always putting patients and service users first. Funding is linked to the direct costs of implementing the Agenda for Change pay deal, which includes both pay and non-pay reforms. As the hon. Member for Heywood and Middleton mentioned, it is not just about headline pay. It is right that those organisations that employ existing and new staff on the Agenda for Change contract and must implement the entire pay deal should receive additional funding for 2018-19.

The hon. Lady is right to raise the matter, and I thank her again for doing so. I have listened carefully to the issues that have been raised, and we will look again at all of them and what we can do to better support our hospices to continue doing their vital work.

I thank everyone who has contributed, and I thank the Minister for her response, but I am disappointed that there was no commitment to provide funding for hospices to afford this pay award. The case has clearly been made on the disastrous effects of not funding the pay award. I had hoped that the Minister might have been able to commit to more than a report that is coming out in November.

We need to deal with the issue as a matter of urgency. I suggest the Minister looks at equivalence and whether appraisals, staff health and wellbeing and the systems that hospices already operate can be classed as equivalent to the agreement set out under Agenda for Change. That would help get over the hurdle of the productivity demands that the Chancellor has made.

Question put and agreed to.


That this House has considered hospice funding and the NHS pay award.

Sitting suspended.