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Hospice Funding: Devon

Volume 743: debated on Wednesday 17 January 2024

Motion made, and Question proposed, That this House do now adjourn.—(Mark Fletcher.)

I am delighted to have secured today’s important Adjournment debate on hospice funding in Devon. I welcome the Minister and colleagues to the debate.

A few years ago, at a dinner hosted by the Rotary Club of Exeter, I was sat between the Bishop of Exeter and Dr John Searle, the founder of Hospiscare, a brilliant local independent charity providing specialist care to people across our county. I must confess that it was a surreal experience for this 30-something-year-old from Devon who is more comfortable in a pub than at black tie dinners. They both spoke to me about local hospice services and the good work they do in Devon. Dr John Searle sadly passed away last year, and I pay tribute to his work, his compassion and his determination. Our society would be so much better off if we had more people like John, and I will always treasure the conversation we enjoyed.

Hospice services in Devon provide incredible support and comfort to those suffering from a terminal or long-term, life-limiting condition. Patients often have multiple conditions and complex needs, and often require a high level of support. As the Member for East Devon, I am acutely aware of the work and impact of hospices locally. Several charities provide hospice services across East Devon, and I want to pay tribute to the ones based in my constituency, Sidmouth Hospice at Home and Hospiscare. Sidmouth Hospice at Home has a day centre in Sidford, with a 24/7 specialist nursing team working with local NHS dementia services teams who benefit from the use of their building. I live in Sidmouth—they do us proud.

This debate is about funding in Devon. I am sure the hon. Member for Strangford could say something that relates to funding in Devon.

Thank you, Mr Speaker. The hon. Gentleman is right to refer to hospice funding in Devon, but while the hospice funding and charity giving in Devon is good, I suggest that it may be even better in Strangford. Each year in Northern Ireland, our fundraisers add £15 million to the four hospices; without that money, those hospices could not function. Does the hon. Gentleman agree that the Government must stop relying on people’s charity to fill the gap, and increase funding immediately to meet that need? I know that his charity givers in Devon do well, but the ones in Strangford do equally well.

I thank the hon. Gentleman for his point. One of the points he raised with me earlier, when he told me he was going to intervene on me, was about fundraising, and that has been really difficult since covid for all sorts of reasons.

Across the rest of my part of Devon, Hospiscare runs hospices at High View Gardens in Exmouth and Searle House in Exeter, and it has run has fantastic clinical nurse specialist teams in Budleigh Salterton, Exmouth and further afield in neighbouring constituencies. Hospiscare is the biggest of the local charities, and it supports 2,500 people each year. However, these charities need dedicated teams and a lot of funding to support many thousands of patients.

Funding matters even more because we know that Devon’s population is ageing and growing. In Devon, there are proportionately more older people than the national average. More than 25% of the total population in the Devon County Council area is aged over 65, compared with less than one in five of the total England population, and 14% of these people are 85 and over. By 2040, Devon’s population aged between 65 and 84 is predicted to increase to 225,000, which is a 27% rise, and the 85-plus population will nearly double to 56,000. Hospices across our county are therefore playing an increasingly key role.

My hon. Friend is right to highlight the future challenges for hospices. Would he agree that plans such as those coming forward for Rowcroft Hospice in my own constituency to very much integrate and provide both nursing and sheltered accommodation, alongside the hospice services they will continue to provide, show a way to generate additional income, while not conflicting with their core purpose?

I completely agree with my hon. Friend. These services are dynamic and they are working, and the people of Torbay are well served.

I was reminded of the increasing importance of hospices by Dr Timothy Dudgeon, a constituent of mine from Ottery St Mary. He first approached me two years ago, and we met at one of my regular surgeries in Exmouth shortly afterwards. His plea was simple: Hospiscare, one of the charities I have mentioned, needs fairer funding from the NHS in Devon to cope with growing demand. I fully agree with him, but here we are two years later because the NHS simply is not listening.

I have raised the matter through meetings, letters and everything else to the NHS Devon integrated care board, and I am taking my call to the Floor of this House because I want the chair of the ICB, Dr Sarah Wollaston, formerly of this place, to realise that I am not letting this unfair deal for Devon’s hospices go without challenge. The issue here is obvious to all, and the solution is simply common sense, which is something we ought to try a little more often.

Hospices across our country and county are facing a perfect storm: income from fundraising is falling while costs and demand for their services are rising. Hospiscare in Devon has told me that it is facing a £2.5 million deficit in the next financial year. Meanwhile, Sidmouth Hospice at Home has told me that its average case load has risen by over 50% in the last year alone. Amid this perfect storm, I have been calling on the NHS Devon ICB to increase its funding for all of our hospices.

ICBs are responsible for determining the level of funding for palliative and end-of-life care in their area. This is devolution, and I support it. The Government do not decide how funding is spent; local organisations should know their area best and where to send their money. However, I question the situation in Devon. If the ICB needs more money to achieve fairer hospice funding, I would bang down the door of any Minister to help them, if asked, but they have not asked, and we have faced a wall of silence.

That was, intriguingly, until a couple of hours ago, when I received a letter from the NHS Devon ICB. It is intriguing timing, do we not think, given that it did not reply to previous letters I sent last year? Now it has finally responded to one of my letters from November. The NHS Devon ICB says that it is

“working on plans to move towards more equitable NHS funding”,

starting in the next financial year. I am sure colleagues here will be pressing for more details about that.

The wall of silence we have all faced in Devon is why I have launched a campaign and a petition on my website to put pressure on the ICB to increase funding to our local hospices, which residents across my constituency of East Devon and beyond are supporting. I first raised this with NHS Devon ICB two years ago after I met with Dr Timothy Dudgeon. I really hope the Minister can support my message to the ICB and its chair Dr Sarah Wollaston. Our message is crystal clear: there needs to be a fairer deal. Hospiscare is funded for 18% of its costs from NHS Devon ICB compared with the national average of 37% from ICBs across England. Sidmouth Hospice at Home receives no funding from the NHS in Devon at all, and that puts it in a small minority in the country receiving no money from a local NHS body. That simply cannot be right.

I am grateful to the hon. Member both for giving way and for securing the debate this evening which is a really significant one. I know from the Seaton and District Hospital League of Friends where there is the Seaton Hospice at Home facility that the palliative care nurses who work there are amazing people, and they help people to die in a very dignified fashion. Given that we have such fantastic people who work for such organisations as Hospice at Home in Seaton and Sidmouth, does the hon. Gentleman agree that they ought to continue to have a physical location in which to work from, as they do currently at Seaton Hospital? Does he also agree that the Minister might do well to talk to NHS Property Services so they can continue to have that facility at Seaton Hospital?

The hon. Gentleman makes a very good point about Seaton Hospice at Home, and it does a fantastic job for the residents of Seaton and the surrounding area. He also makes a good point about Seaton Hospital, which of course we face challenges with locally, as he knows all too well as the Member for Tiverton and Honiton. It is important to recognise that NHS Property Services is an arm’s length body. Having said that, recent meetings with one of the Ministers who has sponsorship of NHS Property Services has shed some light on the attempt to make sure that that building of Seaton Hospital is protected for future generations.

But I want to speak about somewhere else in Devon briefly. My hon. Friend the Member for North Devon (Selaine Saxby) cannot be here, but I am told North Devon Hospice has been trying to get its hospice at home service commissioned for a decade. The ICB agrees that it should be but will still not fund the service, which saves North Devon District Hospital £2.7 million through avoided admissions. Similarly, my hon. Friend the Member for South West Devon (Sir Gary Streeter) and the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) have raised the same issues with St Luke’s Hospice in Plymouth. This is plainly unfair; now must be the time to strengthen our hospices, give them fairer funding and help them take pressure off the NHS.

I am grateful to the hon. Gentleman for introducing this Adjournment debate. The threats faced by the charitable palliative care sector in East Devon are emulated in my own constituency in Scotland. I have two of the largest hospices in Scotland, St Margaret of Scotland Hospice in Whitecrook and the children’s hospice in Ballach, and the big challenge is how to be taken seriously by NHS managerial structures. There are vibrant and committed palliative care structures in these two charities, but sometimes the biggest challenge is them being taken seriously by community health partnerships in my area or integrated care boards in the hon. Gentleman’s area.

The hon. Gentleman has hit the nail on the head; he is absolutely right. Now must be the time to strengthen our hospices, give them fairer funding, and help them take pressure off the NHS. Hospiscare has calculated that its services save between two and three hospital admissions every day. These are patients the local NHS will have to cover if the hospice has to cut its services. Sidmouth Hospice at Home has calculated that it is saving the NHS locally more than 1,300 nights of hospital stays through preventing admission, shortening stay lengths and speeding up discharges. Is that not what we want?

The benefits of fairer funding are plain to see. Strengthening our local hospices takes pressure off our NHS, but without fairer funding, and given the perfect storm of less fundraising income, more costs and more demand, there is a real risk they may have to cut vital services. That includes in-patient beds and specialist community nursing provision. This cannot be allowed to happen. That is why I urge the NHS in Devon to listen to the case I have made today and the Minister to back my call. It is high time for fairer funding for our brilliant hospices in Devon.

I thank my hon. Friend the Member for East Devon (Simon Jupp) for securing this debate about the funding of hospice care in Devon. I know that he is a huge supporter of hospices in his area, including Sidmouth Hospice at Home and Hospiscare. We have heard this evening how passionately he campaigns on behalf of the hospices that serve his constituency and how hard he is working to make sure they get the support and funding they need.

My hon. Friend may know—other Members in the Chamber for certain know—that I responded to a Westminster Hall debate in November on support for hospice services in south Devon. I know this subject is of great interest to Members who represent that part of the country, as well as to colleagues across the country. All of us here recognise the importance of palliative and end of life care, which supports people at some of the most difficult times, whether individual patients or their loved ones.

Most palliative and end of life care is provided by the national health service. Hospices are a crucial part of the network of end of life and palliative care, and they do a truly wonderful job caring for people during those difficult times. I experienced that with my grandmother, who spent the last few weeks of her life in a hospice a number of years ago. They did a wonderful job for her and her family as we spent some precious time with her towards the end of her life. I take this opportunity to send my thanks to everyone working in palliative care, whether in the NHS or in hospices, for what they do to support people at that time, and their loved ones.

Across the country, thousands of people receive palliative and end of life care. We have an ageing population, with many people living with complex health conditions. Approximately 600,000 people die every year in the UK, and it is a demographic fact that that number will increase, in turn likely increasing the number of people needing palliative and end of life care. Hospices specifically support more than 300,000 people with life-limiting conditions each year, in addition to providing hugely important bereavement support.

Most hospices are independent charitable organisations that generally receive funding from statutory sources and charitable donations. They are rooted in their local communities and are cherished for the compassionate care that they provide. Indeed, that funding model is one of hospices’ strengths. Although many will receive funding through the NHS, a significant majority of their funding will be raised from their communities. That is part of the strong relationship they have with their communities. That diversity of funding is another strength of the hospice model.

On the sources of funding for end of life care, the Minister talks about it being a split model in which some is provided by the NHS and some provided as charitable donations and charitable giving. The work of Seaton and District Hospital League of Friends is 100% funded by charitable giving. The same is true for the model that Axminster Hospital League of Friends is seeking to set up. With that 100% funding, the Seaton league of friends built a wing of Seaton Hospital, yet it is expected that that will be given back to NHS Property Services. What can the Minister do about that?

The hon. Member raised that question in the Westminster Hall debate I referred to. He is talking about a specific situation. Rather than spending the limited time I have addressing that, I am keen to respond to my hon. Friend the Member for East Devon, who has secured this debate on hospice funding in Devon.

I was talking about the enormous importance of hospices and their role in our communities, and the strengths of having hospices in our communities add to the significance of the care they provide. I mentioned my own experience. Hospices do this thing of making a time that can seem completely unbearable become somehow bearable. That makes a difference not only for the individual cared for by the hospice but for all those around them.

Let me turn to Devon specifically. Devon does reflect the national picture, with NHS palliative and end of life services such as a specialist NHS team, community nursing care and a Marie Curie night care service. I mention that because some people may think of hospices as the sole provider end of life care in any community. The picture is broader than that, but of course hospices are important. Indeed, NHS Devon has grant arrangements with four Devon hospices that operate in-patient beds. In East Devon specifically, patients can receive end of life care in hospital, at home, in a care home, or from Hospiscare or Sidmouth Hospice at Home, to which my hon. Friend referred.

In England, integrated care boards are responsible for the commissioning of end of life and palliative care services to meet the reasonable needs of their local populations. As part of the Health and Care Act 2022, palliative care services were specifically added to the list of services that an ICB must commission, reflecting the importance of end of life and palliative care in our healthcare system. Adding that will ensure a more consistent national approach and support commissioners in prioritising palliative and end of life care. In July 2022, NHS England published statutory guidance on palliative and end of life care to support commissioners with that duty. That includes specific reference to ensuring that there is sufficient provision of specialist palliative care services, hospice beds and future financial sustainability.

I acknowledge that hospices, like many organisations—and indeed households—are having to contend with financial pressures including rising energy costs. That is why charities including hospices have already benefited from the energy bills discount scheme, which provides a discount on high energy bills and is running until 31 of March 2024. Hospices may also be entitled to a reduction in VAT from 20% to 5%. In addition to that, in 2022 NHS England released £1.5 billion in additional funding to ICBs to provide support for inflation. ICBs were able to distribute that funding according to local need. It was therefore an option for them to support palliative and end of life care providers, such as NHS contracted hospices, with rising costs from inflation.

I recognise the financial challenges that hospices continue to face and the difficulty there is in raising funds from local communities when people themselves are facing pressures with the cost of living. My hon. Friend made a clear case for the financial support that the hospice in his area deserves. I encourage him to continue to argue that point. It is good to hear that he has been in touch with his local integrated care board, which is the organisation responsible for assessing palliative care needs in his community and ensuring that the need is met.

My hon. Friend is not the first Member to ask to meet me to discuss this topic, or to call a debate on it. I am working to increase the transparency and the information available to colleagues and our constituents, so that they can be assured about the provision of palliative and end of life care. To that end, I have organised a meeting next week with representatives from NHS England, and have invited Members from across the House to attend it, for an update on palliative and end of life care and to ask questions directly of NHS England on this topic.

I have welcomed the opportunity this evening to talk about the wonderful work of hospices not only in Devon but across the country. I assure my hon. Friend and other Members present that I am committed to supporting hospices to continue what they do so well in our communities, and to improving access to palliative and end of life care for people across the country, whether that care is given by a hospice or by the national health service.

We are so lucky to have the hospice movement, including St Catherine’s and Derian House in my constituency.

Question put and agreed to.

House adjourned.