Over the last few months, there has been much debate about the Assisted Dying Bill. However, whilst that has consumed so much attention, a crisis has been developing below the radar – namely our vital Hospice sector and its financial situation. We need to wake up quickly to this crisis before it’s too late.
Our Hospices matter, and they are facing a critical moment. That is why I was pleased to secure a debate recently to bring the issue to Ministers. I was joined by colleagues from both the Conservative and Labour benches in urging the Minister to hear why we need to act. I was particularly grateful to Rachael Maskell MP for her active contribution to the debate. This is a true cross-party issue and Rachael is someone who commands much respect for her expertise and commitment to the care sector.
Each year the Hospice sector support 310,000 people and 92,000 family members through the most difficult of moments, providing a vital, holistic care service to people and their loved ones at the end of their life. They are a crucial part of our overall healthcare provision, relieving significant pressure on the NHS.
But our Hospices are now under enormous pressure. They are caught in the triple squeeze of increased demand, increased costs and uncertain funding. It is one of those moments in politics where Government can genuinely fix the issues. Only the Government can eliminate those increased costs or create more certain funding.
It is estimated the demand for palliative care in the UK will increase by 25% over the next 25 years. But as demand for our Hospices increase, costs for them have grown exponentially and virtually overnight. All whilst the sector lacks a long-term financial settlement to enable it to plan its way through.
Let me use the example of the excellent Thames Hospice, based in Maidenhead, that supports many families in my constituency and those of my neighbours.
Like many other hospices, Thames Hospice represents the very best of our communities. People who believe in providing a quality of life, to the end of life, for everyone. Passionate people who care, supported overwhelmingly by people who care enough to support through private donations and support. Through their excellent work they enable 80% of the people they support to receive dignified end of life care in their home, and the rest in their specialist inpatient service.
Despite the cost pressures they release on the NHS, less than one-third of their income comes from the NHS. That funding is always uncertain and short-term. Like many hospices they raise the rest through their charity shops, fundraising efforts and the generosity of private donors.
The budget in Autumn 2024 was like a hammer blow to their finances. It caused an operating deficit of circa £1m to appear, a situation repeated across the sector. The NI increases will add about £300,000 to their costs. The national minimum wage another £200,000 both through the direct impact and the need to maintain pay differentials. Meeting the NHS pay settlement, which they need to do to keep clinical staff, but without government support, adds a further £100,000. Finally, their suppliers facing the same cost pressures are passing those onto them in higher prices.
The Government has responded to these issues by pointing to a 2 year settlement they provided of £100m additional funding for hospices announced in December. It was welcomed by the Hospices, but it was for capital expenditure only. It did not address the immediate operating pressures.
The business case to act seems clear to me. Without hospices like Thames Hospice providing valuable end of life care – the NHS would need to pick up the slack. The cost displacement would either need more NHS funding or we will see the collapse in end of life care provision.
The solutions seem clear cut too. The Government chose – twice – not to exempt Hospices from the Employer NI increase. I suspect the failure to exempt Hospices was an unintended outcome from the budget. It happens – governing is complex as Labour are fast discovering. But there are moments where Governments need to admit mistakes and where a u-turn would show courage and compassion. This is such a moment.
A second solution is to look to bring the staff of Hospices into the NHS payroll structure, where the exemption from NI increases already exists. This was an idea Rachael Maskell MP put to the Minister in my debate. It is worthy of serious consideration given Hospices already need to align to NHS pay structures to retain clinical staff.
Our Hospices matter and we have to find a solution fast. To not act would be to fail families in one of life’s most difficult moments.
A critical moment for our Hospice Sector
