Contribution
My Lords, Amendment 29 is in my name and would prevent commencement of the Act until a full impact assessment is published for hospices. The NI announcement was a big blow for hospices already struggling with their budgets. There is also understandable frustration in hospices being told that this was for the benefit of an NHS that is already chronically underfunding most children’s and adult hospice services.
Sam Royston said:
“We project that over the coming 25 years the need for palliative care is going to rise by 25%, with around 150,000 more people needing”
end-of-life services. He said:
“We have no plan, no plan at all to address the scale of that challenge”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 29/1/25; col. 189.]
Hospices are particularly impacted as most have significant retail operations employing many people close to the minimum wage and many on part-time contracts. These are the employees where, typically, the impact of this tax is proportionally highest.
Many hospices already struggling with deficit budgets modelled the financial costs at between £150,000 and £450,000 in proportion to their turnover. For example, St Christopher’s Hospice in south London said that it will face increased costs of around £450,000 a year, which is equivalent to the cost of nine specialist nurses. Nationally, the hospice movement estimates that the cost to the sector will be £34 million for England and just under £40 million for the whole of the United Kingdom. Only this week, the Kirkwood hospice announced that it would be reducing its costs by £1.7 million a year, which will involve placing 33 roles at risk of redundancy.
We all know how important hospices are and the difference that they make. I got in touch with Rachel Street, who is the CEO of Heart of Kent Hospice. This is a hospice I know well: my mother was a founding patron, and I have seen the dedication of the frontline staff, their professionalism and their compassion. They make—and I use this phrase deliberately—a life-changing difference. I visit it every year to present colleague awards in my mother’s name, and I am always moved by their stories and by the kindness and tenderness that they show to those at the end of life’s journey.
As a charity, Heart of Kent Hospice has been hit with the double whammy that my noble friends Lady Noakes and Lady Fraser discussed earlier: increases to the national living wage and employers’ national insurance. Plus, as a charity employing doctors and nurses, it anticipates being impacted by any increases to the NHS Agenda for Change pay scales. It has more than 60 staff whose salaries will need to be uplifted to the national living wage, which is more than a third of its workforce. It now needs to look to reinstate differentials between roles, otherwise shop assistants and shop managers in its retail operation will be on the same salary. The ripple effects up through the organisation are huge, squeezing pay differentials throughout.
The retail teams are where hospices are seeing the cost pressure the most, drastically reducing the surplus made by their charity shops, which is an important part of their income for the delivery of palliative care services. For all hospices, the main costs of delivering vital services are wages and salaries, and, like other charities, they employ many colleagues on the national living wage, often in part-time roles, so they are all significantly impacted. For the Heart of Kent hospice alone, this change will cost it over £200,000 a year, on top of the £6.5 million it needs to raise, of which only 20% is funded by the integrated care board.