Dr Luke Evans

I yet again thank the hon. Member for Strangford (Jim Shannon). He should be proud of Mona Shannon, and she will be proud of him not just for raising this topic today, but for all the work he does across this House talking about health, because he is assiduous and dedicated to timely health interventions, and that should be applauded across the House and this nation. I am indebted to him for securing this debate. In the hon. Member’s speech, he mentioned who he had spoken to. I, too, have met the organisations Sue Ryder and Marie Curie, including at party conference, and I have met many other organisations, including LOROS and Rainbows, that cover my area. When I saw the title “Ageing Community” for this debate, I must admit that I thought the hon. Member should have applied for a five-day debate, considering what we could cover. I also notice the expertise in this debate. We have a secondary care surgeon, someone with public health experience at the back and me as a GP. It is turning into a multidisciplinary team, and there is a lot to unpack, whether it is prevention, mitigation, healthy lifestyles or looking at the best examples across the world. I recently travelled to Japan and Korea and saw how they look after their elderly and their approach to the lifestyle of the elderly. There is a lot to be learned out there, as across the world we all grapple with an ageing population. There are other topics that we could talk about, and some were touched on. On social care, it is a shame that there has been a change from cross-party talks to an independent commission. I note that Baroness Casey is being taken back to the Home Office, which means she is spread thinly. There is a wider debate to be had on social care, which is: what do the British public actually want? Often we look at the Scandinavian model, but say that we do not want to pay the taxes for it. We want the household or family approach, like the Bangladeshi or Pakistani model, but we certainly do not actually want grandma or grandpa coming to stay with us and we want to stay working. Therein lies the problem in British culture. We are not 100% sure what we want when we cross over from the NHS into social care, and we are not sure how to provide it. Some hard evidence of policies on an ageing community has been talked about, and unfortunately I have to raise the issue of winter fuel. In the Government’s analysis when they took away winter fuel payments—despite all the warnings—they knew that it would put 50,000 people into absolute poverty and 100,000 people into relative poverty. We can contrast that with the Opposition and our recent announcement on stamp duty. Jackson-Stops estimates that in the first year alone, up to 500,000 people above the age of 55 would consider downsizing because of that policy. I do not call that downsizing, as we heard in the debate on stamp duty—it is right-sizing, because it gives a real chance not only for more families to go upwards, but for people to move into more appropriate accommodation as they age. There is a lot to be said in the debate about an ageing population, as the hon. Member for Shipley (Anna Dixon) pointed out, but I will focus my comments on the three questions that I think I caught from the hon. Member for Strangford: the assessment of the need for a national strategy for palliative care; what the Government are doing to ensure that palliative care is included in neighbourhood health centres; and the progress being made on 24-hour support. I will start with the national strategy and funding, and let us give credit to the Government where it is due. When it comes to children’s hospice funding, they have continued the payment and extended it, which is welcome, although it does not offer enough mitigation for national insurance contributions. The Government will say that when it comes to adult funding, they have given £100 million. That is capital funding, though, and as one hospice worker put it to me, there is no point in having new curtains and a lick of paint if there are no staff. As the Liberal Democrats pointed out, the National Audit Office report on the hospice sector that came out only yesterday states: “DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector”, or what the real impact of Government funding is. It continues: “In 2024-25, 11 independent adult hospices in England reported service reductions or staff redundancies, and other hospices announced plans to reduce services, in response to reduced income or increased costs. Cuts appear to be across all types of services offered by hospices. Most hospices reported the increase in the costs of service delivery within the palliative and end-of-life care sector as being the primary reason for service reductions…Six hospices have been designated by ICBs as ‘commissioner requested services’, a mechanism to forewarn ICBs of potential difficulties with services that, should they discontinue, would have significant impact on the local population”. Hospice UK responded to that, saying: “unfortunately the whole hospice sector is…struggling, just as demand for their services is rising. Surging costs mean 2 in 5 English hospices are planning cuts this year, and 20% ended last year with a deficit of over £1m.” What does that actually look like in real life? In my area, LOROS is facing a deficit of £2 million. It has already had to reduce its in-patient capacity from 31 to 20 beds, and it is reducing its day therapy and cutting its physiotherapy, occupational therapy, social work, chaplaincy and complementary therapies, and closing the volunteer home-visiting service. It is not just my region that is affected: a cursory look at Hansard will show that the Kirkwood hospice in Kirklees has made 19 redundancies; the Ashgate hospice in Derbyshire has 52 jobs at risk, with beds cut from 21 to 15; St Catherine’s hospice in West Sussex is looking at 40 job cuts, with half of its new rooms being mothballed; Weston Hospicecare—highlighted both here today by the hon. Member for Weston-super-Mare (Dan Aldridge), and by others, including my hon. Friend the Member for Bridgwater (Sir Ashley Fox) at other times—faces an increased national insurance bill of £139,000; the Arthur Rank hospice in Cambridgeshire is losing £829,000, which is forcing the closure of nine beds, 40% of its capacity; and Marie Curie has pointed out that its national insurance contribution costs have risen by £2.9 million. Through all this, we have still never heard whether the Health team knew that this was going to happen and chose to push it through, or whether it was simply an oversight when it came to challenging the Treasury. Ever since the Budget, we have never heard an answer to that. At the time of the Budget, the CEO of Marie Curie, Matthew Reed, said: “The Health Secretary himself has acknowledged that palliative and end of life care is not good enough, so we are shocked by the lack of measures in the budget to fix it. Palliative care needs are projected to rise by 25% over the next 25 years, around 147,000 more people each year, yet this government lacks a strategy to tackle the magnitude of this challenge.” Have the Government made an assessment of how much the NICs increase has impacted the hospice sector? As has been mentioned, Together for Short Lives estimates that the average hospice is facing a bill of about £133,000. I raised a lot of these questions in a debate in January, and the Minister for Care kindly wrote to me in response. It is not just about the financial side; we are looking at the structural aspect too. He wrote: “As you are aware, integrated care boards…are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. In addition, the National Institute for Health and Care Excellence…has published quality standards and guidelines to support commissioners to carry out this duty. While the NICE guidelines are not legally binding, they act as a regulatory benchmark for best practice in palliative and end-of-life care…Whilst the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.” So there is a grey area about where hospices are covered, and that fits in with the NAO report.