Wimbledon MP Sounds Alarm on Hospice and Palliative Care
Paul Kohler, Liberal Democrat MP for Wimbledon, today (Thursday 13th January 2025) led a backbench business debate on the crisis state of Hospice and Palliative care, with support from Liberal Democrats, Labour, the Conservatives, Reform and the Independent Alliance.
Paul Kohler, Liberal Democrat MP for Wimbledon, initiated this debate after the crisis in hospice funding and concerns over the provision of palliative care were repeatedly echoed in arguments during the debate of the Terminally Ill Adults (End of Life) Bill last November.
300,000 people a year are treated in hospices, but just ⅓ of their funding comes from the NHS, and even clinical costs are often funded by charitable donations*. The majority of care that hospices provide is in the community*.
Paul Kohler MP said much of the care provided to the terminally ill or those with life-limiting conditions is “not something the NHS should be expected, nor can afford, to provide.”
The Lib Dems are pushing for Government support for the sector, as it faces rising costs*, underfunding**, regional disparities** and an insecure future.*
Hospice funding
On the crisis in hospice funding, Paul Kohler MP cited the local case of St Raphael’s hospice in Sutton and Cheam, South West London, who last year were forced to strip £1 million from their £6.5million budget by ending their ‘Hospice at Home’ service. In just one month, these service cuts directly impacted 26 patients, many spending their last days taking up valuable hospital beds, dying in the one place they did not want to die, and putting further strain on the NHS.
Becca Trower, St Raphael’s joint CEO and Clinical Director, said:
“We have a funding crisis and we need to protect our hospice.”
Recent Government announcements of £100 million in additional funding for the sector and the extension of the Children’s Hospice Grant by a further year*** are welcomed by the sector and will mitigate some immediate pressure. However, these are short term fixes. Lib Dems propose raising revenue through a fairer and more sustainable reformed model, and exempting hospices from the government’s National Insurance Contributions (NIC) rise.
Paul Kohler MP said:
“It makes no sense, at a time when the Government is aiming to move medicine into the community, for hospices to be forced into a position that achieves the opposite- a contradiction mirrored in the current funding settlement, where the Government has given with one hand - but taken with the other, by increasing Employers’ National Insurance Contributions.”
The government’s current refusal to exempt charities from the NIC rise will exacerbate the challenges confronting hospices. Paul Kohler MP said this decision will add an additional £200,000 to next year’s costs base for Shooting Star Children's Hospice, which serves families in his constituency.
On this, Paul Kohler MP said:
“Hospices provide a complimentary service which extends well beyond palliative care and for which their charitable funding model is more appropriate and effective.”
Paul Kohler MP emphasised the need for hospices to be included in the NHS 10 year health plan, and their staffing reflected in the next NHS Long Term Workforce plan.
Palliative care
Paul Kohler MP raised regional disparities in palliative care provision. The 2022 Health and Care Act includes a statutory duty for ICBs to provide palliative care but does not establish a minimum standard of core provision. Freedom of Information requests submitted by Hospice UK in 2023 found that adult hospice funding ranged from just 23p to £10.33 per head of population across different ICBs. For children's hospices, this variation was even starker. Research from the charity Together for Short Lives’ found spending per child with a life limiting condition varying from an average of £511 in Norfolk and Waveney to just £28 in South Yorkshire.****
Paul Kohler MP also emphasised a lack of training, time and resources to provide high quality care among palliative care providers. Neglect and under-investment stems from a system that does not regard palliative care as a core function. Much end-of-life care is provided by generalists, such as GPs, trainee doctors and community nurses, and specialists in other disciplines. They are committed to their patients, but for many this is not their primary focus.
Additionally, since the Harold Shipman case, Paul Kohler MP said there is unacceptable legal uncertainty as to the extent to which analgesics can be given to alleviate pain where that might hasten death. As was discussed during the assisted dying debate, this is deterring doctors from pursuing this humane course of action *****.
One Oncologist from Wimbledon said:
“Demand for services, is simply outstripping supply”
“The majority of patients are not getting their end of life care wishes met”
“If a patient receives access to a community palliative care team, you will hear no-one complaining about the care. The care is very good – if you can get it. The issue is most people cannot get access to one in the first-place.”
“The specialist palliative care teams are very good but there are not enough of them and they do not have adequate resources”
One doctor starting the palliative care specialist pathway said:
“Doctors across all specialties have a responsibility to care for patients reaching the end of their lives. As a medical student, I only received 2 mandatory days training on palliative care. This is simply not enough and we need to increase training across the board to ensure patients are given equal access to high-quality care.”
Paul Kohler MP said:
“The system requires a complete overhaul. More emphasis needs to be given to palliative care training throughout medical professionals’ entire career - including robust advice on the legality of giving sufficient pain relief to alleviate suffering...”
“ICBs should be required to provide a minimum level of palliative care as a core function. This would have a transformative effect on how palliative care is funded, both within and beyond the hospice sector, rather than leaving it to the generosity of particular ICBs…”
ENDS
Sources
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https://www.gov.uk/government/news/biggest-investment-into-hospices-in-a-generation
https://www.bbc.co.uk/news/articles/c74599znj7do
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APPG Report - Government funding for Hospices HUK.pdf
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