Hansard

It is a privilege to be able to bring this debate to the Parliament. Not that long ago, back in November, I hosted, on behalf of my colleague Miles Briggs, a round-table event on the dying in the margins study from Marie Curie and the University of Glasgow. It was heartening to see such strong cross-party support at that meeting, and I am delighted to see such strong representation from members on all sides of the chamber today, too.

Ahead of the debate, I have been working with Hospice UK, Marie Curie and St Columba’s Hospice Care to understand more about the key issues that hospices face, particularly the problems surrounding funding. I thank them all for their support in preparing for the debate.

Why are we here? First and foremost, it is because the funding of hospice care is unsustainable. Hospices face an expected deficit of £16 million this year, as statutory funding has not been keeping pace with historical and recent spiralling costs. In particular, the cost to hospices of matching the national health service pay awards in order for pay to remain fair and competitive for their staff has been highlighted to me as an issue.

With the demand for palliative care increasing and the health and care system under significant strain, the support that charitable hospices provide has never been more crucial or critical. Hospices provide vital support to general practitioners, district nurses, care homes, hospital teams and social care through training and education, specialist clinical expertise and strategic leadership.

Hospices bring more than £60 million of charitable funding into the local health and care system each year, and we should not hide from the fact that they lessen the demand on our statutory services by reducing the number of emergency admissions, reducing the length of stays in hospital and supporting people to stay at home. They are, therefore, worth every penny, as they provide significant value for money.

The harsh fact is that the number of people in Scotland who need palliative care is predicted to rise by 20 per cent by 2040. In addition, they will need more complex care, further adding to the pressure on the already overstretched NHS. Charitable hospices are a key part of a cost-effective solution to those pressures, but they can do their work only if the funding and the hospices themselves are sustainable.

Hospices are struggling to stand still, let alone invest in responding to the future challenges that they face. Current funding arrangements do not support hospices to innovate and grow their services. In Scotland, there are 16 charitable hospices—14 for adults and two for children and young people. St Columba’s Hospice Care and Marie Curie hospice Edinburgh, along with Marie Curie’s hospice care-at-home teams, provide hospice care across Lothian. In November, I had a very informative visit to the Marie Curie hospice at Fairmilehead. I am ashamed to say that, in all the years that I have been in this world and living in Edinburgh, that was the first time that I had been there.

In 2022-23, about 8,815 people died in the Lothian region, and 90 per cent of them had a palliative care need. Across the region, 4,060 visits were made to 672 terminally ill people by the Marie Curie hospice care-at-home team. Marie Curie hospice Edinburgh and the West Lothian service supported a total of 1,690 patients through their in-patient, out-patient and community and day-therapy services.

I think that a lot of people have a preconceived idea of what hospice care is and what a hospice is all about. They just see a building and think only of rooms and beds and people being there to die. However, that cannot be further from the truth. Most of Marie Curie’s work is done in the community, with the majority of hospice care delivered beyond the hospice buildings, out in people’s homes and in the community. Hospices give people the option to die with their friends and family in their own homes, supported by teams of experts.

Marie Curie has a fast-track team that helps people with tasks such as washing, caring and showering as they get close to the end of their life. Crucially, that keeps them out of acute hospital settings. The team is essential to keep people in the right place, and it also offers family support to relatives.

I would like to touch on the work of St Columba’s Hospice Care in Edinburgh. In March 2023, it began a trial of a groundbreaking new virtual ward service. As far as we have been made aware, it is the first hospice in Scotland to roll out a development of that kind. The new service across Edinburgh and East Lothian provides patients and families with an alternative model of care, and it allows patients to be fully cared for in their own homes or in places of residence towards the end of life. The care and expertise that the team provides allows patients to remain at home with a very high level of support, which would otherwise require in-patient hospice or hospital-setting care.

The cost to the health and social care service of caring for people in the last year of their life is vast. Almost one in three people in Scottish hospitals are in their last year of life, and 95 per cent of people in Scotland use NHS unscheduled care services in the last year of life, which represents a total cost of nearly £190 million. That is why hospices are crucial.

In 2022-23, hospice care providers made more than 123,000 visits to people’s homes to deliver vital support. As I stated earlier, hospices provide vital support to GPs, district nurses, care homes, hospital teams and social care through their training and education, specialist clinical expertise and strategic leadership. They also bring more than £60 million of charitable funding into the local health and care system each year.

Earlier this week, the Minister for Public Health and Women’s Health attended a round-table event on hospice funding. I heard that, rather disappointingly, the minister opened the meeting by saying that the hospice sector’s call for remedial funding to address the £16 million deficit that the sector faces over the next three to five years is unaffordable. The minister also said that that meeting was the “start of the discussion” and that it would feed into other meetings that are due to be held soon. However, there is no clear timeline for next steps.

I hope that this debate will go some way towards shaping the minister’s thinking and that it will get her up to speed with the invaluable role that hospices play in our society, as our population ages and as people’s needs as they approach the end of their lives become increasingly complex.

In conclusion, I think that we can all agree that a new national funding framework for hospice care is vital to ensure the on-going sustainability of the sector and to allow charitable hospices to continue to support the NHS and provide high-quality palliative care to people in the Lothian region and across Scotland.