Meeting of the Parliament 06 December 2023
I thank Sue Webber for securing this debate on the future needs of charitable hospice care. It provides an opportunity to discuss some of the matters that I have been considering for some time now, in my capacity as convener of the cross-party group on palliative care in this Parliament.
Palliative care is personal to us all, first and foremost. As an elected representative, I am fortunate to have a Marie Curie hospice at Stobhill in my constituency. As a son, I was humbled to have St Margaret’s hospice in Clydebank look after my father with great care, love and compassion in the last few weeks of his life. However, hospices are not silos; they are a vital part of the fabric of our community, offering a wide range of supports, and they are actively involved in a broader range of palliative care support, not least with many of them delivering a model of care that is often described as “hospice at home”.
Such services will only grow in importance, with the requirement for palliative care set to increase by 20 per cent by 2040. Generally, with an older and frailer population, care needs will increase, yet resources for the sector are badly stretched; indeed, we have heard about the funding gap of £16 million that has been identified. We have to expand the hospice movement, not see it contract.
It is clear to me, therefore, that a new funding model needs to be developed to support hospices. We need to better understand the relationship with the NHS and health and social care in order to help reduce the frequency and impact of unplanned admissions to hospital for those in the last year of life. We also need to understand the relationship with delayed or unsafe discharge from the acute sector, when those approaching end of life could otherwise be at home and, indeed, the relationship with hospices and public models of social care that are delivered or procured through the network of Scotland’s health and social care partnerships. In that respect, I am thinking of the round table that was held just the other day.
It is fair to say that there is a variety of funding models, various service level agreements across the country, and a varied level of public funding being invested across 32 local authorities to support hospices or hospice at home services across the country. Variable models lead to variable outcomes and levels of service on offer across Scotland. Funding and provision of services are often inconsistent. Any national care service that we develop must help secure appropriate, dignified, sufficient and equitable provision of palliative care right across the country. I have met Hospice UK, Marie Curie and the minister to discuss many of those issues.
It is often said that death is the great leveller but, by that point, it is too late. In public policy, we must ensure that end of life is the great leveller for us all. With two thirds of people with a terminal illness relying on benefits, we can see that that is not necessarily always the case—it is not a level playing field. Perhaps through NHS agenda for change pay settlements, which we heard about earlier, there could be an expectation that hospices will be given funds to help match that pay award instead of drawing on shrinking reserves.
I know that it will be challenging, but we could move towards that. Perhaps the next NHS pay settlement could, as a matter of course, look at the financial impact on the hospice sector as a fundamental issue before any pay offer is agreed. I would like to see funds for hospices linked to agenda for change in the future. I do not think that we can move to 50 per cent agreed core cost funding, but it has to be a target—we have to get there.
None of us is naive about the Parliament’s funding predicament, but we have to move in that direction. We need longer service level agreements with health and social care partnerships and a clear line of accountability when those partnerships say that they are delivering what they have been told to deliver as part of any national model, and hospices say that that is simply not happening. That must change, too.
There is huge cross-party support in the chamber for all of that. We all agree that there has to be a new national funding settlement; however, none of us knows how that will be funded. I say to Jackie Baillie and others that that is where we have to come together as a Parliament and not play party politics. This is far too important.