I wanted to begin today by thanking you for the care that you provide Hospice UK. Everyone in this room and everyone joining us online across the UK and beyond. I know that I’m speaking to doctors, nurses, carers, allied health professionals, bereavement support workers and counsellors, fundraisers, retail staff, coordinators, support staff, office staff, and of course volunteers. Thank you for the care and the compa...
I wanted to begin today by thanking you for the care that you provide Hospice UK. Everyone in this room and everyone joining us online across the UK and beyond. I know that I’m speaking to doctors, nurses, carers, allied health professionals, bereavement support workers and counsellors, fundraisers, retail staff, coordinators, support staff, office staff, and of course volunteers. Thank you for the care and the compassion that you give to babies, to children, to young people, to adults, the elderly of course, and all this, and their loved ones, in what can be the most difficult time of life. I personally know so many instances where you’ve gone above and beyond, and this government is so grateful for everything that you do. I’m also immensely grateful to those of you here today with lived experience for sharing your insights to highlight when things have gone well and where we need to do better to improve things for others. Your views are vital to the way that we do things, and we will always strive to put the voice of patients and their loved ones first. Now, hospices are a key part of the wider palliative care and end-of-life care ecosystem. And you also have a huge role in the shift of care that we’re talking about from hospital to community. That’s why in December, in a difficult financial context, we still found the money for the biggest investment in a generation for hospices, providing £100 million pounds in capital funding to adult and children’s hospices across England over these two financial years. I’d like to say a big thank you to Hospice UK for your incredible continued support in administering and distributing the money to hospices. You’ve done the sector proud, and our partnership has helped around 150 hospices to buy new beds, upgrade IT systems, and to refresh and refurbish common areas, like gardens and family areas. And that’s not all, because many of the projects will create future savings by making the running of hospices more sustainable - fixing that draughty window, repairing that ancient boiler or even getting me into my friend Ed Miliband’s good books by installing solar panels. Now, when we talk about making our health service fit for the future, that is what we mean — no more short-termism. Earlier this year, I was fortunate enough to visit Wigan and Leigh Hospice to hear from their CEO Jo Carby about how they had used their funding to repair their roof, which was leaking, and how they planned to spend this year’s allocation on a new heating system. I heard first hand about what a difference this would make for patients and for staff. And I heard from the leadership about how this money frees up funding for other areas. I was also delighted to announce just last month the continuation of the children’s hospice funding, previously known as the Children’s Hospice Grant. This revenue funding has now been guaranteed for the three years of the next Spending Review period, right the way through to 2029. This amounts to about £80 million pounds over the next three years. Now, as you can imagine, getting a three-year commitment out of our finance team while Spending Review allocations were continuing and still not settled was a bit of a challenge to say the least. But it was of huge importance to this government that we secured this multi-year settlement to avoid the previous years’ cliff edge of yearly funding cycles that children’s hospices were facing, giving you some of the stability and certainty that are the vital preconditions for your planning and operations. I was privileged to make this announcement at the Noah’s Ark Children’s Hospice in Barnet where I had the opportunity to meet staff and families, including Sophie and her grandmother Rosie. They told me how wonderfully the hospice was at supporting the whole family, and most importantly Sophie. I also had the opportunity to have a chat with Noah’s Ark CEO Sophie Andrews and Nick Carroll, CEO of Together for Short Lives, who told me how this three-year funding will help to bring some clarity and reassurance to children’s hospices, helping them to deliver care over a longer period. Now, although I’m here today to speak and to listen on the subject of palliative care and end-of-life care, it would be remiss of me not to touch upon the ongoing passage of the Terminally Ill Adults Bill through Parliament. Assisted dying is of course an incredibly sensitive topic, but I think the quality of the debate and the respectful way it’s being conducted has shown Parliament at its best. I’ve heard some incredibly moving and personal speeches from colleagues on what might be the most momentous decision of our political careers. The Prime Minister has rightly said that the government is neutral and that the Bill is a matter for Parliament, but it is of course the government’s role to make sure the legislation is workable in the real world should it become law. So, if Parliament does choose to pass the Bill, we will implement it in a way that is safe and practicable. But I want you to know that whatever Parliament decides we must, and we will, continue to work towards building a society where every person who needs it receives high-quality, compassionate palliative and end-of-life care. And regardless of your view on assisted dying, the Bill has undoubtedly put palliative and end-of-life care in the spotlight and raised awareness of the amazing work that happens in hospices every single day. But I see the pressure across the system every day, as do you - more complexity, greater demand, and inequalities in the way that people receive end-of-life care. My starting point is that every person should receive high-quality, compassionate care from diagnosis through to end of life. But a big stumbling block is that some people’s needs aren’t identified in good time, and they don’t access palliative care soon enough. For this to happen, all professionals should access shared care records and advanced care plans as soon as they’re in place. Continuity of care should get better and opportunities for advanced care planning must improve. There’s clear evidence that people’s quality of care is improved by access to 24/7 palliative care, with end-of-life care provision and continued care through a multi-disciplinary team approach. Too many people end their days in hospital unnecessarily, which is both costly to the system and not where most people will want to be at the end of their lives. And all of this comes against a backdrop of fiscal challenges across the entire public sector. Although much palliative care and end-of-life care is provided by NHS staff and services, there’s absolutely no way we could do it without voluntary sector organisations like hospices. I completely recognise the strain that you’re under, some hospices through no fault of their own have had to cut back, close inpatient beds, lose some excellent people, and run at a deficit. I wish that I could stand here and say that government will pick up all of that slack. And believe me in a perfect world that is exactly what I would be saying, but someone who arguably has the toughest job in government — that is the Chancellor — has to deal with momentous challenges such as tariffs, inflation and the astronomical cost of borrowing. The UK’s national debt now stands at almost three trillion pounds, or 95% of our GDP. Today, one in every 10 pounds of taxpayers’ money is spent on debt interest — not on paying that debt down but just paying the interest to our creditors. That’s 100 billion pounds every year, going to hedge funds and overseas investors, not to patients. It’s an eye-watering sum that exceeds the entire education budget for England. So alongside what investment we have been able to provide, we’re doing our utmost to support the sector in other ways. Hospice funding varies across the country, and some of that variation is warranted as it reflects both innovation that’s happening and the needs of local people. But a lot of that variation is not warranted and it’s something of a postcode lottery. So, as we shift towards strategic commissioning and contracting of palliative care and end-of-life care services, we will ensure that services reduce variation in access and quality, whilst recognising that some variation is of course perfectly justified. In the long term, we hope that by supporting ICBs to commission more strategically, we can move away from grant and block contract models. This would be more sustainable and would help hospices to plan ahead. Together, we have to be innovative in finding solutions within the constraints that we’ve inherited. Now, I understand that for some people and their loved ones, an inpatient hospice bed is the right place to be either for complex symptom control or at the end of life, and this can be the right place for a multitude of reasons. But I’ve also spoken to people who would prefer to be supported in their homes, surrounded by cherished memories, familiar furniture and by their loved ones. My job in government is to support this wherever possible. We are, above all else, a patient-centric government with patient choice driving everything we do. And I know many hospices have beaten me to the punch and are adopting this approach, which is not only what patients want but is also better value for money. Now, I don’t doubt for a second that everyone in this room and all of you following online have the skills, the talent and the determination to deliver high-quality care for all. Despite funding challenges, I do think that the unique hospice model is one to be truly proud of. As you know, Dame Cicely Saunders pioneered palliative care in the 1960s. People in other countries have studied how they work and it’s no exaggeration to say that British hospices are the envy of the world. They are a credit to our country and to our health service. Because hospices are rooted in their local communities, they’re the epitome of community spirit, and they are compassion personified. Independent charitable hospices rightly value their autonomy because this flexibility allows you to provide holistic and innovative services. And I strongly believe this diversity of provision, based on a mixture of funding streams, is a strength, not a weakness. That’s why this government is determined to shift more healthcare out of hospitals and into the community, as set out in our 10 Year Health Plan — ensuring patients and their families receive personalised care in the right setting. And palliative care and end-of-life care services, including hospices, will have a big role to play in that shift, including as part of our neighbourhood health teams. Both the 10 Year Plan and the NHS England, recently published, medium-term planning framework, set out in black and white how important palliative care and end-of-life care are to the wider health service. And now these plans are published, we are weaving them into our long-term workforce plan and the neighbourhood health framework to ensure a strengthened position for the palliative care and end-of-life care sector going forward. Yesterday, I was proud to lay in Parliament a statement announcing that we will publish a Palliative and End-of-Life Care Modern Service Framework (MSF) in the spring of next year. This will be one of a small number of Modern Service Frameworks currently under development, targeting issues such as dementia and frailty, cardiovascular disease and severe mental illness, that we’re developing as part of the 10 Year Plan. And look, I know that it’s probably unrealistic at the moment to have completely equal services for everyone everywhere, all at once. But our Modern Service Framework will seek to end unwarranted variation in care by putting a floor under the kind of care that people can expect. The original national service frameworks were created by the last government between 1997 and 2010. [Political content removed] Our Modern Service Framework for Palliative and End-of-Life Care will have five key components. First, an aspirational long-term outcome goal — one that is focused, measurable and time-bound. Second, it will identify the best evidence interventions that we anticipate supporting progress towards that goal, with a focus on value and equity. Third, it will spell out how we intend to support consistent uptake of those interventions by ICBs, clinicians and providers, with a focus on reducing unwarranted variation. Fourth, it will tease out what innovation has the highest potential in the next 10 years. And fifth, it will set out how we plan to work with others to develop, adopt and spread innovation in those domains, including making the shift from analogue to digital. Through the MSF, our aim is to rewire the way in which palliative care and end-of-life care is commissioned, and we will ensure that the best practice models are experienced by everyone, not just the lucky few. Effective engagement with all our partners will be key to how we develop a framework that is fit for the future. And we will be working with the Ambitions Partners, among others, to get the MSF over the line and published by spring 2026. For the MSF to work, we need accountability. If we’re not meeting our targets, someone has to hold our feet to the fire. So, once it’s published, the oversight of the MSF will sit within the governance structure of the National Quality Board, with a clear and effective mechanism to improve care. This will enable the adoption of interventions that are proven to make a difference to patients and their families. These interventions can support, for example, earlier identification of need, care delivered closer to home by integrated universal and specialist teams and strengthened out-of-hours community health support, including dedicated telephone advice. This will enable more people to remain in their preferred place of care, reducing avoidable admissions and deaths in hospital. We have already begun to engage with our partners in the sector on how we improve access, quality and sustainability in palliative care and end-of-life care. And we will continue to work together to shape and deliver this vision. We want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life, and we recognise that access to high-quality, personalised palliative care and end-of-life care can make all the difference to patients and their loved ones. Once the MSF is published, of course the work does not stop there. This will just be the start of the journey and will give us our long-term direction of travel. Because the MSF is a means to an end; it is absolutely not an end in itself. So we will then move into implementation while continuing to work on supporting ICBs and providers, whether it be via statutory guidance, regional conversations, sharing best practice or monitoring the shift in strategic commissioning. One example of best practice we anticipate shining a spotlight on is 24/7 helplines. Here in Liverpool, a specialised palliative and end-of-life care hub providing a dedicated 24/7 phone line was evaluated between 2021 and 2023 and was found to have the following benefits: improved identification of those with palliative and end-of-life care needs; a decrease in emergency hospital admissions for those at the end of life; a decrease in the number of people dying in hospital, and an increase in the number of people dying at home, where we know the majority of us would prefer to be. So, we’re very much looking forward to working together with you on this opportunity to set the direction for a sustainable palliative care and end-of-life care sector, providing accessible, high-quality, personalised palliative care and end-of-life care for all those who need it. We believe that the MSF is a major step in the right direction. But of course, we recognise that there’s a mountain to climb and we are only at base camp. So, I want to end by thanking you all for your time today, for giving the government a fair hearing and for everything you do to help people live and die with dignity. At the greatest time of need, you are doing an incredible job under incredibly difficult circumstances. Despite everything, hospices are still a pillar of our communities, a great British institution, and this government is determined to keep it that way. There’s no magic wand; there’s no silver bullet that we can use to fix our problems in palliative and end-of-life care. But our Modern Service Framework is a really great opportunity to improve the access, quality, and sustainability of this sector and to make it truly fit for the future. Toby, I know that you made a great speech this morning because I read it on the train on the way up from Euston. You spoke of a fork in the road, with one path leading to innovation and integration at the heart of our emerging neighbourhood health service, the other path leading to managed decline. Well, I am here to tell you unequivocally that this government chooses the former of those two paths, because we are clear that the palliative and end-of-life care sector is absolutely integral to our 10-year plan and to our emerging neighbourhood health service. We literally cannot do this without you. We cannot deliver the hospital-to-community shift without you. And we cannot get our NHS back on its feet and fit for the future without you. So, let’s roll up our sleeves and let’s get to work. Thank you.
Speech Brief