1 November 2024
Dear Secretary of State,
I am writing following the announcement of changes to employer National Insurance Contributions in this week’s budget.
Marie Curie is the UK’s leading end-of-life charity. Marie Curie is here to serve anyone living with terminal illness, and those close to them. We bring 75 years of experience and leading research to the care we give you at home, in our hospices and over the phone. And we push for a better end of life for all by campaigning and sharing research and policy recommendations to improve the end-of-life health and care system.
We want to support the Government to transform palliative and end of life care to ensure that more people receive the support they need. However, organisations like Marie Curie can only fully play our role if we are sustainably funded for the palliative care services we deliver on behalf of the NHS.
The announced changes to employer National Insurance Contributions are expected to cost Marie Curie around an additional £3 million in 2025/26 alone.
Since we have aligned clinical and clinical support roles to the core NHS Agenda for Change terms and conditions, the costs of increases in NI employer contributions for Marie Curie comes on top of a 5.5% consolidated pay increase awarded to all eligible colleagues working in clinical and clinical support roles. In previous years, though we have sought to recover the full increase in the pay award from health commissioners, we have often only successfully recouped a small proportion through contractual uplifts.
We very much welcome the investment the Government have made into the NHS this week, but this investment also needs to reach non-NHS providers of NHS services like ourselves – so far we have seen only additional financial pressures with little sign of relief. Realistically, without further support and faced with significant additional cost pressures through increases in the NHS pay award and employer National Insurance Contributions - the only option we are left with is reducing the services we deliver.
As you have recently acknowledged, palliative and end of life care is not good enough. Far too many dying people are already facing avoidable pain and social isolation at the end of life – further financial pressures which reduce the availability of palliative care services can only make these problems worse.
Furthermore, palliative care can play a critical role in reducing pressures on the NHS. For example, services like Marie Curie’s IMPaCT in the North West of England work to improve coordination across palliative care – delivering two “hubs” which patients, carers and health and care professionals can contact through a 24/7 palliative and end of life care telephone line. Services like this can make a real difference – in the case of IMPaCT bringing down emergency hospital admissions at the end of life by 13%.
At the same time, direct provision of palliative care services in emergency departments – like Marie Curie’s REACT service developed with partners in Bradford - can proactively identify, assess, and treat people arriving in A&E, and offer an alternative to hospital admission through a supported transition into community palliative care. For people in their last year of life supported through REACT, and admitted to community palliative care services, the average number of days spent in hospital reduced from 38 to 15.
With as many as 30% of hospital beds occupied by people in the final year of life, it is impossible to imagine that the Government can succeed in its aim of shifting care from hospitals to communities without a focus on enabling growth in services like these. At present, we risk seeing them being lost.
We need to see urgent action to address the impact of increases in employer National Insurance Contributions on non-NHS organisations delivering services on behalf of the NHS. There is some precedent for action of this sort – since 2019 when employer contributions to the NHS pension scheme were increased, Marie Curie have received funding in order to cover the additional costs.
However, action employer NICs alone would be far from sufficient to address the challenges facing palliative and end of life care for the future. It is critical that the NHS Long Term Plan and the Comprehensive Spending Review in the Spring set out a clear approach from Government for transforming the provision of palliative and end of life care for the future, including addressing sustainable funding for providers. This should address the needs of the whole health system – addressing both specialist and generalist provision, and delivery by both NHS and non-NHS providers.
Ensuring financial sustainability will help us to work with the NHS to reduce system pressures and tackle inequalities in access for the most deprived communities. We would be very keen to meet with you to discuss the current risks and challenges facing palliative care, and how we can work with Government to improve provision for the future.
Yours sincerely,
Matthew Reed, CEO, Marie Curie
cc Chief Secretary to the Treasury