My Lords, this group is made up of two of my amendments, Amendments 213A and 312L. The first is a probing amendment, designed to ensure that local planning authorities must consider what facilities are needed to provide the necessary health and social care facilities for their area, including for those with a terminal illness. My second amendment builds on this to ensure that local planning authorities must regularly survey the health and social care requirements for their area when considering any future development requirements.
We know that an ageing population is increasing the demand for specialist health and care services within local communities. We also know that demand for palliative and end-of-life care is rising rapidly as our population ages. In the next 25 years, the number
of people aged 85 years and over in the UK will almost double. We heard some figures around the need for housing for the elderly in previous debates, so this issue covers various aspects of how we plan for the future. In areas such as mine, in Cumbria, where we have what is known as a super-ageing population, there are even more stresses on local authorities and services to provide.
Because of this ageing population, by 2045 there will be over 136,000 additional deaths per year in the UK, compared with projections for 2023. So the demand for palliative care and end-of-life services will increase, particularly due to the larger numbers of people living longer with multiple and complex health conditions. It is absolutely critical that every person at the end of their life receives the care and support they need so that they can live the end of their life in dignity.
Marie Curie has provided some very helpful information, and I thank it for its briefing on this matter. It has estimated that, if palliative care capacity does not increase in line with projected increases in mortality, as many as an additional 14,000 people may die each year without palliative care by 2030, and as many as 86,000 additional people may be in the same position by 2040. In contrast, if capacity in the palliative care system grows to reflect this ageing population, as many as 77,000 more people every year could receive the specialist palliative care they need at the end of their lives. It makes a huge difference to how people can get the support and dignity that they need, as well as support for families in that difficult time.
We know that access to medicines out of hours can be complicated and time-consuming. For example, when Marie Curie surveyed areas in its report on better out-of-hours care, it found that only 25% of areas had a pharmacy open throughout the night that was able to dispense palliative medicines, and 68% of areas had only partial availability of healthcare professionals who were able to administer palliative medicines at night. More facilities within local communities could also relive pressure on the acute sector. Reducing unplanned admissions would reduce pressure on NHS hospitals—and we know how incredibly important that is at the moment with the extra pressures that the NHS is feeling. We know that there are around 5.5 million bed days occupied by people in the last year of life, just in England. The total cost of those admissions to the NHS is more than £1.2 billion. There are huge opportunities to improve life for people and end-of-life care, as well as to support our NHS in the work that it does.
To look at the importance of reducing health disparities for end-of-life care, the introduction of the Health and Care Act 2022 created the first ever duty for the NHS to commission palliative care services in every part of England through integrated care boards. That is very welcome—we know how important they are to local communities and families. However, we need to ensure that local planning authorities identify and allocate land and sites to help health commissioners to deliver the joined-up health and care services that we need within local community settings. By 2030, one in five people in the UK will be aged over 65 and the
number of people receiving palliative care services is projected to increase from 47% of all deaths to 66% over the next decade. That is almost a 20% increase.
At the same time, the nature of care need is also changing, with an increasing proportion of people dying at home or in a care home. This will again lead to growing pressure on primary care, social care and the local community. Too many people already miss out on the care and support they need towards the end of their life, particularly those from disadvantaged groups. The most recent estimate suggests that in England, up to 25%—a quarter—of those who need palliative care are not receiving it. Out-of-hours emergency department attendance increases in frequency as death approaches. It is between five and eight times higher in the month before death than at 12 months before death. It is also more common among people living in the most socioeconomically deprived areas.
Marie Curie and others have carried out research that indicates that certain groups face particular barriers in access to palliative care, including people who are living in poverty, living alone or living with dementia, as well as people with learning difficulties, those who are homeless, those who are in prison, those from minoritised ethnic groups and LGBTQ+ people. There is much to do in this area. I know it is quite a specific area to put into the Bill, but I hope that by putting these amendments forward we can have a proper debate on something that is very important to our society. I beg to move.