The Parliamentary Under-Secretary of State for Health (Ben Gummer)
I thank my hon. Friend the Member for Lewes (Maria Caulfield) for bringing this very important subject to the attention of the House and for doing so with her characteristic passion and verve. It has been a pleasure to answer her points in several previous debates. She has made her points with great clarity and it is with great pleasure that I will respond to every single one.
I will start where I finished on Monday night. This debate is timely, because it follows closely on that evening’s Adjournment debate, which was brought to the House by my hon. Friend the Member for Colchester (Will Quince) and to which other Members contributed with such great passion, interest and detailed knowledge. I firmly believe that, unless the NHS understands that the basis of care is not the end point of healthcare but a good in and of itself, we will not build a satisfactory foundation for the medical care that we hope is the experience of the majority in the NHS. For people for whom the end point is not recovery, but good and decent care, we must ensure that such care is embedded in the foundations of the NHS. If we do not, we will not provide a suitable foundation for good care throughout the system. That is why I see palliative care not as something that is nice to have—an added extra or a bonus within the NHS—but as something that is crucial to the delivery of good care throughout the system, whether or not people are likely to survive at the end of their care in hospital, in the community or at home.
I share my hon. Friend’s judgment of the debate on the Assisted Dying Bill, which I found fascinating. No matter where Members came from in that debate, what was clear was their wish to cherish, support and improve the palliative care services in our country and to ensure that people had access to the very best services not only in the UK, but in the world. That is where I will start my general remarks.
My hon. Friend is right to point out that the provision of palliative care is variable across the country, and I will turn to that in a second, but it is one of the areas that we should be very proud of, not least because of the dedicated work that people like her provide across the system in specialist settings and because of the unique gift that we have in this country of the hospice movement.
That is why the Economist Intelligence Unit, only a few weeks ago, judged that this country had the finest palliative care in the world in terms of access to services and the quality of those services. I do not say that in order to say that there is nothing to do—quite the opposite. The Economist Intelligence Unit pointed out that there are examples of extraordinarily good care across the country. I want to ensure that the experience is not variable, and that no matter where one is in the country, one receives the finest care.
Where should one look? I will point to a few examples of where exceptional care is being provided. In Bedfordshire, Sue Ryder has brought together palliative care services across the county. There is a brilliant linking up of services, whether they be in the community, in hospital or at home. As my hon. Friend knows well, home can encompass care home settings and private homes. That is a beacon of good practice that has been brought together by an expert charitable institution.
The Airedale, Wharfedale and Craven clinical commissioning group has blazed a trail with its expertise in palliative care, particularly through its adoption of the gold line telephone number, which is used not just by clinicians, but by families. People are lucky if they need palliative care and live in the Airedale clinical commissioning group area, because they are likely to receive the very finest palliative care available anywhere in the world.
I know that my hon. Friend has experience of hospital palliative care as a cancer nurse at the Royal Marsden, where exceptional care is provided that is comparable to the best care anywhere in the world. She will also be familiar with the work that is done at Frimley Park, where there is a comprehensive palliative care programme that goes across the hospital and is not seen as a bolt-on extra. The John Radcliffe hospital in Oxford has a similar approach with similar ends.
Sarah Champion
The Minister is citing excellent examples, but does he agree with me—I think that this is the intention behind the debate—that we should not just have exceptional examples, but 24/7 care wherever people are and whatever their condition is?
Ben Gummer
I agree completely with the hon. Lady. I was just about to turn to the very useful intervention that she made earlier, in which she said that palliative care is a mark of the integration of the health and social care sectors. It is no coincidence that one often sees good palliative care where there is good integration of health and social care. In a sense, the state of palliative care is a proxy for where care is well integrated and where it is not. That is why it should be seen as part of the larger challenge of achieving successful integration, on which there is a good deal of cross-party agreement.
My hon. Friend the Member for Lewes mentioned the fact that many people do not die where they would choose. She will be aware of the Choices survey, which was launched by my predecessor in the coalition Government, the right hon. Member for North Norfolk (Norman Lamb). It has reported, and the Government have committed to replying to it. She can take that as an indication that there is policy to come, and that we will study carefully the things we have set up. We intend to ensure that people have greater access to the services they require to ensure that they can die where they wish. We made that commitment in our manifesto—we were very clear about it—and we intend to deliver on it, as we intend to deliver on the rest of our manifesto.
My hon. Friend was entirely right to point out that that will require changes in services where they are not good. That will require commitments on palliative care nurses and the spreading of training. They have been achieved in Airedale, but have not been achieved in other clinical commissioning groups, where care is sometimes significantly lacking. There is much to do in some areas of the country. If I may use Bevan’s words, it is about universalising the best. We know what the best looks like. We now need to ensure that we spread it across the rest of the country.
My hon. Friend was right that palliative care has, unfortunately, in some cases been associated with cancer care. That is not how it should be seen. She will be aware in great detail of the European Partnership for Action Against Cancer system, which is being used to ensure that cancer patients can indicate their wishes for the end of life. It can also help clinicians to manage that end-of-life period. The EPAAC system was originated and developed specifically for cancer patients, but we intend to roll it out for patients no matter what the cause of their death.
My hon. Friend mentioned the need to provide services 24 hours a day, seven days a week. Without wanting to state the obvious, that is one reason why we want to get a seven-day NHS working. When people need the NHS—whether they need medical attention that will save their life or pain relief that will mean that the end of their life is bearable—it cannot be right if treatment is deferred to a Monday because we do not have services available on Saturday and Sunday. That is the crux of what the Government are trying to achieve across our NHS reforms: we want to achieve a truly seven-day NHS.
Briefly, on the Bill introduced by Baroness Finlay in another place, I cannot disagree with the general sentiments of the proposal. The degree of variability that we have is obviously wrong and we must put it right. It should be right, in a sense, to say, “Let us legislate in order to make it so.” I have reservations about the Bill—I have made them clear to Baroness Finlay—but I should like to outline them to explain why I believe it may not achieve what it wants to achieve, and why, on a wider point, it might be counterproductive.
If enacted, the Bill would be the first instance in the history of the NHS that means we would make specific clinical demands on clinical commissioning groups about a specific clinical area. To take an analogy, we have not had a cancer services Bill that demands things of CCGs on cancer services. The Bill would therefore set a precedent, which requires very careful consideration. My current judgment, and that of the Secretary of State, is that we do not want to determine that demand from the centre in the manner in which Baroness Finlay wishes.
There are other instruments for achieving what Baroness Finlay wishes to do, such as the mandates to CCGs and to Health Education England. There are ways to achieve by similar means the same ends that she wishes to achieve, which is putting certain obligations on CCGs to ensure that they commission care in a way that we expect. We need to be careful about how we do it. Airedale is so good because it has come to that point by itself and developed its approach organically. Other CCGs around the country have come to equally good solutions in a different way.
I would not want to impose a solution from the centre that squashes the local innovation of good leaders. I think we can all agree that the NHS in the past has not been good at allowing staff locally to celebrate leadership and innovation. There are lots of brilliant people in the NHS who have great ideas, but they do not feel empowered to bring them forward. We need to be careful, therefore, about imposing solutions from the centre, either from the Department, NHS England or this place, that do not recognise the ability of local people to come up with local solutions. I have told Baroness Finlay that I want to develop policies that do what she wants to do but not by the means she proposes. I hope to empower local people to get to where she wishes to go, and I hope to do so in a manner that celebrates success and exposes failure, so that we can put it right, and universalises the best as quickly as possible, without taking a top-down approach, which might have the contrary effect.
We are in a better position than other countries because of the remarkable work of charities and voluntary bodies over the last few years, and we have now accumulated a mountain of evidence from charitable groups and Government. My hon. Friend pointed to the 2011 NICE guidelines, but there were also the five priorities outlined last year in “Priorities of Care for the Dying Person”, and we now have the NHS Choices review, to which the Government will respond. We have enough paper evidence. We know what looks good, how to make it happen and that it needs to happen, and we know that many people die in circumstances that leave much to be desired. I point in particular to those who die in hospital. It is clear from the VOICES survey, which tracks the experience of families and individuals at the end of life, that people’s experience of dying at home and in community settings, especially in hospices, is generally much higher than in hospitals. Broadly—I generalise—half of people in hospital do not have an optimum experience of death.
We can change some things quite quickly, but we have got to this point because of the sustained effort over many years and the accumulation of evidence in a clinical area where Britain leads the world. I pay tribute to my hon. Friend and other colleagues with expertise in this area, to the many academics who have worked hard on this, and to the hard work of NHS England and its director of palliative care, Professor Bee Wee, who is a remarkable clinician. Over the next few years, as we fulfil our manifesto pledge, I hope that all parties can work together on this, calling on the experience of people from every part of the country—it was great to hear from the hon. Members for Torfaen (Nick Thomas-Symonds) and for Strangford (Jim Shannon), who shared their experience from other parts of the UK. If we can bring all this together, I think we can do something rather remarkable for people with no medical hope at the end of their life but to whom we should give the absolute guarantee that their care will be exceptional and will make what is never going to be a happy moment at least bearable and full of meaning for them, their families and their loved ones.
Question put and agreed to.