The Parliamentary Under-Secretary of State for Health (David Mowat)
I congratulate the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) on bringing this debate to the House. This is an important subject and it is good that we have the chance to talk about it.
It is also good, as the hon. Lady said, that we are debating it on the UN’s International Volunteer Day. She reminded the House, if it needed reminding, how much of the palliative care burden is taken up by volunteers. We should all reflect on the fact that there are 6 million informal carers in this country. Without those people, things would be much more difficult. We have a carers strategy coming out in the next few months, which I will discuss during my speech.
The hon. Lady talked about her hospice, the work that the Marie Curie charity does there and the helper service it has pioneered in Newcastle. I am happy to acknowledge the fantastic work that hospices do. I have one in my constituency, St Rocco’s, which also does brilliant work. The hon. Lady used a good phrase: we should recognise that at their best hospices celebrate life. That is important.
The Government’s position is that high-quality, end-of-life care, reflecting individual needs, choices and preferences, should be available to everyone. That is our objective; that is what we are working to achieve. Much is being done, despite perhaps the tone of the hon. Lady’s remarks. However, of course there is more to do: more can always be done. This is not something that will ever be finished, but I want to set the context in which we are working.
Jim Shannon (Strangford) (DUP)
The Minister has rightly acknowledged, as has the hon. Member for Newcastle upon Tyne North (Catherine McKinnell), the importance of charities and the work that they do. In his response to the points that she has made, will he say what the Government intend to do for young carers who look after those who are at the end of life? I am aware of the pressure on those young carers given their age, and their ability to cope with the life-changing event that will happen to them and their family very shortly. We need something for them, Minister. Can I make a plea for them?
David Mowat
I thank the hon. Gentleman for that intervention. He is right. There are about a quarter of a million informal carers under the age of 25, half of whom are under the 16-to-18 age range. There are issues for education and future employment. The carers strategy is addressing that and I will have more to say about that.
On the context, 480,000 people in England die every year. Thirty-six per cent. of those are over 85 and about 350,000 of those deaths are expected, in the sense that they are not a surprise. Roughly half that number get some specialist palliative care as part of the pathway. The hon. Lady talked about that not being enough, and I will come back to that. Forty-seven per cent. die in hospital, which is an improvement: 57% of people were dying in hospital 10 years ago. There is an emphasis—the charities, particularly Macmillan, are offering a lead on this—on ensuring that fewer people die in hospital.
In terms of authoritative evidence of how that is working—the hon. Lady mentioned some of the points made by Marie Curie—the Office for National Statistics conducts a yearly survey called “Bereaved VOICES”, which looks at how carers and bereaved people evaluate the last three months of the end-of-life care for their loved ones. About 75% of those services are regarded as good, excellent or outstanding. Ten per cent. are regarded as poor. Ten per cent. is 48,000 deaths a year, and that is still too high. Nevertheless, 75% of those services are regarded as good, excellent or outstanding. The highest proportion of those services are in hospices. Care homes rated about the same as hospices, with hospitals doing less well. The figures are patchy, however, and that is generally linked to deprivation. They are not as good in areas of relatively high deprivation as they are in other areas. That is partly because hospice availability is somewhat skewed by the fact that the charities that run them tend to operate in more affluent areas.
The hon. Lady mentioned the need for spiritual and emotional attention at the end of life, and I can tell her that 70% of those who responded to the survey regarded their loved ones as having received good or outstanding spiritual or emotional care. That reflects well on those in the voluntary sector and the NHS who provide that care, and we should acknowledge that.
I do not wish to sound complacent, because I acknowledge that things could and should be better. I have had this job for four or five months, and there are very few of the areas I cover in which the UK could be said to be the best in the world. Let us take cancer outturns as an example. We know that our one-year survival rates for most types of cancer are worse than those of most other countries in Europe. Last year, however, the Economist Intelligence Unit compiled a quality of death index, which evaluated 50 or 60 countries in the world against a number of criteria, and the UK came top in end-of-life care. As I have said, I do not know the situation across all the areas for which I am responsible, but we should acknowledge this finding. To put it into context, Germany came seventh, France came 10th and Sweden came 16th. That has been achieved through the work of people in charities and in the NHS, but we must also acknowledge that things could be better.
The hon. Lady spoke about social care funding—although that is a slightly different area—and about delayed transfers of care and all that results from them. I have acknowledged many times in the Chamber that social care funding is under pressure and that that can cause delayed transfers of care, or bed-blocking, if we want to use that term. However, in terms of adult social care, if we compare the top 10% of councils with the bottom 10%, we see that there is a factor of 30 times in the difference between their performance in delayed transfers of care. That is not related to budgets; it is related to best practice, leadership and all that goes with that. We are sometimes quick to say that money is always the issue, but although that is of course part of it, it is not the only issue. It is important to understand that other factors are involved. Among other areas that need to be improved, we need to continue our drive to ensure that more people do not receive their end-of-life care in hospitals, where they generally do not wish to be. We should also acknowledge that there can be non-uniform commissioning among clinical commissioning groups, and we can do better in that regard as well.
The hon. Lady talked about the choice review, which was produced in 2014 by the National Council for Palliative Care, helped by Macmillan and Marie Curie. It contained some 62 recommendations. The Government’s response came out in July—it was one of the last acts of my predecessor—in the form of a five-point charter. In it, we accepted that we would have personalised care plans in place by 2020, that everyone was entitled to an honest discussion about their end-of-life care and to support in making informed choices, that family and carers would be involved in those choices, and that all people going through an end-of-life process would have an identified contact at all times.
Those elements will need to be implemented right across NHS processes, technologies and pathways, and we have set up the end-of-life care board under Bruce Keogh, the chief medical officer, to oversee that. All arm’s length bodies will be represented on the board. This has not yet been published—it is my role to ensure that it is—but the requirement now is to turn the commitments in the review response into tangible milestones, deliverables and responsibilities. I recently met several members of the End of Life Care Coalition and undertook to have a transparent process so that between 2016 and 2020 we know what we are implementing and when and how that is being done. It is important that that happens. We are extremely committed to it—it is a Government priority. We could do things better as a country, but we do pretty well and we need to do this to make things even better.
Thangam Debbonaire
I thank the Minister for his responses to my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell). On that point about the plan for between 2016 and 2020, given that the last days of someone’s life are etched into the memories of those who are left behind—I can remember every single moment of the day 23 years ago yesterday when I lost my father—will the Minister commit to report back to the House at various points over that four-year period, or will he report on progress in other ways?
David Mowat
That is a very reasonable request. That intervention was not quite what I was expecting, but it is entirely reasonable and I will commit to do that either in debates such as this or at Question Time, or whenever. I am unsure whether a statement would be appropriate, but it is a reasonable thing to request of a Minister and I am happy to do it. I will at least write to the hon. Lady on the process, because I am determined that the programme of work will be transparent and meaningful with clear deliverables that achieve what we need to achieve.
In addition to implementing the choice review, other ongoing and day-to-day work needs to happen. The Liverpool care pathway was pretty much supplanted last year by the five priorities for dying people that were mentioned in an earlier intervention. We are trying to embed those things within the structure of the NHS. They exist in training programmes, in Health Education England, and in the choices that people make when working in this sector. It is not rocket science; the priorities relate to sensitive communication, the need for individual plans covering food and drink, and also spiritual things for those who need or want them. Fundamental to all this—it should not really need saying —is that the dying person is involved in all aspects.
We put end-of-life care as a priority in the NHS mandate. Clinical commissioning groups must commission end-of-life and bereavement care, and there are NICE guidelines for that. That does not mean that it is not patchy, as the hon. Member for Newcastle upon Tyne North said, but those are the requirements. When the CQC evaluates care homes, hospitals and hospices, it specifically looks at end-of-life care, and those that want high rankings will need to address such things and work effectively.
I talked about milestones. One important initiative that I expect to come out of the choice review is electronic palliative care records, through which care plans are accessible to the many different workers who need access. I recently saw that happen in London, where the system is called “Coordinate My Care”. The idea is that if a person is in need of an ambulance or paramedic, the paramedic will have access to the care record on the way to the call-out. The record might explain that the person may not want to go to hospital, depending on the issue, and such decisions will become embedded in the process, which is important and good. I want that technology to be rolled out as quickly as possible.
Catherine McKinnell
I was concerned at the beginning of the Minister’s remarks that he sounded complacent about this issue, but he does certainly seem committed to making this review work over the next few years. Will he just acknowledge that if the NHS is not able to get the support from the social care sector and is not able to utilise the funding required, it will fail in its efforts? It will fail unless the funding is there within the community sector and the NHS itself in order to achieve what the Minister sets out as a very important strategy going forward.
David Mowat
I am getting towards the end of my speaking time, so I will finish by answering that as best I can. Of course money matters, and every process works better if there is plenty of money for it. The facts of the matter are that both adult social care and the NHS are under cost pressures. To be honest, that will always be the case in every system, and I just gently say to the hon. Lady that she may be surprised to know that we spend about a third more on adult social care, which is a particular responsibility of mine, than either France or Germany.
Catherine McKinnell
The Minister acknowledged that the challenge in addressing this issue properly is often the patchwork nature of services in our country and the postcode lottery. He also acknowledged that some of the areas that fare the worst are the most deprived, and they are also the areas facing the biggest cost pressures in terms of social care funding. Will he acknowledge that something needs to be done to ensure that that does not undermine these efforts?
David Mowat
This is not the autumn statement, and I cannot make commitments on funding other than to say that many Members on both sides of this Chamber would like to see, when the time is right, more funding for our vital public services. I again just gently make the point to the hon. Lady that we spend considerably more on adult social care than countries such as France and Germany, those it would be reasonable to compare us with, and it is not just about money in terms of the delayed transfers of care performance of different councils—it is hugely different.
Let us agree that what really is important is that over the next few years we implement the choice review: what is important is the Government’s commitment to implement that and our clear intent, as signalled by Bruce Keogh leading the implementation board, that we will be held accountable for it. I will be held accountable for it, and I will report back to the House in due course on that.
I thank the hon. Lady for raising this important issue.
Question put and agreed to.