NHS: Death at Home

Lord Howard of Lympne Excerpts

Thursday 8th November 2012 Lords Chamber

[Lord Howard of Lympne]

My Lords, I begin by declaring my interest as chairman of Help the Hospices, the national charity for the hospice movement, supporting more than 240 hospices across the United Kingdom. I congratulate the noble Lord, Lord Warner, on securing this debate. I find myself agreeing with much of what he says and, as best I can, I shall endeavour to avoid repetition.

Of course, we all bring to our consideration of this question our personal experiences. My father died more than 50 years ago at home, looked after by us his family and by the most wonderful of nuns from the nearby convent, of whom I have never been able to speak too highly. My mother died much more recently at the age of 98 in a care home in which she had spent the last few weeks of her life. They looked after her very well, assisted in the management of her pain by help from a nearby hospice. My mother-in-law died in hospital. I have no doubt at all that the best death, if one can use that phrase—and I believe one can—was that of my father; and the worst death was that of my mother-in-law. There is no doubt at all that far too many people die in hospital. That is the central truth of this debate. The central fact of this debate is that 63% of people say they would like to die at home and a far smaller proportion actually does so. This is what needs to change and I hope that the Minister will give us hope that the Government intend to help bring about this change.

In the time that remains, I want to say some words about the role of hospices in caring for people as they approach the end of their life. I referred in my declaration of interest at the outset of these remarks that there are a number of hospices in the UK. In your Lordships’ House, I need hardly pay tribute to the extraordinary work which the hospice movement carries out. I regard it as an enormous privilege to be associated with it in the way I am. However, there is a misconception about the role of hospices which is highly relevant to this debate and which I want to try to correct. I suspect that when they think about hospice care, most people—certainly very many—think about the care provided to in-patients in our hospices. Yet most hospice care is not so provided. Fully 70% of hospice care is provided for people living in their own homes. Indeed, “hospice at home”, as it has become known, is the fastest growing part of hospice care. So if, as we all hope, more people are going to die at home, the role of hospice care in looking after them is likely to grow significantly. That brings me to my last point. Hospices collectively have to raise £1.5 million a day from charitable sources if they are to keep going. On average, only about a third of their costs are met by the state.

I am sure that the Government do not want to do anything to damage that extraordinary movement, which is the subject of so much admiration both here and abroad and which has been held up by the Prime Minister himself as a superb example of the big society, but the new arrangements for the National Health Service have—I am sure, accidentally—introduced a considerable and unwelcome element of uncertainty into the continuation of even that very modest level of government support. The absence of end-of-life care from the draft NHS mandate, to which the noble Lord, Lord Warner, referred, has, I fear, increased that uncertainty and aroused a good deal of concern.

I wrote to the Secretary of State some time ago to ask for a meeting to discuss all that and, sadly, it has not yet been possible to arrange such a meeting. I do not expect the Minister in his reply to offer me a date, but I hope that he will be able to say something about the future of public funding for hospices that will provide a degree of comfort to those involved in that wonderful work and will enable them to continue to play a growing role in helping those people who wish to die at home to do so.