NHS: Death at Home

Lord Hunt of Kings Heath Excerpts

Thursday 8th November 2012 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, this has been a fascinating debate with uniformly high-quality contributions. I, too, am very grateful to my noble friend for initiating it and have a great deal of sympathy with the thrust of his argument.

As we have heard, some people die as they would wish but many do not. Some people experience excellent care but, sadly, many do not. We know that many people experience unnecessary pain at the end of their lives. Although we have made progress and although the current Government are carrying on where the previous Government left off in relation to this matter, we know that much more needs to be done. We are faced with the fact that a large majority of deaths, following a period of chronic illness, occur in NHS hospitals yet many people would prefer to die at home.

My noble friend Lord Warner was right to say that an increasing number of people will have more complex medical needs and that that might push them into the hospital system unless we are very careful and are determined to provide the choice and service required if one is to die in the community or in one’s own home. That means responding not just to the requirement to improve health and social care services but also to the points raised by the noble Lord, Lord Howard, and the right reverend Prelate, particularly in relation to support for the hospice movement. This has been a recurring problem. We have to face up to the real issue of the reluctance of NHS bodies properly to fund hospices in the past and, indeed, the reluctance to give them certainty of funding for two or three years ahead as opposed to funding on an annual basis.

I would like to ask the noble Earl, Lord Howe, about the implications of the White Paper and the draft Bill in relation to care and support. My understanding is that it has some words of comfort around certain free end-of-life care services. I should be grateful if the noble Earl could provide some clarification on that.

This is not the time to debate the Liverpool care pathway, but I was moved by what the noble Baroness, Lady Masham, said. However, I did not recognise the issue of the Liverpool care pathway in what she said. I would draw a distinction between the philosophy that the noble Baroness, Lady Finlay, gave about how it should work and what may be the problems in practice in some parts of the country. It is important to distinguish between the pathway as it should be and poor practice, which of course must be rooted out and investigated.

An important point made by my noble friend Lord Dubs and other noble Lords is that in seeking to help people to die at home and to help their relatives, it is important to educate people on the reality of that. People who wish to die at home surrounded by their family have a desirable aim but, as Sue Ryder has pointed out to us, often the family can get very consumed with caring responsibilities and issues can arise that make end-of-life care at home more stressful. We therefore need to understand the implications of choosing to die at home.

We should not forget the contribution of social care. A recent Nuffield Trust survey showed that this is a significant part of the care that needs to be provided for people in the final months of their life. However, there is a great variation in the use of social care from local authority to local authority; it matches the NHS variations in different parts of the country in terms of how many people are able to die at home, as my noble friend mentioned. That is not acceptable and comes back to the Government’s response to this.

I know that the noble Lord, Lord Howard, and other noble Lords have raised the issue of the mandate, and I am aware that there is a consultation on the NHS constitution. It is proposed that the constitution be amended, in relation to patient choice and involvement in healthcare, to state:

“You have the right to be involved fully in all discussions and decisions about your … health and care, including in your end of life care”.

That is welcome. I ask the noble Earl: is that enough, because it does not actually mean that the kind of services that would enable choice to be exercised will be made available?

I also say to him that the consultation document states that the report from the NHS Future Forum made it clear that there is a problem with the constitution in terms of whether the health service is sufficiently cognisant of the constitution and what it means. I know that in the consultation there are proposals to make NHS staff more readily aware of it. The point that I would put to the noble Earl is: if it turns out that that is not sufficient, will he be prepared to consider my noble friend’s suggestion that a legislative solution may be required to ensure that the services provided are sufficient to enable people to exercise real choice and to have the kind of end-of-life care in their home that we would all wish people to have?