End-of-Life Care

Baroness Coffey Excerpts

Tuesday 28th June 2011 Westminster Hall

[Peter Aldous (Waveney) (Con)]

It is a pleasure to speak under your chairmanship, Mr Walker. I am grateful to my hon. Friend the Member for Great Yarmouth (Brandon Lewis) for securing this debate on a topic of such importance to our two constituencies, and to the northern part of the constituency of my hon. Friend the Member for Suffolk Coastal (Dr Coffey).

My hon. Friend the Member for Great Yarmouth has set the scene admirably. I shall make a few observations based on my own finding and experiences in the past year representing Waveney and over the past 40 years as a resident of the area. I will outline five distinctive health features in the area that place a burden on the NHS generally and on end-of-life care more specifically.

First, Lowestoft and Great Yarmouth include pockets of extreme deprivation which are not immediately apparent to those with only a passing knowledge of Suffolk and Norfolk. Secondly, a high percentage of the population is elderly; the East Anglian coast has long been a popular retirement area. I do not begrudge people moving into the area—in fact, I welcome them—but the Government must recognise that they are an added financial cost for those providing health services, and that must be reflected in the funds made available. Thirdly, the influx of holidaymakers in the summer months is an added pressure. I well remember visiting my father in James Paget hospital some 10 years ago and observing that many of those in his ward were not local to the area.

My fourth point, with regard to where people die in the Great Yarmouth and Waveney area, is the limited hospice provision. In England as a whole, 5.2% of people die in a hospice, but in our area only 0.1% do. In the west of the Waveney constituency, those in the Bungay area are well served by the excellent All Hallows hospital at Ditchingham, but there is a glaring lack of a similar facility in the Great Yarmouth and Lowestoft area. East Coast Hospice, of which my hon. Friend the Member for Great Yarmouth and I are both patrons, is determined to redress the balance, as he said. It has a lot of work to do, however, and it is vital for the Government to ensure an environment and climate giving it every assistance and encouragement as it sets about its task.

Finally, despite the lack of facilities in the area, we have a tremendous community spirit, with many voluntary groups and charities doing all that they can to provide services and to raise funds. As well as All Hallows and East Coast Hospice, we have Waveney Hospice Care, which is merging with the St Elizabeth hospice, and does great work providing day care. Palliative Care East has reached its target for providing day care and support for those using the James Paget hospital, and East Coast Truckers continues its sterling efforts to raise funds for East Anglian Children’s Hospices.

Moving on, I will outline three areas of end-of-life care in which we must do better. First, as I mentioned, more hospice care is needed—my hon. Friend set that out clearly. Secondly, linked to that, is the urgent requirement for more respite beds, so that carers can get away for a much-needed break. Last Friday, I was with Crossroads Care, which reinforced that point.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I congratulate my hon. Friend the Member for Great Yarmouth on securing the debate and my hon. Friend the Member for Waveney (Peter Aldous) on his contribution. Does he agree that, although we do not have the range of choice, we ought to pay tribute to places such as Patrick Stead hospital in Halesworth, which manages to provide some respite care but could easily provide more if the funding were available?

[Peter Aldous]

I agree entirely. The Patrick Stead is my local hospital, so I also endorse its excellent work.

The third area is the need for the provision of 24/7, around-the-clock community care, which must be a priority. It could provide people with the option to spend their last days in their own homes, with their families and friends, which so many people wish to do. My father, who died last year, died in hospital and not at home. For my mother, who cared for him in the last few months of his life, the availability of such a service would have made her job as a carer that much easier.

In conclusion, what am I looking for from the Government? I want two things: first, a fairer funding settlement, to address the needs that I have outlined briefly; and, secondly, a system or framework that enables the voluntary and charitable sector to work with and flourish alongside the NHS. The Department of Health tends to distinguish only between the NHS and private providers, but the third sector must not be forgotten and it must be set free to flourish without the bureaucracy that currently bears down on hospices and carers.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

As ever, it is a pleasure to serve under your chairmanship, Mr Walker. I congratulate my hon. Friend the Member for Great Yarmouth (Brandon Lewis) on securing this debate. He is closely involved with charities in his constituency, and the issue is close to his heart, as it is to mine, having worked in the NHS for 25 years before entering this place. I congratulate him and all the local people who have worked tirelessly to raise funds in his area.

Many people receive excellent care at the end of life, but not everyone does. Services in some parts of the country are not as good as services in other parts, and people with some diagnoses are more likely to get good, high-quality, end-of-life care than others. My hon. Friend is right that choice is absolutely central. Choice is about where one is cared for and where one dies. The end-of-life care strategy, published under the previous Government in 2008, aimed to improve care for people approaching the end of life, whatever their diagnosis, wherever they were, including enabling more people to be cared for and die at home, if they wish. It is worth noting that the figures indicate that 17% of people, when asked where they would like to die, reply that it depends. That depends largely on the sort of support that they feel that they might get. My hon. Friend the Member for Waveney (Peter Aldous) mentioned respite care, which is an important element. People feel they might like to die at home if their family could get some respite from their responsibilities.

The end-of-life care strategy covers all adults with advanced progressive illness, and care given in all settings. We know people want choice about where they die. Some want to die at home, but not everybody. Some people are happy to die in a care home, where that has become somebody’s home, which we must not forget. However, we know that most people die in hospital; the figure is about 57%.

We want to ensure that the services are there to help people die and live the end of their lives in a comfortable setting. For choice to become a reality, we need commissioners and providers to ensure that the right services—including community-based services, such as 24/7 care, as mentioned by my hon. Friend the Member for Waveney—are available to support people at home. Ensuring that those services are available cannot be done overnight. We have said that we will review the progress we have made in developing and improving services in 2013; that will be an audit of where we have reached.

We also want to review the payment system to support end-of-life care, including exploring options for per patient funding. The funding has to be right to provide the incentives to commissioners to purchase the care that we want to see. We have set up an independent palliative care funding review to look at the matter, as mentioned by my hon. Friend the Member for Great Yarmouth. The review, covering both adult and children’s services, has been looking at options to ensure that the funding for palliative care providers is fair and encourages the development of community-based services. As I said, it is important to get the levers and incentives in the right place. We hope to be able to respond formally to the report by the end of the year.

Of course, hospices and the important role that they play are in the mix of care facilities that need to be provided. When I worked in this area of nursing there were very few hospices in the country. One cannot talk about end-of-life care without mentioning people such as Colin Murray Parkes who spearheaded the hospice movement. We want to see hospices flourish, develop and continue the expansion of their remit for caring for those with illness other than cancer, and into community-based support for patients, their families and their carers.

Only a comparatively small number of people die in a hospice, but a great many more benefit from their services and expertise in other ways, such as day therapy or hospice at home. My hon. Friend the Member for Great Yarmouth mentioned the £40 million capital grant for hospices, but that an area must have a hospice to get the grant. His point is well made. The one-off grant allowed us to fund 123 projects in 116 hospices, which is quite a far reach. For the longer term, the palliative care funding review will help us move towards a fairer funding system that puts the levers in the right place.

However, it remains for local NHS commissioners to determine what services should be provided locally. I urge all hon. Members to ensure that they work closely with the local NHS. I understand that the estimated need for palliative care is higher in Great Yarmouth and Waveney than in any other PCT. NHS Great Yarmouth and Waveney, together with Norfolk and Suffolk county councils, have commissioned the Marie Curie “Delivering Choice” programme, one of the first to be established in the east of England. That programme brings together local organisations, patients and carers. I can assure my hon. Friend the Member for Great Yarmouth that the Department of Health never forgets the third sector. The third sector is a very important part of the mix of health care providers. We never forget it because there are people around the country who work tirelessly in the third sector, not just to support people who are ill or at the end of their lives, but their families and carers.

My hon. Friend the Member for Great Yarmouth is right that hospice provision is part of the mix of care. Ideally, no care setting should have priority over any other. The settings are like the pieces of a jigsaw: the picture is not complete until all the pieces are in place. The choice is not there until all the choices are available locally. Many care homes have developed a lot of expertise in the area and are now delivering excellent end-of-life care. The knowledge and expertise owned by the professionals in end-of-life and palliative care are what matters.

I will return to the subject of the local area. NHS Great Yarmouth and Waveney have put together this programme, and a new end-of-life pathway has been defined and specifications written for the services required to deliver it. The new services that have been commissioned are specialist palliative in-patient services; a care resource and outreach service; and a nursing end-of-life care facilitator.

I fully understand the concerns that prompted my hon. Friend to secure the debate, and it wonderful that he has the support of other hon. Members. I am sure that working together with the local NHS, they will move the programme forward. I applaud his commitment to the campaign for the best-quality end-of-life care for his constituents. I believe that the initiatives and steps that the Government are taking will help improve this important area of health care. We look forward to continuing to work with everybody, including those in the hospice movement, to achieve that aim.

I would like to finish by mentioning the incredible efforts, not just of those in the east of England but around the country, who are tireless in their efforts to raise money, to support those at the end of their lives, and to support the families who are looking after them.

[Dr Coffey]

I welcome the Minister’s warm words for actions already undertaken by my hon. Friends the Members for Great Yarmouth (Brandon Lewis) and for Waveney (Peter Aldous). At some point, would she come to our part of the world, to meet people who are actively involved, and to hear about other aspects such as the community nursing care fund, which, as long as she helps us get a hospice, may provide a good role model for elsewhere in the country?

[Anne Milton]

I would be delighted to visit the east of England. The hon. Lady has struck a good deal. I am always interested to see progress made. As she says, it is important to spread good practice. For anybody who is in need of NHS services or care, nothing but the best will do. We should never lower our standards in trying to achieve that aim. Nothing but the best will do on the day one is born; and nothing but the best will do on the day one dies.

NHS Future Forum

Baroness Coffey Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I am afraid that that is a further repetition of invention by Labour Members, who appear to have been given one or two figures of their own. It is complete nonsense. In the impact assessment associated with the Bill, which we will now revise to reflect these changes, we explained that there was an estimated £1.4 billion total cost of reorganisation, but that that would lead to a £1.7 billion recurring annual benefit in savings, which would accumulate to more than £5 billion over the course of the Parliament.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

Building on the question from my hon. Friend the Member for West Worcestershire (Harriett Baldwin), HealthEast pathfinder consortium in my constituency crosses two district councils—in fact, it crosses two counties—and it might be appropriate for GPs from a third council area to join it. Will my right hon. Friend assure me that no barriers will be put in the way of what should be effective care for patients rather than simply political boundary lines?

[Mr Lansley]

As I have said, we will expect, and the Future Forum says, that commissioning groups should not normally cross local authority boundaries—in this respect, boundaries for social authorities—but they should be able to make a case for doing so based on benefit to patients. The one thing I would urge is that they are very clear with their local authorities about how they can secure the continuing integration of health and social care at a local level.

NHS Reform

Baroness Coffey Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I am afraid the hon. Gentleman does not seem to understand that the public support the principles of the Bill. The public want patient choice. When they are exercising their choice over treatment, they want to be able to go to whoever is the best provider. Patients believe that general practitioners are the best people to design services and care on their behalf. Patients, the public and professionals support the principles of “no decision about me without me”, focusing on outcomes and delivering an outcomes framework, and the devolution of responsibility. What we are talking about now is ensuring that other important principles, such as governance, accountability, transparency and multi-professional working, are genuinely supported by the structure of the Bill.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

My constituents in Suffolk were very concerned at the last election about the fact that only two doctors covered them for out-of-hours care, and that was for 600,000 patients. They welcome the reforms in the Bill. Indeed, Waveney and Great Yarmouth have come together as one pathfinder consortium and resumed out-of-hours care. Will the Secretary of State assure me that such important changes will continue to be important for patient delivery in the new Bill?

[Mr Lansley]

Yes, my hon. Friend makes an important point. When people talk about primary care trust commissioning, they might care to look at the report produced by the Care Quality Commission on how primary care trusts went about commissioning out-of-hours care. The answer is that they pretty much did it on the basis of cost and volume, rather than quality, and once they had a contract they did not monitor it, follow it up or ensure that the right quality was there, including the right calibre of doctors. It is clear that general practice-led commissioning consortia will take a wholly different and preferable approach to that kind of commissioning.

Health

Baroness Coffey Excerpts

Tuesday 21st December 2010 Commons Chamber

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

It is a great privilege to speak in this pre-Christmas debate. I have already exchanged seasonal greetings with your good self, Mr Speaker, and other colleagues.

I rise to speak about the integrated drug treatment system, which is the drug treatment system for people in prison. The issue came to my attention when I visited my local prison, Hollesley Bay. I do not want to get into the rights and wrongs of drugs today; that issue has been debated in Westminster Hall. I am more concerned about value for money and the diversion of funds from primary care trusts to the continuation of prisoners taking heroin substitutes, at the taxpayer’s expense.

In a recent Question Time, the Lord Chancellor and Secretary of State for Justice spoke of how important it is to get prisoners off drugs and to remove drugs from our prison estate. I fully endorse that view. Everybody was depressed in the mid-’90s when a judge ruled that it was against somebody’s human rights not to be allowed drugs when in prison. A number of hon. Members, including you, Mr Speaker, have raised questions on this topic. This is yet another example, dare I say it, of a conflict between the judiciary and the common sense of the general public.

The cost of the IDTS to the taxpayer for the last three years has been £23.8 million, £39.7 million and £44.4 million. I am sure that my local residents would love an increase in health spending of such an amount. Such funding for the three prisons in the Suffolk district area and the one in the Great Yarmouth borough and Waveney district area has risen from £400,000 to £555,000. In Hollesley Bay prison in my constituency, £190,000 is allocated to just one prisoner. It is astonishing that under this system, one prisoner can continue to have a heroin substitute every day, at the expense to other people of just less than £200,000. The figures show no sign of decreasing.

[Guy Opperman (Hexham) (Con)]

Does my hon. Friend agree that it cannot be right that we have inherited a system under which approximately 300 of the 1,000 prisoners in my major local prison of Durham are on methadone? The reality is that either we give them drugs on a prescribed basis, or they will obtain drugs illegally. What does she think we should do about that?

--- Later in debate ---

[Dr Coffey]

That is an extraordinary situation, and I am sure that the people of Hexham and Northumberland would be astonished to hear that the taxpayer is continuing to fund it.

I understand that Subutex, one methadone substitute, is highly valued and is traded in our prisons. Although I do not condone the policy of continuing to give methadone to prisoners, perhaps we should switch to liquid-only substitutes and remove the element of drug trading.

I cannot pretend that Suffolk is the most expensive part of the country for treatment costs. In Suffolk, the average cost per treatment is about £800. I am sure that the people of Cambridgeshire will be delighted to know that Whitemoor prison has been given a budget of about £312,000 from the PCT to pay for nine expected treatments, at a cost of £34,708 per treatment. That is scandalous in this day and age, and something has to be done. I hate it when politicians say that, but I genuinely believe that this issue is within our control and that we can do something about it.

When people come into prison, we should be trying not to continue their habits, but to get them off their habits. I understand that the primary reason we have switched increasingly to methadone prescription in drug treatment is that if people leave prison having been off drugs, they are more likely to have a bad reaction when they get their first fix. Perhaps I am a bit traditional, but my response to that is, “Tough!” I would rather that our precious NHS money was used on health care. I know that we are increasing the funds, but health care costs are also increasing. I dare say that the constituents of Suffolk Coastal would rather the money was spent on improving health care at Ipswich hospital. Despite the review by Professor Boyle, constituents in places on the coast such as Aldeburgh and Orford are still being put at risk, because if they have a heart attack the expected treatment time from when an ambulance is called to when it arrives is beyond the national guidelines. That is because there is not enough money to serve everybody.

I am not saying that we should not treat people to try to help them with their drug problem when they go into prison. In fact, I think it was the father of a famous pop star, whom I will not publicise, who said that one reason people commit offences is so that they can go into prison and get off drugs. I endorse that, and we should provide such help. Drugs are a scourge on the country because of the misery and crime that they generate.

I will conclude, because plenty of other Members want to speak about health. I could have addressed my points to the Ministry of Justice, but I believe that the Department of Health can move us forward and ask whether the situation that I have described is the best way to use our precious resources in the NHS.

Oral Answers to Questions

Baroness Coffey Excerpts

Tuesday 7th September 2010 Commons Chamber

[Anne Milton]

The hon. Lady made the point that urban and rural areas have very different needs. What is vital are the people on the front line, making decisions and offering the leadership and vision to shape those services. I do not think that she will find many people lining up to save PCTs, whose commissioning has not always been as successful as she would like to believe.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

I should like to suggest to the Minister that it might help GPs who are commissioning in rural areas if the formula for capitation were to include the information that their patients live in sparsely populated areas, as well as information about their age, especially in constituencies such as mine and that of my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter).

[Anne Milton]

My hon. Friend is right to raise the issue of the distances covered in rural areas. I believe that only ambulance trusts currently have the opportunity to reflect that. This is why it is so important that local commissioners will shape the services for their patients. It is they, not the pen-pushers in the PCT, who know best what is right for their patients.