Covid-19: Social Care Services

Baroness Meacher Excerpts

Thursday 23rd April 2020 Lords Chamber

[Baroness Meacher (CB)]

My Lords, I declare my interest in the register as chair of Dignity in Dying. One of the unexpected outcomes of the pandemic has been a national awakening, albeit very late, about the vital role of care workers and their commitment and determination to continue caring for their most vulnerable of patients, risking their own lives in the terrible absence of PPE. This is surely the moment to re-evaluate the care sector, not just for now but for the longer term. We know that care home residents who contract Covid-19 are generally not encouraged to go to hospital. Their end-of-life care is left in the hands of the care staff. This may be the wish of the patient, but we do not know that this is the case. Are the wishes of the patient the determining factor in decisions about hospital admission and other end-of-life decisions?

Many noble Lords have focused on the vital issue of funding for the social care sector. I want instead to focus on the implications of the vital role in end-of-life care being played by care homes, not only during this crisis but always. The reality is that care homes sit alongside hospitals and hospices in caring for the dying. This is skilled work. Apart from physical nursing care and symptom relief, it requires skills in assessing the mental capacity of patients, undertaking sensible conversations about a patient’s wishes as their condition deteriorates, and the preparation of advanced care plans. All this has come to the fore in the Covid-19 crisis, but of course these skills are always needed in care homes. We need to revisit the training, skills and pay of care staff.

I welcome the advice from the CMO and the Chief Nursing Officer on 7 April encouraging vulnerable patients to discuss their treatment preferences and record them in an advanced care plan. Only then can we be sure that their wishes are respected. This advice should apply much more widely. None of us knows when we will be struck down by a heart attack, stroke or deadly virus. Every one of us needs an advanced care plan. A number of charities, including Prostate Cancer UK and Compassion in Dying, the sister charity to Dignity in Dying, provide excellent materials and guidance on end-of-life planning, but these services need to be supported by the Government, not just now but in the future.

In this context, I strongly support Care England’s call for a commissioner for older people. Can the Minister set out the Government’s response to this proposal? When people think about dying, they desperately want to have some control over how and when they die. A commissioner could help to achieve this. Sadly, many Covid-19 victims suffer terrible deaths. Their end- of-life wishes were never known.