Dignity in Dying

Danny Kruger Excerpts

Wednesday 8th December 2021 Commons Chamber

[Mr Mitchell]

I will get a little further with my case, and then I will certainly give way.

Furthermore, this leniency does nothing for those who cannot afford a trip to Switzerland; who cannot access the necessary medical records; who cannot travel due to illness or disability; or who cannot access the services of Dignitas for a host of other reasons. It forces all those who accompany the dying person to break the law and run the risk of prosecution on their return to this country.

I am saddened to tell the House that David Peace has today died at Dignitas; it is a coincidence that he happened to die today. Many colleagues may have seen a touching interview with David over the summer, in which he spoke about his desire to control his death, rather than let motor neurone disease choose his death for him. Earlier this week, before he left this country—his home—for Switzerland, David said:

“I have terminal motor neurone disease, a fatal illness for which there is no treatment or cure. It has robbed me of my ability to speak, swallow, balance and walk. It is rampaging through my body, paralysing my muscles. Nothing will stop it. Palliative care cannot give me the death I want, I simply want the right to die on my own terms...My only option has been to plan an assisted death at Dignitas in Switzerland, which I have done in meticulous detail over the past few months. Though stressful and hugely expensive, this has given me comfort and peace of mind. Covid-19 measures have been a real concern throughout this year, knowing that travel restrictions or lockdowns could jeopardise my plans”.

He continued:

“The emotional and logistical nightmare I have endured over the past few days would have been avoided entirely under the Assisted Dying Bill, which would have enabled me to go peacefully and with dignity in my own home at a time of my choosing.”

David’s call is echoed by another proud Englishmen, Ray Illingworth, the legendary English and Yorkshire cricketer, who was diagnosed with oesophageal cancer a year ago. He said this of having to go abroad to obtain an assisted death:

“If that was the only option I would, but we shouldn’t have to do that. I’d like to be put to sleep in peace in my own home in Yorkshire.”

Ray has represented his country, and is now asking his country to help him have the choice of dying on his own terms.

Those who cannot travel to Switzerland have only a few agonising choices here at home. For many, our world-leading palliative and end-of-life care will ensure a peaceful and dignified death, but even with the very best care, 17 people a day will die in excruciating pain, to say nothing of those who die with uncontrollable symptoms, or without dignity in their final days. For those who wish to hasten their death, the option remains open of withdrawing from life-sustaining treatment, or voluntarily stopping eating and drinking with the intention of hastening death; but there is no option to take direct steps to end one’s own life with medical support.

Perhaps most tragic are the cases in which dying people, trapped in pain and despair, decide to end their life by suicide. The best estimates are that hundreds of suicides every year are of people living with a terminal illness. I know from speaking to people who have direct experience of losing their loved one to suicide that these dreadful decisions are taken not lightly, but as a last, desperate choice, due to the lack of a safeguarded assisted dying option.

We must be honest about recognising the victims of our laws—the dozens of our citizens who feel they must travel overseas to achieve the death that is right for them; the hundreds of terminally ill people who die by their own hand; and the thousands of people who die beyond the reach of the very best end-of-life care we can offer. Every year, we condemn too many people to becoming casualties of a law that lacks compassion and public support, and belongs to a bygone age.

[Danny Kruger (Devizes) (Con)]

My right hon. Friend is making a powerful speech, as expected. He refers to a very small number of people to whom he wants to give this new right. I recognise the extraordinary pain and distress of those individuals and their families, but is he aware that in Oregon—the legislation being proposed in the other place is based on the law there—over half the people who apply for assisted death do so not because of terrible pain and suffering, but because they do not want to be a burden on their family? That is the consideration that motivates them. Does he not agree that that is likely to be replicated here, given the sad prevalence of abuse and neglect of elderly relatives in our country?

Surely the answer to the distress of people facing death is to improve palliative care, which, as he says, though it can be excellent in this country, is tragically patchy, which is not good enough. Surely we should invest significantly in palliative care to ensure that everyone in this country has the opportunity to die with all the care that they need, and does not have a terrible, distressing death, before we ever consider this terrible step of allowing assisted suicide.

Menopause (Support and Services) Bill

Danny Kruger Excerpts

2nd reading
Friday 29th October 2021 Commons Chamber

[Carolyn Harris]

I am sure that the Minister will enlighten us on that issue. That is the issue: whatever we do today, it has to be communicated to the wider population so that they understand our commitment to their health.

The biggest complaint I have received over the past few months is from women who need both oestrogen and progesterone. Women who have had a hysterectomy can take oestrogen on its own, but everyone else needs both. Despite the two hormones being combined into one product, women are charged individually for the hormones, meaning that each prescription costs them £18.70, and with 86% of women getting only three months’ supply each time, the costs begin to add up.

[Danny Kruger (Devizes) (Con)]

The hon. Lady is being very good about giving way—I am very grateful to her. On the question of cost, I was struck by what she said earlier about her own really difficult experience of being prescribed antidepressants because she was not properly diagnosed with the menopause. I chair the all-party parliamentary group on prescribed drug dependence. She might be aware that last week Dr James Davies of Oxford University published research showing that the NHS currently spends half a billion pounds a year on unnecessary prescriptions of habit-forming drugs. Will she join me in raising serious concerns about that, and does she agree that we must press the Government to review properly the prescriptions of dependence-forming drugs?

Baby Loss Awareness Week

Danny Kruger Excerpts

Thursday 23rd September 2021 Commons Chamber

[Danny Kruger (Devizes) (Con)]

I have very much appreciated being able to listen to this debate and hear very moving speeches from Members on both sides of the House. I pay particular tribute to my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) for her leadership on the issue, and to the Chair of the Health and Social Care Committee, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), for his work. I join him in commending the work that has taken place in recent years to improve maternity services and reduce baby loss in our NHS, but I note his comparison with Sweden, the fact that we could do so much better, and the need for changes to services and to the culture of how we support babies and mothers in the NHS.

I was born in the old Westminster Hospital, which looked over the Houses of Parliament, so it could be said that my path was set. My children were born in Queen Charlotte’s Hospital, looking over Wormwood Scrubs prison; I hope that their path is not set, but my wife and I have done a lot of work in prisons. In the context of this debate, I would like to draw attention to yesterday’s report on the very tragic and scandalous events at HMP Bronzefield in 2019.

A young woman, a girl aged 18, was left alone in her prison cell to give birth. The baby died, and nobody found out until the next day that the woman had given birth. There have been a series of reports on and investigations of the tragedy; they conclude that a litany of mistakes were made, with a confusion of services and staff. There was obviously no malice anywhere along the line, but there was a lot of misunderstanding and dysfunction in the system.

I wonder—it would be good to get an indication of the Minister’s views on this—whether it is appropriate for pregnant women to be in prison at all. In recent decades, there has been a significant reduction in the incarceration of women, and indeed of pregnant women. That is very positive, but we still have women’s prisons, although their numbers are reducing. I remember going many years ago to the women and babies unit at HMP Holloway, which was actually a very impressive and wonderful place. That prison has now closed because we do not lock up so many women.

[Nickie Aiken]

I thank my hon. Friend for highlighting the report. Does he agree that questions have to be asked about why an 18-year-old who was on remand and pregnant should be in prison?

[Danny Kruger]

That is the point that I am making: there is a big question about the incarceration of women and the appropriate punishment for women, but I think that it is absolutely the right question for us to consider. I know that in their sentencing, judges take into account whether women are pregnant, but I suspect that something went wrong in this case. From what I read, it sounds as if the girl was very troubled; in my uninformed view, she should not have been in prison at all for the time that she was pregnant.

Given the sophistication of modern electronic tagging, which is increasing all the time—the Government are investing significantly in it, and I commend them for that—I wonder whether consideration should be given to changing the rules around the incarceration of pregnant women.

Social Care Reform

Danny Kruger Excerpts

Wednesday 23rd June 2021 Commons Chamber

[Helen Whately]

I would not see this as either/or. We have said that we will bring forward proposals for social care reform. To the hon. Lady’s point about discharge, it is well known at that, particularly for an older person, spending a long time in hospital can be harmful to their prospects of recovering and living a good quality of life. I have seen that in my own family as well as knowing that it is a long-standing challenge across our health and social care system. It is absolutely right that we should take steps to support people to be discharged from hospital to home when they are clinically ready.

[Danny Kruger (Devizes) (Con)]

I very much welcome the plans for integrating the NHS, local authorities and social care providers. Can the Minister assure us that the plans will not lead to any more centralisation or bureaucracy in the system, and that, on the contrary, we will see more local flexibility, more choice and control for patients and, crucially, more support for the families and community groups that are so important in the delivery of social care?

A Plan for the NHS and Social Care

Danny Kruger Excerpts

Wednesday 19th May 2021 Commons Chamber

[Danny Kruger (Devizes) (Con)]

I have spoken to two constituents this week who have both given me permission to share their stories. The first is Lachlan Robertson, the son of Christine Robertson, who was a dementia sufferer with some additional medical needs. Mr Robertson described to me what he called “the Kafkaesque chaos” of trying to get someone—anyone—in the health and social care system to take responsibility for his mother’s care. Very sadly she died last year, quite unnecessarily, after a fall that took place in hospital that should never have happened.

The second constituent is Nick Stokes, whose wife Joy died earlier this year of cancer after a litany of missteps and misdiagnoses by his GP’s surgery. Mr Stokes believes his wife would still be with us if she had simply been able to see a doctor in person, rather than be fobbed off with a series of phone calls and online consultations.

These constituents give me licence to be blunt. We all—I certainly do—revere the founding principles of the NHS and honour the staff who work in it, but the fact is that the systems that manage the NHS and, in particular, its internal communications, too often let patients down, and that is why profound reform is so needed. The watchword of that reform should be the simple word “humanity”. We need more human systems.

I am entirely in support of all the digital revolution that is happening. Yes to more online telemedicine, and yes to artificial intelligence and machine learning—I yield to no one except possibly the Health Secretary in my enthusiasm for technology—but all of this tech should simply have one focus, which is to enable more face-to-face consultation and better internal communication.

I particularly welcome the steps that have been set out towards more integrated care services. That is absolutely the right principle. I particularly thank the Health Secretary for the announcement that happened this very day of a new integrated care centre finally being built in Devizes after many years of campaigning. I pay tribute to Ministers and also to my predecessor, Claire Perry, who campaigned long and hard for this treatment centre. It means we can finally end the long tradition of the MP for Devizes standing in an empty field with the Health Secretary on a photoshoot pointing to the empty plot of land where this building is going to rise, because as of next month, shovels will go in the ground. We will now get our integrated care centre, which is absolutely in keeping with the principles that the Government are setting out.

I encourage the Government to be as bold as possible in the reforms that are coming. We are no longer in the 1940s, when a great state system was created. We are not in the 1990s, when market disciplines were introduced into the NHS. We are in a new era, and we need a new NHS that is not state-led, not market-led, but properly community-led. I think that is the direction of travel that the Government are on, and I welcome it wholeheartedly.

Cardiopulmonary Resuscitation in the Pandemic

Danny Kruger Excerpts

Tuesday 13th April 2021 Commons Chamber

[Danny Kruger (Devizes) (Con)]

I rise to speak about the use of “Do not attempt cardiopulmonary resuscitation” notices during the pandemic. Last year, the health service was hit by the worst crisis in its history. The whole country was told to stay at home for one simple reason: to save the NHS. That meant not overwhelming the system with too much demand—too many people needing care. We faced a real nightmare scenario of the NHS not being able to treat people who were sick and dying. The horrific idea emerged of doctors or local health managers or the NHS itself having to play God to decide who should live and who should die by deciding who should get treatment and who should not. Thankfully, the NHS was not overwhelmed. This, of course, was mostly due to the heroic work of frontline staff. It is also because every measure possible was put in place to reduce pressure on hospitals. That included people staying at home, building new hospitals at record speed and getting people out of hospital as fast as possible, including to care homes. This is where the occasion for the DNACPR notices came about.

Care homes found themselves under enormous pressure, too. Stories emerged last spring of blanket DNACPR policies being put in place in care settings. They were for people with certain characteristics—people with learning disabilities, people with certain complex needs, and people with life-limiting illnesses. This was done, the report said, without consultation with patients themselves or with families. All this was quite wrong and against all the guidance. Indeed, in April last year, the Care Quality Commission issued a joint statement with the British Medical Association, the Care Provider Alliance and the Royal College of GPs, reminding all providers that it is unacceptable for advanced care plans with or without DNAR notices to be applied to groups of people of any description. I am pleased that they did it. I am particularly pleased that the Department of Health and Social Care— I understand that the Minister herself was responsible—asked the CQC to investigate these reports and to review how DNAR orders were used during the pandemic. I will come to its findings in a moment.

I want to make it clear that DNACPR orders are an appropriate part of our health and care system and can be a right and proper part of an individual’s care plan. We need to distinguish between what might be called beneficial and futile uses of CPR. An obvious example of beneficial CPR is for young people with neuro-degenerative conditions. Respiratory arrest is common for these patients, but with CPR they have an almost 100% survival rate. For them, it is essential and necessary. If a patient’s other vital organs are shutting down—if they are dying—CPR can do little.

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman and I share a very common cause, and I appreciate him bringing this debate forward. Does he not agree that for families such as mine who, last year, lost a loved one—my mother-in-law—we would like to believe that any and every measure was taken to save life. The stories that we have heard and that he has referred to are certainly heartbreaking. I very much share his concern.

--- Later in debate ---

[Danny Kruger]

I thank the hon. Gentleman for his intervention and I extend my condolences to him and his family for the loss that they have suffered. I absolutely agree with him. The value of this debate is perhaps to help communicate the expectation that all patients receive the care that they need right up until the moment of death.

CPR can greatly distress the patient and their family in the last moments. CPR involves a team rushing to the bedside, shoving aside any family members who are gathered around and using what is basically a violent procedure, sometimes involving the breaking of ribs to try to restart the heart. As one doctor interviewed about CPR described it, it can be chaotic, traumatic and brutal. That is not what any of us would wish when our death is imminent, even if it extends life for a few minutes or hours. I have every sympathy with doctors and care home staff who want patients who are approaching death and their families to consider using DNACPR notices, but we have to be really careful about how they are used. That is not just because of the obvious immorality of a blanket policy that effectively judges some people as worth saving and some people as better off dead without consideration for their circumstances or their wishes, but because having a DNACPR notice influences the care people get more generally. There is anecdotal evidence from care homes that patients who have requested they are not resuscitated are not cared for as well as others. They might miss out on antibiotics for a chest infection, for example, or some other treatment for a reversible condition.

The essence of the responsibility of doctors and care staff is that care should persist for all, whatever their condition or capacity. That responsibility is well established in law and guidance, and I particularly value the principles in the Mental Capacity Act 2005, which seeks fundamentally to honour the dignity of the individual, no matter their capacity or condition. The 2005 Act also sets out guidance on best interests, which is the test that should be used to determine medical treatment in the event of the individual being unable to decide for themselves. Crucially, a best interests consideration requires decision makers to take a view as if they were the patient. It is not about what they think is best, but what they think the patient would want, and that is vital.

The CQC review concluded in February, and I am greatly relieved by some of its findings and very concerned by others. I am relieved that it did not find evidence of blanket DNACPR policies being applied as official practice by any health or care provider. It also found evidence of really good care being provided, including with the use of DNACPR orders on an individual case-by-case basis, with proper consultation and consideration of the patient’s best interests.

The CQC report also causes me concern that de facto blanket policies may have been in operation largely because we simply cannot tell everything that has been going on. The report highlights some very serious failings. Of the 166 care records that the CQC reviewed, 103 should have included a best interests assessment. In only 33 of these cases is there evidence of an assessment being carried out. Talking to patients and their families, the CQC found that 30% of patients with a DNACPR decision and 43% of families and carers did not feel that the patient’s best interests were fully considered. I am glad to say that the opinion of people with learning disabilities and their families was more positive about best interests considerations in their DNACPR decisions.

I do not believe that providers have been applying blanket policies, but what I am concerned about is the potential for such a thing. I am concerned that not all health and care providers are properly applying best interests considerations in the advance care planning they do with patients.

As the CQC said, we need to take a number of essential steps to prevent the possibility of abuse. There are three main practical recommendations, and I hope the Minister can confirm that her Department is working to implement all of them. The first is that we need a more consistent national approach to the use of these notices. That emphatically does not mean a blanket policy for which patients should receive them, but the opposite: a process to ensure that all patients are treated as individuals. The CQC report particularly highlighted the recommended summary plan for emergency care and treatment—or ReSPECT—process, which helps everyone involved to make informed decisions about an individual’s future care and treatment.

Secondly, we need to enable these conversations through proper investment in the training and support of the staff who will have them. Thirdly, and crucially, we need proper oversight and assurance that the decisions made have proper record-keeping. It really is scandalous that that was not in place already last year. We need comprehensive records of conversations and decisions. Integrated care systems should be responsible for monitoring the use of DNACPR notices, and the CQC should be responsible for investigating anomalies, such as particularly high or low numbers of orders in particular places.

I conclude with a final and more general observation about what we need, which goes beyond these vital but ultimately technical remedies to the potential for abuse. We need a moral framework that honours the dignity of sick, disabled, elderly or dying people. That is not something that the CQC or the DHSC or this Parliament can simply draw up on a piece of paper. Indeed, I am nervous about the idea of over-regulating end-of-life care and reducing it to a process, because at the end of that road lies the awful scenario we are trying to avoid—a blanket rule on who should live and who should die.

We are never going to be able to write the rules of life and death and every attempt to do so is ultimately dystopian. That is why the ultimate locus of decision making should be in the conversations between doctors and patients, and those who know and love them. We cannot regulate for good conversations, but we can certainly do our best to facilitate them, and the CQC recommendations will help that. The only way to ensure good conversations is to ensure that doctors and families have at heart the best interests of patients. We in this place can encourage good conversations and the right decisions by stating as clearly as we can that human life is infinitely precious, right until the end.

Future of Health and Care

Danny Kruger Excerpts

Thursday 11th February 2021 Commons Chamber

[Matt Hancock]

Yes. The changes in Greater Manchester, in which the hon. Gentleman had an important role, are a good example of where we can drive this sort of integration. I can confirm that nothing I am proposing would get in the way of that. In fact, I hope that the changes in the White Paper will help areas that, like Greater Manchester, are already some way along this journey to go further, and will support them by ensuring there are fewer legislative barriers to the sorts of actions that they want to take. That includes both the measures across the NHS and the integration between health and social care.

[Danny Kruger (Devizes) (Con) [V]]

Frontline health and social care providers have shown enormous flexibility, innovation and collaboration in dealing with this crisis. I welcome the Secretary of State’s proposals. I am particularly pleased that he suggests the need both for clear political accountability and strong local autonomy for the frontline. Will he assure me that, unlike Nye Bevan, the Secretary of State does not want to hear the sound of dropped bedpans in his office in Whitehall, and that, rather, we need a more local, more collaborative and more community-led approach to health and social care, as proposed by the Conservative Henry Willink—as he says, the original designer of the NHS?

[Matt Hancock]

Yes, that is absolutely right. In fact, my hon. Friend put it rather better than I did. Perhaps I will take up his rhetorical suggestions for how to make this case. Accountability is important, but the more local the decision making, the better. There should be local decision making across a whole range of partners—not just in the core NHS, but by providers of services, from whatever sector they come, including the voluntary sector, which, during this pandemic, has been embraced more. We need to build on that to make sure that we have a system that can truly serve local needs. Ultimately, all healthcare is locally delivered, because it is delivered to an individual to improve or save their life. Essentially, we need to make sure that the appropriate decisions are taken as locally as reasonably possible.

Coronavirus Regulations: Assisted Deaths Abroad

Danny Kruger Excerpts

Thursday 5th November 2020 Commons Chamber

[Matt Hancock]

The hon. Lady is absolutely right to raise that issue. We provided more than £150 million of extra funding to hospices during the first peak. Locally, many clinical commissioning groups fund their local hospice and contribute to that support, but we always keep it under review, because hospices are such an important part of the provision of end-of-life care.

[Danny Kruger (Devizes) (Con)]

I am concerned that in this discussion there is a danger of focusing too narrowly on the specific option around assisted suicide. Modern medicine can palliate the pain of dying in almost all cases, but it can also extend life, in many cases artificially, beyond what most people would consider its natural span. Before we enter into a parliamentary review, Government review or Select Committee review of the precise options around assisted suicide, should we not have a much broader conversation about how we manage death and dying in this country?

[Matt Hancock]

I agree with my hon. Friend that the question should be located within that broader debate. I understand the yearning from people not to shorten life, but to shorten a painful death. Of course, no specific proposal has been brought forward; that would be for Parliament to develop rather than the Government.

Public Health: Coronavirus Regulations

Danny Kruger Excerpts

Tuesday 13th October 2020 Commons Chamber

[Danny Kruger (Devizes) (Con)]

I start by paying tribute to the Ministers for the work they have been doing. I recognise that they are in an incredibly difficult time and doing their best, so I pay tribute to them personally. They are trying to strike a balance between clarity and giving, as my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) has said, a consistent message to the public, and trying to achieve flexibility in recognising that the infection works in different ways in different places. They need to strike a balance between the national and the local, which is not easy, and I recognise the challenge in striking that balance.

I do not want to talk about the risk to the economy that we face, because other hon. Members have made that point very powerfully. I simply want to raise the tragedy that this pandemic represents for our communities. The tragedy is that, as a virus, it works through human relationships, through families and households, through communities and the gathering places of our neighbourhoods —the pubs, churches and sports fields, the institutions that give our lives not only pleasure but identity and meaning. I know that the Government share that sense of tragedy and want us out of this situation as soon as possible.

I accept the advice the Government are getting on the transmission and the value of all the different lockdown measures. I simply want to make an appeal for a response to the virus that is less about big business and big government. I accept why big business and big government —Deloitte and Public Health England—were called in at the outset, but surely we can say that we have tested that approach sufficiently to suggest that there might be a better way to deal with this, a response that is less about big government and big business, and more about local communities and trusting the people and the professionals in our local places.

I know that the Government share a belief in the important of civil society, local government and trusting public health professionals locally. I hope that, as we move through this terrible winter, we can adopt a different model, relying less on the undoubted intelligence, goodwill and good intentions of people in this postcode and more on the people in the places we represent.

Oral Answers to Questions

Danny Kruger Excerpts

Tuesday 6th October 2020 Commons Chamber

[Scott Mann (North Cornwall) (Con)]

What steps his Department is taking to support the adult care sector during the covid-19 outbreak.

[Danny Kruger (Devizes) (Con)]

What steps his Department is taking to support the adult care sector during the covid-19 outbreak.

[The Minister for Care (Helen Whately)]

We have sweated blood and tears to support the sector through this pandemic. Last month, we launched the adult social care winter plan, with regular testing for care home staff and residents, free personal protective equipment and mandatory infection prevention and control measures for care providers, supported by £546 million of Government funding. I am enormously grateful to all those on the frontline in social care. I recognise the challenges that they have faced and how many feel daunted by the winter ahead. I say to care workers: “I cannot thank you enough for what you do and I am with you every step of the way.”

--- Later in debate ---

[Helen Whately]

I thank my hon. Friend for his comments, but most of the credit should go to those working in social care, who have been looking after some of the most vulnerable people in our society in such difficult circumstances. He is right that it is really important that we ensure that there is no transmission between one care home and another, which is why we are requiring care homes to make sure that their staff work in only one setting and are providing additional funding to enable them to do this.

[Danny Kruger]

Care homes are rightly the focus of our attention at the current time, but I know that the Minister is reviewing the future of social care. Does she agree that our focus in that regard should be on more community-based services, not solely on residential provision? Will she also set my mind at ease by ruling out the creation of a new national care service run from Whitehall?

[Helen Whately]

First, may I congratulate my hon. Friend on his recent report on levelling up our communities? As he said, care homes have indeed been the focus of our social care response to the pandemic, but I would not want anyone to think that that was the limit of our support for social care during the pandemic; the winter plan also includes support for domiciliary care, supported living and others. I agree with him that as we look to the future, we should support the aspiration that most people have to live independently, with their own front door, well into their old age. There are no plans to create a national care service run from Whitehall.