Care of the Dying

Diane Abbott Excerpts

Tuesday 17th January 2012 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

First, I congratulate the hon. Member for Enfield, Southgate (Mr Burrowes) on securing the debate. We have lived through an era when MPs have been seen as irrelevant, not to say venal, and when Parliament has been seen as remote. However, increasingly, in this Parliament, we have found that we are seriously debating issues at the centre of current political debate. The present debate is one of them. I want to touch on policy issues that relate to palliative care and to say a little about assisted dying, but I will begin by saying that in a busy, urban 21st century society people seem increasingly reluctant to talk about death or even to face the possibility of death.

At the risk of generalising, I will mention that, as many hon. Members know, my family come from rural Jamaica. In such rural communities, people make a point of talking about death. People stay up all night with bereaved families, night after night. That may seem strange to some, but it is a way of saying, “Death is a reality, and we will support you through it. Your community is here for you.” In a way, the rather hurried, perfunctory and frightened way that we deal with death in modern urban Britain is not necessarily an advance on the way people deal with it in rural communities around the world.

End-of-life care is of course an important issue, not just because death will come to us all, but because it is a major issue for the NHS. It represents billions of pounds of NHS spending—a fifth of NHS costs and a total of £20 billion altogether. Yet, as hon. Members have said, whereas most people would prefer to die at home, most do not have that privilege. It has been a concern of successive Governments to find out how we can give people the range of choice that they want for end-of-life care and how we can improve the level and type of care that is available.

Among the published reports on the issue, the King’s Fund report identified improving the primary care management of end-of-life care as one of the top 10 priorities for new commissioners. We have heard about the unevenness of funding of hospices and end-of-life care, even within the same part of the country, so I should like to ask the Minister whether it is the Department of Health’s view that end-of-life care should be a national priority and how she proposes to deal with the considerable variation in quality, efficiency and funding. What is the Department doing to ensure that the NHS can support the voluntary sector hospices and other specialist palliative care providers? Can the Minister give the House some reassurance that the Government’s proposed commissioning arrangements in the Health and Social Care Bill, which is being considered in the other place, will ensure that there is planned 24/7 provision of community support, including care co-ordination, nursing and symptom control?

As I have said, we know that most people would prefer to end their life at home, but most cannot. We also know that half of all complaints to the NHS involve criticism of the circumstances in which someone died. Often the time when a relative is dying is one of the rare occasions when a whole family come together and perhaps watch the process minute by minute. Therefore, a focus on and concern with end-of-life care comes to us all, and we will all have a view on it. The Minister will be aware of the Demos report, “Dying for Change”. Demos made a number of recommendations and said:

“Unless we can devise ways to get people to talk about how they want to live while they are dying, our efforts to improve services will be like groping in the dark.”

That is a reminder of the need to talk about and face death and to say, while still well enough to give an unconstrained opinion, how we want things to happen. Demos referred to training in palliative care and the important question of linking hospices to groups of care homes, so that hospice skills and values can migrate to care homes. It said that services need to be commissioned in an integrated way. The Minister will also be aware of Age UK’s public policy proposals on those issues.

The House would expect me to say a word about Labour’s record. Under the previous Labour Government, the NHS end-of-life care strategy was launched in 2008. It covered all adults with advanced progressive illnesses and care in all settings. The 10-year strategy was backed by an extra £268 million. There is no question but that progress was made, as I am sure that the Minister will acknowledge. The number of staff using models of care specifically designed for the end of life rose. Those models are now used by 75% of GP practices and hospices and 85% of acute hospitals.

Is the Minister aware that the King’s Fund has warned of the dangers of losing momentum in the drive to improve end-of-life care? Is she also aware of the report of Dr Rachael Addicott, “Implementing the End of Life Care Strategy: lessons for good practice”? Dr Addicott expresses concern

“that the decision not to hold a review until 2013 risks losing momentum and missing the opportunity to build on the progress already made.”

I have been fortunate, as a Hackney MP, to have a close relationship with St Joseph’s hospice, which was set up in 1900 by five Sisters of Charity and is the place where, in the 1950s, Cicely Saunders developed the principles of modern hospice care. My respect for the men and women who run hospices cannot be bettered by anyone in the Chamber today.

As for assisted suicide, I do not want to take a position one way or another. I have great respect for colleagues who advance the case for it and for people in the media who earnestly want to be able to decide how and where they end their lives. However, I have represented a busy, kaleidoscopic urban constituency for 25 years. In Hackney, the best of life and the worst of life can be seen—and the best and the worst of people. I have seen what fantastic support families can give, even when the state lets people down; but in a tiny fraction of cases, I have seen how venal families can be.

My concern about assisted dying would be for that tiny handful of cases involving elderly people who did not want to be a burden—and how many times have hon. Members sat in advice sessions and heard elderly people say that? I would worry about the cases—tiny in number, but still representing the lives of actual people—in which, if we were to provide a legal framework to make assisted dying possible, such people might feel almost an obligation to move forward. I stress to the House that that is a personal view. It comes, as I have said, from seeing the best of people, but also the worst of people, in more than 20 years of being a Member of Parliament.

End-of-life care is one of those issues that is at the centre of people’s debate and concern, because death comes to us all. Advances have been made in recent times, partly through what has happened in the voluntary sector—in hospices all over the country, such as St Joseph’s, which is a wonderful hospice—and partly through conscious Government policy. I am interested in what the Minister has to say on policy going forward.