Dignity in Dying

Gillian Keegan Excerpts

Wednesday 8th December 2021 Commons Chamber

[The Minister for Care and Mental Health (Gillian Keegan)]

I begin by thanking my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) for securing a debate on this issue and for not only outlining his views on assisted dying, but taking many interventions on both sides of the debate.

It remains the Government’s view that any change to the law in this sensitive area is a matter for Parliament to decide and an issue of conscience for individual parliamentarians, rather than one for Government policy. I have the utmost sympathy for all those who have suffered the pain of watching a loved one battle a life-threatening or degenerative condition; many of us will have witnessed that, and it will inform our decisions.

As my right hon. Friend mentions, in order to develop more precise estimates of suicide risk for people with specific debilitating and terminal illnesses, the Office for National Statistics is consulting with clinical experts and is due to publish its report next year. We will consider its findings carefully.

We know that this issue is also being considered across the wider UK family, with—as my right hon. Friend mentioned—an ongoing consultation with the Scottish Parliament and legislation being drafted by Jersey’s Council of Ministers. We will await further details of any proposals that may be presented, at which point we will be able to say more about how medical professionals can work within the different countries. The Government are, however, committed to ensuring that patients of all ages are treated with dignity at the end of life, and have the opportunity to benefit from high-quality personalised care that takes account of their wishes.

The NHS constitution states our commitment to putting respect, dignity, compassion and care at the core of the way in which patients are treated. Dignity means different things to different people, but as the Parliamentary and Health Service Ombudsman pointed out in a 2014 report, there are some key actions to ensure that people have dignity at the end of life They include allowing patient choice through appropriate care planning and promoting good and timely communication, with patients and their families and between the people and organisations supporting them.

We have seen many changes in the health system over the last decade, including an ambition to move more care out of acute, in-patient settings and make it available to people at—or closer to—home. The place where care is provided is particularly important for people at the end of life, and palliative and end-of-life care services have adapted to allow patient choice wherever possible.

We know that the covid-19 pandemic brought new challenges, with a sudden and significant increase in both the number of deaths overall and the proportion of people who passed away at home, but despite those challenging circumstances, our dedicated and exceptional palliative and end-of-life care workforce demonstrated their pragmatism and resilience and continued to provide world-class care for patients around the clock, working hard to adapt to meet the needs of patients and their families and ensure that dignity was maintained. We are immensely grateful to them. They have truly gone above and beyond throughout the covid response, and they deserve our unwavering support and recognition.

However, despite the efforts of our health and care colleagues across the system, before and during the pandemic, we know there is still more that we can do. Improving quality of care requires a confident workforce with the knowledge, skills and capability to deliver high-quality palliative and end-of-life care. Health Education England continues to provide comprehensive training for all health and care staff involved in palliative and end-of-life care through the availability of resources from the End-of-life care programme.

Furthermore, NHS England and NHS Improvement have committed themselves to supporting the transformation of palliative and end-of-life care services, as was pointed out by my hon. Friend the Member for Devizes (Danny Kruger). They have developed a three-year strategic delivery plan, aligned with the long-term plan, which prioritises the importance of improving access, quality and sustainability. They are committed to providing dignified, personalised care for people at the end of their lives, including opportunities for shared decision-making conversations about their treatment and support. Those conversations between healthcare professionals and patients ensure that patients’ preferences and needs are taken into account when their care is being planned.

NHS England and NHS Improvement will be publishing advance care planning principles in early 2022. They will focus on the importance of providing opportunities for a person and his or her family or carers to engage in meaningful discussions, led by the person concerned, which consider that person’s priorities and preferences when he or she is nearing the end of life. The Health and Care Bill presents a fantastic opportunity to strengthen the existing partnerships across the health and care system and continue the excellent work that non-statutory integrated care systems have started.

NHS England and NHS Improvement are already supporting commissioners through their strategic clinical networks. These networks are using integrated whole-system collaborative approaches to continue to drive improvements in outcomes for patients at the end of life, including through encouraging innovation and sharing best practice. One example is the work of the north-west palliative and end-of-life care strategic clinical network, which is focused on delivering activities to promote equity and reduce health inequalities in palliative and end-of-life care across the region.

If passed, the legislation will increase integration between health and social care further by removing barriers to data sharing and enabling joint decision making and collaborative practice. As a Government, we value collaboration at all levels, and just this morning I met colleagues from Marie Curie to discuss services for people at the end of their life. I am keen to continue to work with our passionate and dedicated stakeholders to further consider the opportunities for embedding best practice at local and national level, and to ensure that there is no postcode lottery or patchy services. Building on the great work that is already happening and looking to the future, we know that demand for palliative and end-of-life care services has increased and will continue to do so as our population ages. The Government will continue in their commitment to enable high quality personalised palliative and end-of-life care, and we are committed to ensuring dignity and choice for all, even at the most difficult of times.

Question put and agreed to.