Care of the Dying

Guy Opperman Excerpts

Tuesday 17th January 2012 Westminster Hall

[Mr Burrowes]

I am grateful for that point. Integration is needed, and we see that in the context of hospices and palliative care. We hope for that future in the reforms that are going through Parliament.

Although we should be proud, rightly, of individual examples in our constituencies, we should not rest on our laurels. We need to build on that solid foundation, because far more can be done. End-of-life care is not available to everyone who needs it. In fact, the palliative care funding review found that 92,000 people die in England every year without access to the services that they need. That figure equates to nearly 500,000 people during the term of this Parliament, and 700 people in each of our constituencies dying without the good palliative care services that they deserve.

Nationally, hospices receive about a third of their funding from the NHS, but that can vary substantially across the country. Indeed, in my constituency in Enfield, the NHS contributes less than 20% of what the hospice spends on care for Enfield patients. One of the biggest issues facing the terminally ill is where they will die. Currently, more than half the people who die in England do so in hospitals and just 20% die at home, although various studies have shown that two thirds of people would choose to die at home.

In Enfield, there are excellent palliative care services. I pay tribute to Nightingale Cancer Support Centre and North London hospice, which provides a community service providing care in people’s homes alongside an in-patient unit. In Enfield, the North London hospice community team are able to ensure that only 28% of people cared for by the hospice die in hospital.

According to the Minister, the Government should consider allocating national resources to continue to promote and extend palliative care. I look forward to hearing from the Minister about the progress in implementing the new per-patient funding system for hospice and palliative care providers, which will provide incentives to enhance services within community settings.

[Guy Opperman (Hexham) (Con)]

Will my hon. Friend give way?

[Mr Burrowes]

I will conclude in a moment, because a large number of colleagues want to contribute.

Jean Rostand, the French biologist, said:

“For my part I believe that there is no life so degraded, debased, deteriorated, or impoverished that it does not deserve respect and is not worth defending with zeal and conviction. I have the weakness to believe that it is an honour for our society to desire the expensive luxury of sustaining life for its useless, incompetent and incurably ill members. I would almost measure society’s degree of civilisation by the amount of effort and vigilance it imposes on itself out of pure respect for life.

I look forward to hearing hon. Members demonstrate that respect for life, for the dying, today.

--- Later in debate ---

[Tony Baldry (Banbury) (Con)]

I do not intend to refer to the policy of the Director of Public Prosecutions in cases of encouraging or assisting suicide or to the report of the Commission on Assisted Dying because I note that my hon. Friend the Member for Croydon South (Richard Ottaway) has been given a debate by the Backbench Business Committee. Hopefully that debate, in which I suspect that many hon. Members present today will seek to catch Mr Speaker’s eye, will give us the opportunity to make our views known on those matters.

I fully endorse everything said so far today in the debate initiated by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), so I hope not to repeat anything. However, it is important for us to recognise that we will all die. As a society, we need to talk much more about dying and the care of the dying. As the psalmist says:

“The days of our age are threescore years and ten; and though men be so strong, that they come to fourscore years: yet is their strength then but labour and sorrow; so soon passeth it away, and we are gone.”

All too often in modern medicine death is seen as a failure in some way, but supporting those who are dying is an important part of modern medicine.

Three crucial things, therefore, ought to happen for anyone who is dying. They should be informed and fully know and understand, as far as possible, what is happening with their medical treatment. So far as is possible, they should be relieved of pain and should be able to die where they would most like to die. Most people, when asked, say that they would like to die at home, yet home hospice services in this country are pretty noticeable by their absence. I agree with the comments of hon. Members so far: we do have exceptionally good palliative care in this country—where it is good it is very good—but all too often it is mediocre.

[Guy Opperman]

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing the debate. A lot of people present are passionate Christians and see the subject from a religious standpoint. I speak as someone who was given warning of death on 26 April, before my operation last year, and with respect I take the view that, of the choices faced by individuals, one is the choice of their death—when they would choose to go. Does my hon. Friend the Member for Banbury (Tony Baldry) accept, as a matter of both law and faith, that that choice belongs to us?

[Tony Baldry]

I want to resist the temptation to be drawn into a debate on assisted dying, because many people present want to talk about palliative care, but I state simply that the only person who should determine when we die is the Almighty—it is not us. If we get into a situation in which we pick and choose who dies and who lives, it is a slippery slope. However, I will wait until the debate to be initiated by my hon. Friend the Member for Croydon South before I develop those arguments.

On the need to enhance palliative care, I hope that much more emphasis can be given to junior doctors in particular. I understand that at present they get comparatively little training on palliative care and, given the pressures that junior doctors are under, they often feel that if a patient dies they have somehow failed that patient. They might not have: patients die, and it is a fact of life that people will die. Every hospital trust should have a clear policy on palliative care and on how to enhance it. We should never forget the role of hospital chaplains. People approaching death often need spiritual support as well as medical assistance. Spiritual support is no less worthy and necessary.

We should never underestimate the role of hospices. Hon. Members have referred to hospices in their constituencies, and I have the excellent Katharine House hospice in mine. However, we must try to ensure that they are better integrated in support of NHS palliative care services. Many moons ago, in the mid-1980s, Jack Ashley and I set up the all-party group on hospice support, which is now the all-party group on hospice and palliative care. Even then, we were concerned about the varying amount of support from the NHS to local hospices. I hope very much that NHS commissioners will, whenever possible, see local hospices not just as a resource in developing excellence in palliative care, but as an invaluable resource to help those who are dying and those who are terminally ill. I suspect that the voluntary hospice movement still needs to be much better integrated in supporting the NHS and those who are terminally ill. I hope that the introduction of new forms of commissioning will enable that to be done much better. How we support those who are dying is a measure not just of the NHS, but of us as a society, and we should be judged by how we care for those who are bereaved.