End of Life Care

James Davies Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Dr James Davies (Vale of Clwyd) (Con)]

I very much appreciate the opportunity to talk about this important topic today. As a GP, I have been involved in delivering palliative care—as has my wife, who is a district nurse. It was mentioned earlier that during the debates on the Assisted Dying (No. 2) Bill last year, end-of-life care was highlighted as an important topic that needed to be discussed. We have a world-class palliative care service in parts of this country. Indeed, many other countries look at our hospice movement and want to adopt it for themselves. My local hospice, St Kentigern, which I visited recently, provides excellent care as well as guidance to clinicians, as do so many hospices. However, there are variations in different areas of our country, between the care provided by different clinicians and between the palliative care available for differing conditions.

I have joined the Health Committee since the general election, so I was not part of the inquiry that led to the report. I do not intend to provide an exhaustive list of issues that I feel need addressing, but I thought it might be helpful to give the House a GP’s perspective on some issues that are important to me. The lack of prior planning and discussion for patients is a very real issue. There is certainly a need for more information for patients, carers and family members. It is worth noting, however, that health policy can influence patients’ awareness of developing conditions, and I would like to mention dementia in this context.

The Government have focused on dementia in recent times, and the Prime Minister’s challenge has been quite successful in increasing diagnosis rates. The rate has now gone up to about 67%. A diagnosis gives patients the opportunity to look to the future and decide how they see the end of their life. Sadly, the diagnosis rate in my area of Wales is only 43%, which shows how health policy can influence the debate in many ways.

Care homes are clearly critical to end-of-life care. My practice certainly felt that it was able to contribute to this domain through a local enhanced service that allowed oversight by one practice and continuity of care, which is extremely important. That service also helped to prevent unnecessary admissions to hospitals. It resulted in better opportunities for staff training.

Clearly, there is pressure on hospice beds and community hospital beds. There is also a need to address privacy in the acute secondary hospital setting, where hospital is the right place for end-of-life care. We know that so many patients wish to die at home, and out-of-hours services are crucial to that. We have heard a lot about a seven-day NHS in recent times and this is one crucial area where providing services at weekends and in the evenings is so important. If a patient is waiting for a delayed period for a syringe driver, for instance, that prolongs their discomfort. We also know that there are limited community services in some instances, particularly for children.

I have seen discharge liaison services in hospitals moving heaven and earth to meet patients’ wishes and allow a death at home. Those need to be focused upon to ensure that, wherever possible, that can take place, with adequate support for carers once the patient is discharged home. Finally, clinicians need the confidence to identify what constitutes an end-of-life situation and to manage it appropriately, and so clearly there is a need for education. One in five of those who die is not receiving the end of life care that it is felt they should receive, so clearly there is still much work to be done, despite the best efforts of so many in this country.