End of Life Care

Debate between John Howell and Andrea Jenkyns

Wednesday 2nd March 2016 Commons Chamber

[John Howell (Henley) (Con)]

It is a great pleasure to participate in this debate today. A number of common themes run through the debate, the first of which is the fact that most people want to die in their own beds. Before coming to this debate, I tried to find some statistics on the subject. I trawled through a whole lot of figures on the internet, and what I came up with was the fact that 70% of us want to die in our own beds, yet 60% of people die in hospital.

Why is there such a discrepancy in the figures? Is it a ridiculous aspiration for 70% of us to want to die in our beds, or do we need to be better at organising end-of-life care services? The evidence from the Netherlands suggests the latter In particular, there needs to be more emphasis on the social care aspect, the reorganisation of that and its delivery.

What does that come down to in practice? The issue came to the fore in my constituency with the re-provision of a hospital in Henley, the Townlands hospital. The hospital will be re-provided with a greater range of services for people to access and a limited number of beds at the side of the hospital in a care home. The gap is being taken up by a system that has come to be called ambulatory care, involving greater use of social care packages. This follows a change in practice, where the aim is to reduce the number of beds and keep people out of hospital for as long as possible.

[Andrea Jenkyns (Morley and Outwood) (Con)]

My own father died at home. The Government’s response to the report states that a priority is to ensure that families are kept in the loop in the final days, but in our case, we did not know it was my father’s final days. A nurse turned up on the last day with an end-of-life care kit. In front of my father she said, “Here’s the end-of-life care kit,” and he died a few hours later. Does my hon. Friend agree that better communication is needed with those who want to die at home?

[John Howell]

I thank my hon. Friend for making that point. As many hon. Members know, I recently lost my mother. Contrary to what I said earlier, she died in hospital, but I have to say that the services provided were exemplary. We were taken into the thinking of the clinicians as her illness progressed, we were told exactly what would happen, and this led to a greater feeling of comfort with the whole process when she eventually died. I am reconciled with the idea that it was what she wanted. That fits in with the idea of personal choice, where that is possible. In my mother’s case it was not possible because of the illness, but I do not know the circumstances of my hon. Friend’s case. It is something that needs to be borne in mind.

There are still those locally who cannot see that the best interests are served by reducing unnecessary admissions to hospital and moving people out of hospital as soon as possible. I have listened to the clinical advice and the clinical evidence that this is the best way to go. Hospitals, contrary to what they may seem, are not necessarily healthy institutions. Even a short stay reduces the ability of muscles to function and affects quality of life. I spoke to the Alzheimer’s Society about this. The evidence was clear: although admission to hospital or, better still, to care homes will inevitably be required, the best advice was to keep people out of hospital for as long as possible. That was true even in the case of people suffering from Alzheimer’s.

This approach is not just about providing services to those who need periodic treatment, especially end-of -life care. It demands a revolution in the way social care is provided. I am a great advocate of integrated social care and healthcare, and I have heard from doctors about the way in which they decide on the services to be provided. When somebody presents to them with an illness, whatever it might be, the choices are a medical solution—they can be shipped off to hospital or given a prescription—or a social care solution. The feedback I have received from doctors is that they do not have control over the social care aspect, they cannot provide the services and it is very difficult for individuals to access those services, particularly at weekends.

We need this revolution for better control of social care by clinical commissioning groups. We need this revolution for the better use of providing medicine in the home, for example by using internet services, as has been mentioned, which I think is a magnificent way to go. We need this revolution for the timeliness of the provision of services. I agree with my hon. Friend the Member for Poole (Mr Syms) that we need to work across organisations to get this right, including those in the charity sector. If we do that, we can get a really integrated approach.