End of Life Care

Liz McInnes Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to take part in this debate and to follow the hon. Member for Henley (John Howell). When the House debated assisted dying last year, the point was made very strongly that good quality palliative care should be available to all; that at the end of life people deserve a good death, with access to palliative care and support; and that, rather than being subject to a postcode lottery, consistent, high quality end-of-life care should be available to all. Yet the quality of care and support that people and their families experience still varies significantly depending on where they live. Sadly, many people who would benefit from palliative care do not receive any at all. It is estimated that over 100,000 people a year in the UK—almost one in five of all deaths—would benefit from palliative care but do not receive it.

I want to talk about hospice care, as many Members have done. Hospice care forms a vital part of palliative care, supporting people through illness, the end of life, bereavement and into remembrance. It provides for the medical, emotional, social, practical, psychological and spiritual needs of individuals, as well as the needs of their family and carers. Although many might think of hospice care as in-patient care, in fact 90% of it is provided through day care and at-home services, enabling patients to stay in their own homes—many Members have mentioned how important that is—and giving much-needed respite for carers.

Hospice care relies heavily on the support of local communities; it is estimated that 125,000 volunteers donate their time and expertise to UK hospices. On average, Government funding covers only a third of the expenditure of hospices. My constituency is served by an excellent local hospice, Springhill, which works closely with the community and is well known and well respected. The cost of running the hospice exceeds £3 million a year, and 70% of the running costs comes from fundraising in the local community. Year on year, Springhill hospice has to attract 70% of its income through fundraising events, charity shops, lottery, legacies and donations. Like many local people, I am doing my bit to help this year by running the Manchester 10k in aid of the hospice.

Springhill, like most hospices, provides a wide range of services in addition to in-patient and out-patient services, all of which improve the end-of-life experience for both patients and their carers and families. As part of its education programme, the hospice has developed a palliative care education passport for staff in care and nursing homes, and it has just celebrated the first group of 34 staff who have completed the passport. To complete the passport, health and care staff must demonstrate kindness, as well as the skills, confidence and the application of knowledge in the care of those with palliative care needs; transferable skills that, once part of everyday practice, will enhance the care of all service users. That is just one example of a hospice working in partnership with other healthcare providers to deliver better care to more people and to help reduce pressure on the NHS. Such partnerships are vital to deliver the improved end- of-life care we all want to see.

Although we would all agree that our hospices are doing great work, I would like to take this opportunity to talk about statutory funding and commissioning arrangements for our local hospices. NHS and local authority funding for hospice care varies considerably between localities, and a variety of commissioning and contracting practices exists. More than two thirds of hospices had their funding from local CCGs frozen or cut in 2014-15, and more than eight in 10 hospices do not think they are funded fairly and sustainably by the NHS and local authorities. If the Government invested more in hospice care, they could reduce the number of people in hospital at the end of their life who had no clinical need, and no wish, to be there. That would help to relieve the pressure on the NHS and the strain on A&E and acute wards, and it would improve the end-of -life experience for the patient and their family.

I cannot talk about end-of -life care without paying tribute to the work of Marie Curie and Macmillan nurses, without whom patients are more likely to use A&E services and to spend longer in hospital. Although a small number of people would prefer to die in hospital, that is the least preferred option for the majority. As the Chair of the Select Committee mentioned, the Nuffield Trust has shown that using the Marie Curie nursing service results in a £500 reduction in total care costs per person. That cost saving can be replicated by other palliative care providers, meaning that investing in community-based palliative care can save the NHS money and reduce pressure on hospitals.

Changing demographics mean that the situation around end of life care will get worse. By 2040, an extra 100,000 people will die each year. The number of people with long-term conditions will have grown from 1.9 million in 2008 to 2.9 million in 2018. Unless the Government take action now to improve access to palliative care, the situation can only get worse, not better.