Palliative Care

Maria Caulfield Excerpts

Wednesday 4th November 2015 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I am pleased to have secured this debate tonight on the important topic of access to palliative care for those who are dying. There are three key reasons why this debate is so timely and so important. First, it follows hot on the heels of the assisted dying debate that we had here on 11 September. No matter how Members voted, there was cross-party support for the movement for better access to palliative care in this country. Secondly, it is an important subject because from my experience as a cancer nurse working in one of the best cancer units not only in the country but in Europe, I have seen at first hand the difference that good palliative care can make, not just to patients and their families at the time of death, but in the last few weeks and months, making patients’ lives as fulfilling as possible.

Thirdly, the debate is important and timely because it fits in with the discussion of the Access to Palliative Care Bill in the other place. That Bill aims to ensure that wherever people are in the country and whatever disease they are suffering from, palliative care services are available to them. It would put palliative care services into the mainstream for the many, not the few.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I congratulate the hon. Lady on securing this debate. Should we not see palliative care in its broadest sense, including medical care as well as social care? That co-ordinated approach could make end of life far more tolerable and would mean that people had to go into hospital to a far lesser extent.

[Maria Caulfield]

I agree, and I will highlight that point later in my speech.

For me, palliative care is about support and services that help to achieve a good death and underpin the care in someone’s final weeks and months of life. What happens now is that all too often the provision of palliative care is distributed on the basis not of need but of availability, and depends on the diagnosis, where the person is treated, and sometimes even their age, leading to a patchy and ineffective service. We heard during the Adjournment debate on Monday night about the impact of not having good bereavement services, which stays with relatives not just at the time someone dies but for years afterwards, and may never go away if they have had a bad experience.

This patchy service continues despite all the hard work in recent years reviewing palliative care provision across the country. As far back as 2008, an end-of-life care strategy was produced, and in 2011 the National Institute for Health and Care Excellence produced quality standards, yet palliative care services remain patchy. To highlight that further, let us look at a few more statistics.

Unfortunately, we know that 100% of us will die eventually, and that three quarters of those deaths will be expected. That means that three quarters of the population could benefit from palliative care, but currently only 48% of people who have palliative care needs receive palliative care support. Of the 500,000 deaths that occur in this country every year, 82.5% are among the over-65s, yet fewer than 15% of that group have access to palliative care. That tells us that those who need it most often have the hardest job accessing it. For older people, death is often seen as inevitable and not something that palliative care should be helping with.

More shockingly, between 50% and 70% of people who are dying say they would like to die at home, but only 30% actually do. Most people end up dying in hospital—just over 50%. Hospitals are amazing places, but they are acute settings helping to deal with urgent and emergency cases. While they do need to do more to provide better palliative care, we need to invest in our excellent hospice movement and facilities so that if people want to die in a hospice, they can. We also need to support our community outreach programmes so that if people want to die at home, they can have that choice too.

[Jim Shannon (Strangford) (DUP)]

The need for palliative care always comes at a time when people and their families are feeling vulnerable. The importance of charities and Churches at that time is something that we all know very well. The hon. Lady referred to hospice care groups and organisations. Does she agree that their role should be recognised more by Government and by the authorities so that they can take better advantage of hospice care and do better for those people through it?

[Maria Caulfield]

I thank the hon. Gentleman. I absolutely agree. That point is picked up in the Bill.

The most shocking statistic concerns the diseases that people are suffering from. The London School of Economics says that 92,000 people a year miss out on palliative care help. At the moment, 88% of our palliative care provision goes to people with cancer. As a cancer nurse, I am certainly not saying that that needs to be reduced, but the majority of deaths are due to other diseases. Only 29% of people die of cancer, with 28% of deaths due to heart disease, 15% due to respiratory illnesses, 10% due to stroke, not to mention Alzheimer’s disease, motor neurone disease and multiple sclerosis. Until we ensure that palliative care provision is mainstream, and not just for patients with cancer, the majority of people will be denied access to a good death.

The Bill introduced in the other place comes up with solutions to resolve this situation and place the responsibility firmly in the hands of local clinical commissioning groups to ensure that all patients, no matter where they want to die or what disease they have, will get access to palliative care services. That will take the pressure off existing acute facilities that are currently having to provide them. The Bill makes some key practical proposals. The first is about the ability to admit people directly to palliative care facilities. This happens really well in a lot of places, but it does not happen everywhere. That goes back to the point made by the hon. Member for Strangford (Jim Shannon) about investing in our hospices to ensure that it can happen more widely. The Bill talks about support for healthcare professionals in all settings, so that whether they are an intensive care unit nurse or someone who works with motor neurone disease, they have a signposted facility to access specialist palliative care that helps them to help patients manage their symptoms.

The Bill fits very firmly into the Government’s seven-days-a-week NHS in calling for the availability of seven-days-a-week palliative care services. As I know only too well, it is at 4.30 pm on a Friday that a patient will phone up in pain and say they cannot cope, when pharmacies are closed and it is possible to get a prescription but not a drug. Someone who is breathless and needs a chest drain often has to wait until the Monday morning, in the meantime being admitted to A&E or a medical assessment unit and then finding it very difficult to be discharged to go home. This is why we need a seven-days-a-week palliative care service.

The Bill calls for some really basic things that should exist now but do not, such as sufficient equipment for our community services. It is unbelievable that a ward nurse who wants to discharge someone with a morphine pump cannot do so because the pump belongs to the hospital. Unless the community has a spare pump, that patient will not go home. That is why only 30% of people are dying at home—they are stuck in hospital because communities do not have the necessary equipment to look after patients. There are shortages of mattresses and feeding pumps, which would make a crucial difference if they were available.

[Sarah Champion (Rotherham) (Lab)]

I congratulate the hon. Lady on calling this debate on such an important and often overlooked issue. I support what she is saying 100%, but does she agree that it is not just the NHS, the community and the charitable sector that need to join up? Joining up health and social care would enable the seamless transition she is talking about.

[Maria Caulfield]

Absolutely. I am touching on some of the Bill’s highlights, but we also need to incorporate social care, because that is often the kind of support that carers need in order to be able to look after relatives.

The Bill also highlights the fact that medication is not available at all times. I know only too well that if a patient’s pain needs to be better controlled, they can get a prescription but they cannot get the drugs on a Saturday or Sunday or during the night. Once again, they are admitted to A&E for help in managing their pain. That is not acceptable.

Practical solutions are available to enable people to choose where they want to die. I was disappointed by the response of Lord Prior of Brampton in the other place when he dismissed the Bill so easily by saying that we did not need to legislate for good palliative care. I strongly disagree. If we can legislate for a charter of budget responsibility, which I strongly supported because it is important for this country to run a surplus, and if we can legislate to freeze VAT and national insurance because that is also vital to this country, and to charge 5p for every carrier bag, why can we not legislate to provide good palliative care for every person who needs it?

I urge the Minister to consider the Access to Palliative Care Bill, which is currently going through the other place, as a way to improve access to palliative services and to support patients, families and NHS staff.

[Mims Davies (Eastleigh) (Con)]

On legislation, does my hon. Friend agree that it gives us as individuals and families the opportunity to start thinking about the unthinkable, to improve the process and to shape the palliative care we will want in the future?

[Maria Caulfield]

I completely agree with my hon. Friend. We need to make death a normal part of life, but until palliative care is available to everyone it will still be seen as something that happens in dark corners in hospitals, when it should be happening at home.

The NHS is supposed to be there from cradle to grave, but this country is not getting death right. People are going abroad to commit suicide because they cannot face a natural death. We are doing something fundamentally wrong. I therefore ask the Minister to consider legislating on access to palliative care. Years of reviews have not solved the problem. With 100% of us facing death, we need to ensure that end-of-life care is treated as a priority.