Strengthening Standards in Public Life

Debate between Thangam Debbonaire and Catherine McKinnell

Wednesday 17th November 2021 Commons Chamber

[Thangam Debbonaire]

Oh goodness me! My right hon. and learned Friend the Leader of the Opposition, in contrast with the Prime Minister, is actually trying to strengthen the rules, not weaken them. In strengthening them, he is showing no fear, no favour and no concern for whether that has an impact on MPs on the Opposition Benches or on the Government Benches. He is trying to propose something that strengthens the rules across the board. I think that is important and really matters. The Leader of the Opposition has also quite properly declared everything. We should note that in all parties there are lawyers, doctors and members of the armed forces who serve as reservists, whose professional qualifications we may wish them to keep up. Since he became the Leader of the Opposition, my right hon. and learned Friend has not taken on any private practice, and I believe he has relinquished his licence. That shows admirable dedication, in contrast with the Prime Minister: all he has done is try to rip up the rulebook.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I apologise for interrupting the flow of my hon. Friend’s excellent speech. Does she share my dismay over where we have got to today? We are still debating this issue and, rather than raising and elevating this House, the interventions from Government Members appear to wish to drag us all into the gutter.

[Thangam Debbonaire]

I thank my hon. Friend for her intervention. It is a very sad day, because, rather than taking this on the chin, admitting they made a mistake, which they seemed to be doing last week, and moving on constructively, the Government just want to give the very false impression that all MPs are for sale. That is simply not true and they know it.

Paid advocacy has been against the rules since 1695, so it is not a new rule, but, throughout the centuries, especially in the past three decades, the standards system has been strengthened—until the last fortnight. That consensus has been systematically shredded by this Government—whether it is the Prime Minister not enforcing the ministerial code on his Cabinet or the Leader of the House seeking to undermine the standards procedure—and this has to stop. It is not good enough. The public—our constituents—rightly expect and deserve better than this.

The previous Labour Government legislated to clean up politics after the Tory sleaze of the 1990s. I give as examples: the Political Parties, Elections and Referendums Act 2000; the ministerial code; freedom of information; public registers of donations and national election spending; and the Electoral Commission, which this Government also seem to want to undermine. Those all came about because of the Labour Government, whereas in 2018, when the independent and external Committee on Standards in Public Life, set up to deal with the previous Tory scandal, recommended that the MPs’ code of conduct should be updated, the Tory Government ignored it. The report said:

“MPs should not accept any paid work to provide services as a parliamentary strategist, adviser or consultant, for example, advising on parliamentary affairs or on how to influence Parliament and its members. MPs should never accept any payment or offers of employment to act as political or parliamentary consultants or advisers.”

It could not be clearer, and that is what our motion today sets out to achieve. I hope that the Government will be supporting this, because, as I have said and I will say it again, no MP should be for hire. This is not about outside interests per se, because the vast majority of Members work tirelessly to represent their constituents and are not seeking to privately profit from that work. Outside interests are often a way for MPs to connect with the world outside of this place—a point that has been made by many MPs and others.

Terminal Illness: Support

Debate between Thangam Debbonaire and Catherine McKinnell

Monday 5th December 2016 Commons Chamber

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

It is appropriate that this debate, on an issue that will touch millions of people and their families at some point in their lives, should take place today, given that 5 December has been designated International Volunteer Day by the United Nations since 1985. Its purpose is to

“celebrate the power and potential of volunteerism”.

The UN states that IVD is

“an opportunity for volunteers, and volunteer organisations, to raise awareness of, and gain recognition for, the contribution they make to their communities”.

This year’s IVD theme of #GlobalApplause seeks to give volunteers around the world the recognition they deserve, while also “giving a hand” to potential volunteers by encouraging them to give up some of their time for others.

Of course, the link between IVD and this debate is that the vast majority of end-of-life palliative care outside hospital is provided by the charitable sector and only partly funded by the NHS. For that reason, people who donate their money to—and, crucially, their time through volunteering with—end-of-life-care charities play an immeasurably important role in ensuring that the majority of us, and our loved ones, will get the right care and support when we are dying. We will need more volunteers as more people die each year and the demand for high-quality palliative and end-of-life care increases, which is something I will return to later.

I have long been an advocate of the need for good palliative care and support to be available to those who need it, but it is as a result of my recent work locally with the charity Marie Curie that I sought this debate. As I am sure all hon. Members will know, Marie Curie has been providing care and support for people living with terminal illness and their families for the last 65 years. It was able to care for more than 40,000 people across the UK in the last year alone, in large part thanks to the support of more than 10,000 volunteers.

In October, I had the absolute privilege of meeting my constituent Don Lowther, who has terminal cancer, and Faye Morrison, a 21-year-old student from Gateshead who has befriended Don through Marie Curie’s helper service. This pioneering service, which has been available in the Tyne and Wear area since last year, matches trained volunteers with people living with terminal illnesses, providing them and their loved ones with companionship, emotional support and practical help with the aim of ensuring that their quality of life is the best it can be in its final stages.

Since last December, Faye has been making regular visits to see Don in his home, and over that time they have developed a close friendship. Faye is able to ensure that Don, who can no longer drive, can still get out of the house to places such as North Shields for fish and chips. Perhaps most importantly, Faye is a non-family member who Don can talk to and share his concerns with. The impact of Faye’s volunteering on Don’s quality of life, and that of his wife’s, is clear to anyone who meets them, but Faye is the first to say that she has—from giving her time and being part of the helper service—gained as much as Don has.

The Marie Curie helper service also helps to co-ordinate local services, enabling people affected by a terminal illness and their families to understand what is happening, and ensuring that they are supported throughout this challenging journey. In the case of Faye and Don, this has involved signposting Don to the services provided by Marie Curie’s Newcastle hospice, which I also heard more about from Lead Nurse Michelle Scott when I recently visited this facility, which is located in the west end of the city in the constituency of my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah).

I saw for myself the newly opened complementary therapy and relaxation area, with its Alnwick garden theme, and the different types of accommodation available to patients and their carers, including for respite care. I learned more about the wide range of medical and nursing care, physiotherapy and occupational therapy available, and about the practical, psychological, emotional and spiritual support provided by the highly experienced hospice team. What I took away most from my visit, however, was the hospice’s absolute dedication to celebrating life and to ensuring that those using its services—whether terminally ill parents with young children or those, such as my constituent Don, who use their day services and activities—receive the best possible support and enjoy the best possible quality of life as their time comes to an end. Don told me he was concerned that once he stepped inside the hospice, he would never leave, but that is just not the case. Thanks to the helper service and Faye, he was signposted to the care and support provided at all stages of terminal illness. That support is not negative about death and dying, but treats them as a part of life. Of course, not all Marie Curie’s nursing care takes place in a hospice setting, because the charity’s nurses also provide overnight care in people’s own homes.

Marie Curie is certainly not the only charitable organisation providing end-of-life care in the Newcastle area. Other vital organisations include Macmillan Cancer Support, with whom I recently had the pleasure of enjoying coffee and cake at the Lemington Centre and St Cuthbert’s Primary School in Walbottle, as well as St Oswald’s hospice in Gosforth, which has worked to

“make the most of time and improve quality of life for everyone in the North East living with an incurable condition, and their families”

for the past 30 years.

Despite the incredible efforts of these charities and the NHS for people who are dying, the risk that they will not get the care that they need to manage their symptoms and to maintain their quality of life until the end of their life is worryingly high. Research undertaken last year by the London School of Economics on behalf of Marie Curie found that a deeply concerning 92,000 people who need palliative care in England each year are not receiving it. That means that one in four people are not getting the good end-of-life care—care for managing pain and other symptoms, alongside psychological, social and spiritual support—that they clearly need.

The people who miss out most frequently on this support are those with a terminal illness other than cancer, such as heart failure or chronic pulmonary disease. Indeed, written evidence submitted by the National Council for Palliative Care to the Health Committee’s inquiry into end-of-life care, which was published last year, drew attention to the fact that people with cancer access over 75% of specialist palliative care services, although cancer causes around 30% of all deaths. Concerns about the availability of palliative care for people with non-cancer diagnoses have been raised with me by a constituent living with idiopathic pulmonary fibrosis.

Others who are likely to miss out are people aged over 85, including those with dementia, despite the fact that dementia is now identified as the leading cause of death in England and Wales. Written evidence submitted by Age UK to the same Health Committee inquiry highlighted that while one third of all deaths are of people aged over 85, only around 15% of the people who gain access to specialist palliative care fall into that age group. Worrying inequalities already exist regarding the quality of end-of-life support available, depending on a person’s illness, age and, as ever, where they happen to live.

A growing concern is that the existing system, which is already unable to provide care for all who need it, is coming under ever greater pressure as our social care services fast approach breaking point. Marie Curie states that in its own services, it is seeing people waiting weeks in hospitals and hospices for social care packages to be put in place so that they can get home or into a care home to spend their final days in the place of their choosing. Very sadly, that situation means that it is not uncommon for people to die while waiting. This does, of course, have a terrible human impact, not only on the person dying, but on their families, making what is already a hugely traumatic situation immeasurably worse. This state of affairs is also totally cost-inefficient for our NHS, which could be using those hospital beds for people who need acute care.

The situation I have outlined will come as no surprise to any hon. Member, given that adult social care budgets have been cut by some £4.6 billion, or 31% in real terms, since 2011. They continue to fall in the face of an increasingly elderly population and therefore increasing demand. I have no doubt that the Minister will want to champion the social care council tax precept that the Government have allowed local authorities to raise for this purpose, but I gently remind him that that is anticipated to raise £1.4 million a year in Newcastle, yet the city council faces a social care shortfall of some £15 million.

[Thangam Debbonaire (Bristol West) (Lab)]

I thank my hon. Friend for bringing this issue to the House’s attention. She is making a powerful speech. Let me also pay tribute to the hospices in my constituency— St Peter’s hospice, and the hospice that cared for my father and my mother-in-law in their dying days.

Does my hon. Friend share my concern about the fact that the Government have not made adequate progress in meeting the recommendations of last year’s inquiry into end-of-life care by the Health Committee? Will she join me in asking the Minister to explore the question of how well the five principles of end-of-life care are being followed across the country?

--- Later in debate ---

[Catherine McKinnell]

I think that we would all like the Minister to try to explain that key point. Marie Curie’s main concern, which I know is shared throughout the sector, is that the provision of palliative care is simply not growing to meet the demand for services. That is clearly extremely troubling, given that one in four people are already unable to access the end-of-life care and support that they need. Like the rest of our health and social care services, the palliative and end-of-life care sector—including those who provide such care in hospitals and care homes—is facing a demographic crisis. More people are dying each year, at an older age, and with more long-term and often complex conditions. Indeed, the number of deaths per year will rise by 100,000 over the next five years.

Given those facts, when the Government announced in July this year in their

“response to the independent review of choice in end of life care”

that they would establish a board within NHS England to implement the recommendations of the review, it came as a grave disappointment to all involved in the sector that they had chosen to reject the review’s key recommendation that £130 million of funding should be made available at the next spending review to

“invest in social care and NHS-commissioned services, to deliver a national choice offer in end of life care.”

Along with my hon. Friend the Member for Bristol West (Thangam Debbonaire) and, I am sure, others who are listening to the debate, I ask the Minister to state clearly how, without the additional funding that was recommended by the independent review, the Government will ensure that palliative and social care services grow to meet existing and increased demand in the coming years.

[Thangam Debbonaire]

Does my hon. Friend agree that the autumn statement provided an ideal opportunity for the Government to produce sums to meet the ever-increasing demand for social and end-of-life care, and that that opportunity was missed?

[Catherine McKinnell]

That is a good point. Everyone was disappointed not to hear a commitment from the Government. I think we would all like to know how, without those additional funds, the Government will end the distressing and unacceptable circumstances in which 92,000 people—one in four—are missing out each year on the care and support that they and their families need at the end of their lives, and how on earth the Government will prevent that deeply concerning figure from growing ever bigger.

I am acutely conscious that there are many more issues that I could have raised in a debate about such an important issue. They include the provision of end-of-life care for children and young people with life-shortening conditions, which, according to the charity Together for Short Lives, is often

“inappropriately coupled with the palliative care needs of adults, when their needs can be much more complex”.

A key concern for that charity, and for all of us, is that the number of children and young people affected by life-shortening conditions is not properly monitored, which makes it impossible for the Government, the NHS and local authorities to plan properly and budget for their needs.

Another serious issue relates to the fact that our welfare system can let down too many people with debilitating and terminal conditions such as motor neurone disease. While welcoming the recent and long overdue announcement that people with severe lifetime conditions will no longer have to undergo reassessments for employment and support allowance, the Motor Neurone Disease Association and many other charities remain extremely concerned about the Government’s determination to devolve attendance allowance to local authorities, and the impact that that could have on the vital support that people with extremely challenging conditions currently receive.

I have raised a number of issues with the Minister this evening about the additional funds for end-of-life care that the NHS, charities and their much-needed volunteers clearly need. When people do not have the palliative care that they need, there are real and damaging consequences. They may die in pain or discomfort, which causes distress not just to them, but to their families, friends and loved ones. That will be avoidable if the Government can make a commitment to those people. I look forward to hearing the Minister’s response to the important concerns that I have outlined this evening.