Asked by: David Davis (Conservative - Haltemprice and Howden)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, on what basis some care homes were chosen by the NHS to put do not resuscitate orders on all their residents during the height of the covid-19 outbreak.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
The Department does not hold data on the numbers or assessment of Do Not Attempt Cardiopulmonary Resuscitation Decisions (DNACPR).
Agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their families, carers, guardians or other legally recognised advocates. There has not been a national instruction or directive issued for blanket DNACPR decisions to be put in place. We remain clear that the blanket application of DNACPRs is unacceptable and that standards and quality of care should be maintained even in pressurised circumstances.
Asked by: David Davis (Conservative - Haltemprice and Howden)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how many care homes were instructed by the NHS to put in place do not resuscitate orders between 1 February 2020 to 1 August 2020; and how many people were placed under those orders.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
The Department does not hold data on the numbers or assessment of Do Not Attempt Cardiopulmonary Resuscitation Decisions (DNACPR).
Agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their families, carers, guardians or other legally recognised advocates. There has not been a national instruction or directive issued for blanket DNACPR decisions to be put in place. We remain clear that the blanket application of DNACPRs is unacceptable and that standards and quality of care should be maintained even in pressurised circumstances.
Asked by: Clive Lewis (Labour - Norwich South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department plans to take to ensure stocks of medicines for end of life do not run short.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
As part of our concerted national efforts to respond to the COVID-19 outbreak, we are doing everything we can to ensure patients continue to access safe and effective medicines, including those used in end of life care. The Department is working closely with the pharmaceutical industry, the National Health Service and others in the supply chain to help ensure patients can access the medicines they need, and precautions are in place to reduce the likelihood of future shortages.
NHS England and NHS Improvement have advised clinical commissioning groups to establish local hubs to ensure rapid access to anticipatory medicines. These hubs could be a community pharmacy, primary care network (general practitioner practice), community hospital, acute or other setting where palliative medicines (including controlled drugs) can be safely and legally stored and rapidly released when needed.
The Department and NHS England and NHS Improvement have published a standard operating procedure (SOP) for the use of medicines labelled for one patient, who no longer needs them, to be used by another person, in hospices and care homes. This will protect the medicine supply chain and ensure that patients can access critical medicines at end of life. The SOP can be found at the following link:
Asked by: Mark Menzies (Independent - Fylde)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps the Government is taking to (a) help reduce the mortality figures in care homes and (b) ensure that residents receive appropriate treatment and palliative care during the covid-19 outbreak.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
We are working closely with local authorities, the care sector and NHS England to understand the impact of COVID-19 on care homes and ensure everyone has access to the right care, in the most appropriate setting for their needs. We have provided extensive support and guidance to care homes throughout the COVID-19 pandemic.
Every death from this virus is a tragedy and we are working around the clock to give the social care sector the equipment and support they need to tackle this outbreak. The safety of residents and staff is always a priority. On 15 May 2020 we published a care home support package which outlines the next phase of our response for care homes, using the latest domestic and international evidence brought together by Public Health England, and drawing on the insights of care providers. To support this, on 13 May we announced an additional £600 million to support providers through a new Adult Social Care Infection Control Fund.
The adult social care action plan states that end of life care must continue to be planned in a holistic way involving social care, community nursing, general practice, occupational therapy. Provision of end of life care should reflect the individual patient’s needs and preferences, and where and how these can best be met. The Government, with the NHS, has published a new Standard Operating Procedure for the re-use of medicines in care homes and hospices. This will enable easier access to critical the end of life medication in these settings.
This is an unprecedented global pandemic and we will continue to review our guidance and national support in line with the latest scientific advice.
Asked by: Lord Pearson of Rannoch (Non-affiliated - Life peer)
Question to the Cabinet Office:
To ask Her Majesty's Government how many deaths attributed to COVID-19 have been recorded in (1) care homes, (2) hospitals, (3) individuals' homes, and (4) other locations.
Answered by Lord True - Leader of the House of Lords and Lord Privy Seal
The information requested falls under the remit of the UK Statistics Authority. I have therefore asked the Authority to respond.
Dear Lord Pearson,
As National Statistician and Chief Executive of the UK Statistics Authority, I am replying to your Parliamentary Question asking how many deaths attributed to COVID-19 have been recorded in (1) care homes, (2) hospitals, (3) individuals' homes, and (4) other locations (HL3277).
The Office for National Statistics (ONS) produces a weekly report on provisional deaths registered in England and Wales[1], including deaths involving COVID-19. The week runs from Saturday to Friday, and data has therefore been provided for all deaths attributed to COVID-19 up to the most recent week available, ending 17 April. ONS mortality statistics are compiled from information supplied when deaths are certified and registered as part of civil registration.
Table 1 below shows the number of deaths that occurred where COVID-19 was mentioned on the death certificate up to and including 17 April 2020. We have included these figures as they are presented in our weekly report.
Yours sincerely,
Professor Sir Ian Diamond
Table 1: Provisional figures on total death registrations where coronavirus (COVID-19) was mentioned on the death certificate in England and Wales up to 17 April 2020 by place of occurrence[2][3][4][5][6][7][8][9][10]
| Total deaths (COVID-19) |
Care Home | 3,096 |
Hospital (acute or community, not psychiatric) | 14,796 |
Home | 883 |
Other | 337 |
Total | 19,112 |
Source: ONS
[2]Coding of deaths by cause for the latest week is not yet complete and counts could be subject of change.
[3]For deaths registered from 1st January 2020, cause of death is coded to the ICD-10 classification using MUSE 5.5 software. Previous years were coded to IRIS 4.2.3, further information about the change in software is available.
[4]These figures represent death registrations, there can be a delay between the date a death occurred and the date a death was registered. More information can be found in our impact of registration delays release.
[5]An 'underlying cause of death' refers to the main cause of death, whereas a cause being 'mentioned on the death certificate' means that it might be the main reason or a contributory reason to the cause of death
[6]Deaths at home are those at the usual residence of the deceased (according to the informant)‚ where this is not a communal establishment.
[7]Care homes includes homes for the chronic sick; nursing homes; homes for people with mental health problems and non-NHS multi-function sites.
[8]Other includes:
Hospices: including Sue Ryder Homes; Marie Curie Centres; oncology centres; voluntary hospice units; and palliative care centres.
Other Communal Establishments: including schools for people with learning disabilities; holiday homes and hotels; common lodging houses; aged persons’ accommodation; assessment centres; schools; convents and monasteries; nurses’ homes;
Elsewhere: including all places not covered above such as deaths on a motorway; at the beach; climbing a mountain; walking down the street; at the cinema; at a football match; while out shopping; or in someone else's home.
This category also includes people who are pronounced dead on arrival at hospital.
[9]These figures are calculated using the most up-to-date data we have available to get the most accurate estimates.
[10]Non-residents are included in the England and Wales total but not England and Wales separately. For this reason, counts for "England" and "Wales" may not sum to "England and Wales".
Asked by: Rosie Cooper (Labour - West Lancashire)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the effectiveness of the NHS Long Term Plan in achieving the Government’s commitment to end variation in end-of-life care by 2020.
Answered by Caroline Dinenage
‘Our Commitment to you for end of life care’, published in July 2016, set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality care a reality for all. Since its publication, NHS England has been working to deliver the Choice Commitment, as set out in the Government’s Mandate to the National Health Service. Through its National Programme Board for End of life Care, a range of activity has been coordinated and undertaken with all key system partners care and stakeholders to improve equity of access to, and experience of, palliative and end of life care. A progress report was published the following year on 21 September 2017.
Key to reducing variation and delivering personalised care is ensuring that patients are identified as likely to be in their last year of life. This means their end of life care can be improved by personalising it according to their needs and preferences at an earlier stage. However, it is also vital that services are available to provide the care to people in the community and in their homes in a timely way. The Long Term Plan published on 7 January 2019, set out significant investment and activity to drive further improvement in both these areas in support of the Government’s Choice Commitment.
Asked by: Lisa Cameron (Conservative - East Kilbride, Strathaven and Lesmahagow)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 1 December 2017 to Question 115401 on Mental Health Services: Nurses, to which NHS Trusts will the first cohort of nursing associates be assigned, and what specialisms he expects that cohort to undertake.
Answered by Philip Dunne
Nursing associates are an England only role. There are currently 2,000 nursing associates in training within 35 Health Education England Pilots, due to complete and become qualified nursing associates in 2019.
Health Education England (HEE) have published a list of the first and second wave nursing associate test sites on their website found at the following links:
To support national consistency and coherence in the delivery of the education and training model for nursing associates, HEE has developed and published a national curriculum framework in partnership with Skills for Health and Skills for Care. This framework provides details of the breadth of skills and professional competence nursing associates will train to. The Framework can be downloaded from HEE’s website at:
The following tables shows health and care settings for nursing associate placements (this is not an exhaustive list) taken from the Nursing Associate Curriculum Framework.
Health and care settings for placements (not an exhaustive list) in hospital |
- National Health Service and independent sector (adult, children and young people) - Paramedic services - Emergency assessment units (community hospital settings) - Mental health inpatient service - Learning disability inpatient services |
Close to home |
- Hospice (adult and child) - Primary care, general practice and general practice nurses - Respite care with nursing service - Mental health crisis house with nursing services - Mental health community outreach teams - Reablement services (nursing) - School nursing - Substance misuse services - Community learning disability services integrated teams - Child and adolescent mental health services (CAMHS) - Public Health England nursing services |
At home |
- Nursing homes - District and community nursing services - Assisted living for people with learning disabilities - Supported living services - Children’s domiciliary care services - Older person services - Paediatric nursing services - Health visiting services - Community palliative care teams (child and adult) - Charitable end of life services, e.g. Macmillan - Community mental health teams (older people, adult, child) - Perinatal mental health teams - Early intervention for psychosis teams - Offender healthcare units |
Training of the NHS workforce in Northern Ireland, Scotland and Wales is a matter for each of the governments in the devolved administrations.
Asked by: Royston Smith (Conservative - Southampton, Itchen)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, how many terminally ill people were offered end-of-life care in their own homes in each of the last three years.
Answered by Jackie Doyle-Price
The Department has made no specific assessment of local palliative services care in England. As system leader, NHS England is responsible for securing the provision of high quality care for patients at the end of life, and as with the vast majority of NHS services, the commissioning of palliative and end of life care is a local matter, over which individual clinical commissioning groups (CCGs) have responsibility.
CCGs are best placed to understand the needs of local populations and commission services to meet those needs accordingly, and as such, decisions to increase palliative care service provision are for the local, not the national, National Health Service. NHS England works to support local commissioners in improving the services they provide, including palliative care, and has recently collaborated with Public Health England and the Care Quality Commission to provide bespoke end of life care support to Sustainability and Transformation Partnerships, include Hampshire and Isle of Wight. A copy of the support pack is attached.
Much of the palliative care patients receive will be provided either in outpatient or community settings, by nurses, community teams or general practitioners as part of general NHS services provision, rather than as an identified palliative care service. In such services, data are either not available or does not identify palliative treatment. In addition, social and voluntary sector organisations can provide additional support to patients and the end of life. Therefore, figures for the average cost and average time for treating a terminally ill person and figures for the number of patients offered end of life care in the home are not available.
On 5 July 2016 we published ‘Our Commitment to you’ for end of life care, which set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality, personalised care a reality for everyone. This includes measures to enable personalisation, measures to improve care quality and education and training in end of life care and measures to encourage the spread of innovative models of care. The commitment sets out that by 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home. A progress report on delivery of the commitment was published on 21 September 2017.
A key tool in measuring choice and quality in end of life care is the National Survey of Bereaved People (VOICES) survey, which collects the views of bereaved family and friends about the care received by the person they were caring for at the end of life. The survey does provide some information about preferences for care at the end of life, including place of death. The Government Choice Commitment; progress report on the Choice Commitment; and latest VOICES survey report can be found at the following links:
www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
Asked by: Baroness Massey of Darwen (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether NHS-funded continuing healthcare is available for hospice patients receiving palliative care; and what distinction, if any, is drawn between patients in hospices and those in nursing homes in determining the availability of continuing healthcare.
Answered by Lord Prior of Brampton
Eligibility for NHS Continuing Healthcare (NHS CHC) is not limited by the setting in which the package of support can be offered or by the type of service delivery.
When making decisions about eligibility for NHS CHC there is no distinction drawn between individuals residing in hospices and those in nursing homes.
Asked by: Andrew Percy (Conservative - Brigg and Goole)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, what steps he plans to take to improve understanding of palliative and end-of-life care in nursing and care homes.
Answered by Ben Gummer
We are committed to ensuring everyone at the end of life receives high quality, compassionate care that is tailored to their individual needs and preferences. This applies to all settings in which palliative and end of life care is delivered, including nursing and care homes.
To achieve this, we introduced a new approach to end of life care in 2014 based on five priorities for care of the dying person. It is for individuals and organisations delivering end of life care, including care homes, to ensure that the care they provide is based on the priorities. The Implementation Guidance for Service Providers and Commissioners and the Duties and Responsibilities of Health and Care Staff, which accompanied the priorities, set out clear expectations for organisations to ensure their staff receive the right training in palliative and end of life care.
In addition, Skills for Care, which works to support staff working in adult social care to develop their skills and knowledge has developed end of life care qualifications, guidance and resources to equip workers to recognise and manage end of life situations effectively.
In April 2015, Skills for Care launched the new Care Certificate, an identified set of standards that health and social care workers should adhere to in their daily lives. The Certificate includes end of life care and provides confidence that all health and care workers have the same introductory skills, knowledge and behaviours to provide compassionate, safe and high quality care and support.
I intend to announce further policy on end of life care in due course.