Examination of Witnesses (Questions 271
- 279)
WEDNESDAY 26 MAY 2004
MISS MELANIE
JOHNSON MP AND
DR STEPHEN
LADYMAN MP
Q271 Chairman: May I welcome our
witnesses and express our thanks to the Department for your co-operation
with this inquiry. Would each of you introduce yourself to the
Committee and perhaps say a little about where your responsibilities
are, in terms of palliative care?
Miss Johnson: I
am Melanie Johnson. I am the Minister for Public Health. My responsibilities
in respect of palliative care are related to my cancer responsibilities,
which are in addition to my general public health role. Those
cancer responsibilities include all of the adult palliative care
side of things.
Dr Ladyman: I am Steve Ladyman.
I am responsible for children's health, and so I have responsibilities
in respect of children's palliative care. I am not responsible
for children's social services, which sit with the Minister for
Families in the Department for Education. I also have responsibility
for older people's health. So if the Committee wants to investigate
issues around continuing care, then they sit in my portfolio.
Q272 Chairman: Can I begin by exploring
for a moment a theme that we have touched on before? You are probably
aware from the minutes of previous meetings that I have raised
the question of societal attitudes to death and dying. I wondered
what your thoughts were on where we are in relation to our attitude
to death and dying, in the context of palliative care policy.
One of the points that I have raised over a number of sessions
is that, certainly growing up in the 1950s and 1960s, I think
our attitude to death and dying then was more open than it is
now. When we are looking at how we can try to move more towards
people's choice to die at home—which appears to be the choice
of most people and, in the main, their carers initially—why
is it that we cannot do that? Is there a connection with attitudes
to death and dying? If our attitudes have a bearing on policy,
what is the Government's responsibility to address the whole issue
of death and dying, for example in the education system? I know
that you are not responsible for that, but it is an issue which,
I am sure you will appreciate, links into what we are looking
at with palliative care.
Miss Johnson: To start with, I
am not sure that I entirely agree with you that things were better
a couple of decades ago.
Q273 Chairman: I did not say that
they were better. I think that they were more open.
Miss Johnson: I am not sure whether
they were more open.
Q274 Chairman: Maybe it was a different
environment and just a different area of the country.
Miss Johnson: It may be there
are different attitudes around different parts of the country.
We are talking here not of government policy but of experience
and understanding, as it were. I think that there is still not
enough focus on the needs of dying people, nor enough acknowledgement
that we need to provide for them; nor enough focus on it in general;
nor is there enough openness about death. I think that you are
quite right in saying that that is a big issue. I am just not
sure that I agree with you about the historical bit of it, as
it were. There may have been different ways of dealing with things
in a more ritualised way in the past but, as we have moved away
from the more formalised rituals around this, we perhaps have
not instituted anything that has taken its place. The lack of
provision that enables people to die in their own homes is of
continuing concern to us and a matter which we are determined
to do something about.
Q275 Chairman: Regardless of our
differences on whether or not things have changed, do you think
that the Government have a role to play in perhaps encouraging
healthier attitudes towards dying and death? If so, what can you,
as a Government, do in encouraging this change in attitudes?
Miss Johnson: Of course the Government
have a role. We all, as individual adults, have responsibilities—in
respect of our family, the children we bring up, grandchildren,
and so forth—ourselves to demonstrate a different attitude,
and not all of it can be passed to the Government. I think that
the Government has responsibilities too. The Government have responsibilities
to make sure that healthcare professionals have the right sorts
of skills and understanding, and deal with things appropriately.
We need to make sure that the service is focused appropriately,
and we need to make sure that patients are given the sort of information
and choices that they should have at all stages of their care,
including palliative care.
Q276 Chairman: I know that education
is not your responsibility but, from your knowledge of what we
might call health and social education, are you satisfied that
we give sufficient time to exploring these issues of death and
dying in the school environment?
Miss Johnson: As an ex-Ofsted
inspector, I think that we too often place too many responsibilities
on schools. There is a limit to what can be done within a 25-hour
school week, in effect. We cannot go on cramming things into schools.
Of course it is good to include more education of a basic kind,
but when you think about the number of hours in school against
the number of hours a child spends out of school, I think that
wider society, community provision, the role of the family, the
role of parents, and the role of government outside of schools
are as important as what goes on in the schools.
Q277 Chairman: As an ex-Ofsted inspector,
do you feel that teachers are adequately prepared to deal with
questions of death and dying in the classroom environment? I will
give you an example from my childhood, when we used to be encouraged
to give our news. My news to the class, probably at the age of
ten, was that I had seen this dead body in a coffin at a funeral.
The teacher moved on to somebody else immediately and was not
able to explore that. It struck me that, on reflection, that teacher
did not know how to handle that kind of area with kids as young
as we were. Do you feel that we sufficiently prepare teaching
staff to handle questions, where a child has had a bereavement
or a child in a class may have died, and they have to respond
to that loss?
Miss Johnson: I think that you
do need to talk to education Ministers about the current state
of teacher training and how well equipped teachers are. But it
is fair to say that different adults will themselves have different
abilities to deal with very emotional and difficult issues, and
indeed different levels of fear about the issues with which they
are dealing—and different degrees of sensitivity about how
they deal with those issues. It is probably not realistic to think
that all teaching staff can be skilled up to a certain level on
that. They have gone in to teach children particular subjects
or general skills. The idea that they are all going to be equally
good and equally sensitive—it would be lovely to get there,
but it is probably utopian.
Dr Ladyman: I would just add one
thing, before I go back to your original question. It is actually
quite difficult to teach children the difference between being
and not being. Twenty years ago, and perhaps in our childhoods
before that, these things were taught in a religious context.
Children were taught about being on earth and alive, and then
being in heaven. Now, increasingly, we do not teach these things
in a religious context. Many of us do not have religious faiths.
It is much more difficult to deal with the concept in a child's
mind of just being and not being. In that, there are quite a lot
of difficulties in bringing up children to understand death. Going
back to your original question, we have also to accept that there
is a difference between the role of palliative care for children
and palliative care for adults. In general, in so far as you can
generalise about these things, palliative care for adults is about
an end-of-life experience. For children, broadly speaking—unfortunately
not always—it is about dealing with a life-limiting illness,
where death is going to be postponed, and which is about a much
longer-term process of care. So I think that we need to realise
that we are dealing with two very different concepts when we talk
about palliative care for adults and palliative care for children.
Q278 Mr Amess: The Minister has already
mentioned about home deaths, but I must comment, Chairman, on
your opening question. I have to say to our two Ministers that
the expert witnesses we have had so far have definitely given
us the impression that there was more openness and a more relaxed
reaction to death than there is at the moment, and they very much
hope that perhaps it will change eventually.
Miss Johnson: Perhaps I can just
respond to that remark. I think that there is increasingly more
openness; it is just that we have not got to where we would like
to be, nor where we should be. I think that there is a trend in
the right direction. You have had a lot of very expert people
come and give you evidence on this inquiry, and that may well
be what is being reflected; but I do not think anybody would say
that we have arrived at where we ideally ought to be on this.
Q279 Mr Amess: It is just that we
have been given the general impression that children have perhaps
been protected from death. They do not go to funerals as they
used to and, as our Chairman has said, they do not see dead bodies.
But let us move on.
Dr Ladyman: There is a different
societal change, in my view. I will be really controversial here.
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