Examination of Witnesses (Questions 280
- 299)
WEDNESDAY 26 MAY 2004
MISS MELANIE
JOHNSON MP AND
DR STEPHEN
LADYMAN MP
Q280 Chairman: Be careful!
Dr Ladyman: I do not think that
the difference is necessarily a difference in attitudes to death.
I think that there is a serious change, and a very worrying change
to my mind, about society's attitude to caring. As the Committee
will be aware, I have announced that we are going to produce a
new vision for adult social care. One of the biggest questions
in my mind—and I have started people off on trying to think
about it as we write that new vision—is the way it seems
that we no longer want to care for each other in extremis: whether
it is because of old age, disability, or for whatever reason.
We are increasingly willing to let somebody else do it, usually
the State. If somebody comes along with a solution for caring
for somebody in our family, it often appears preferable to providing
the caring ourselves. The role of family, the role of neighbourhoods,
the role of the community, are gradually diminishing in a caring
context. In my view, it is one of the most worrying trends about
society for the current generation, because the state cannot provide
all the caring that we are rapidly giving up doing.
Q281 Mr Amess: You are absolutely
right. You have touched a chord with all of us, when we are presented
with constituency problems and have to bite our tongue on some
occasions because of the unreasonable demands.
Miss Johnson: You also have to
recognise, however, that the people in the family units have their
own needs, and how their fears, their anxieties and their issues
are being addressed in all of this. Often we have to look not
just at the individual but at the whole family support network
and what those needs are, if we are to address some of the issues
that Stephen is rightly raising.
Q282 Mr Amess: To get back to home
deaths, it appears to the Committee that, for any number of reasons,
many people do want to die at home or be given the opportunity
to die at home. To deliver 24-hour nursing care in parts of the
country really is not feasible. However, given that there is this
demand for people to be given the opportunity to die at home—I
know that it is at an early stage in terms of what the Department
is doing—can you share with the Committee some ideas as
to how this can be achieved?
Miss Johnson: First of all, there
is a whole complex set of things that will help this to happen,
not least some of the changes that are going on in out-of-hours
provision. We could come on to it in a moment, because I am sure
you will be interested in that—though I know that there
is a separate inquiry on it in any event. In terms of the approach
we have, it is encapsulated in Building on the Best. It
is looking at the way in which we can care for and improve the
care of people coming to the end of their life by ensuring, for
example, that there are training programmes in place to make sure
that all people will have access to high-quality palliative care.
That is why the Secretary of State announced in December a £12
million investment on the training side, to increase the skills
base and widen the skills mix of a large pool of staff who are
actually there. We also have the Cancer Services Collaborative
who are working in conjunction with Macmillan, Marie Curie and
also the Lancashire and South Cumbria Cancer Network. They are
looking specifically at the implementation of specific end-of-life
care tools. The investment over time and the fact that we are
going to give greater choice to patients in where they want to
live and die, and the decreasing numbers of old people who are
transferred from care homes to district hospitals in the last
week or so of their life, will mean that more people will be able
to die at home. But, as I said in response to your earlier remarks,
a lot of it is also about the family support and looking more
widely than the individual patient.
Q283 Mr Amess: The Committee enjoyed
a very pleasant visit to Edinburgh last Monday and Tuesday. As
part of the programme we saw the excellent facilities at the Marie
Curie centre there: an absolutely spot-on, centre of excellence.
It was very impressive. Perhaps I may share with both of the Ministers
that, as regards the report that was commissioned by Marie Curie
into the economic case for people dying at home, they told us
that £100 million invested into services to support dying
at home would free up to £200 million for the acute sector.
Do you agree with their analysis of it? If you do agree, do we
have anything in progress to try and make this happen?
Miss Johnson: I think that their
analysis is a very interesting and powerful one. We have not audited
their figures, as it were, but I can quite believe that their
figures are along the right lines. What we want to do is to make
sure that we are actually enabling more people to make the choices
that they want to make. That is not to say we should be prescriptive
about what those choices are. The whole point is that there should
be a service based on the needs of patients and their families.
In terms of the provision, therefore, there are changes that we
already have in place—like the single assessments for older
people, for example—which are generally encouraging a greater
focus on needs and recognising the way in which we ought to integrate
people's needs across the piece and provide services. I mentioned
the out-of-hours provision. There is huge scope for integrating
a whole range of professional skills to support people in remaining
at home, simply out of the changes in the out-of-hours provision.
It is recognising that, if we do things like develop district
nursing—district nurses are very keen to be trained and
there is huge interest in the work that is going on in training
district nurses in palliative care and support -we stand a much
better chance of providing for people in a home setting. Also,
if there are immediate problems—a problem with a catheter
or with something else—that previously would have led to
an A&E admission, maybe only for a day or so or maybe for
longer, those patients will remain at home more easily and much
better supported than they have been in the past.
Q284 Mr Amess: So this study that
has been commissioned is helpful on the part of the Department?
Miss Johnson: It certainly is.
We welcome it.
Q285 Mr Amess: And the Department
is not going to challenge the savings?
Miss Johnson: As I say, I do not
have any figures in front of me, so I could not comment on the
detail of the figures. But it is certainly true that we welcome
the work that they are doing. Indeed, the Secretary of State launched
their campaign on this. You can tell from that, therefore, that
there has been a close working with and close support from the
Department. We are certainly looking to see the extension of better
and more palliative care in home settings, and obviously that
is the focus of the work that they are doing.
Dr Ladyman: So far as my portfolio
is concerned, children and older people, I readily acknowledge
that there are massive savings to be made by our being more proactive
about, first of all, stopping people getting into hospital in
the first place and also delivering far more care at home—both
healthcare and social care. It will be a major theme in the vision
for adult social care that we need to start shifting resources
to where it can most effectively be used. In many areas that will
be social care, in order to prevent some people ever getting into
the healthcare system in the first place.
Q286 Mr Burns: Many people consider
that the Canadian Government are leading the way in producing
a comprehensive palliative care policy with their new national
strategy. Are you familiar with what the Canadians are doing?
Miss Johnson: No, not in detail.
You are going to tell me. I do not think that you will tell me
that you have been visiting there as well, are you?
Q287 Chairman: I am afraid not!
Miss Johnson: If you felt the
need to visit, I might also find a need to visit!
Dr Ladyman: It is not warm enough!
You will probably need to look at Hawaiian palliative care!
Chairman: We were in Finland when it
was 17º below.
Q288 Mr Burns: Let me help you by
outlining some of the things they are using the legislative process
to provide in Canada. They are giving the right to carers to have
six weeks' paid leave to care for a dying friend or relative.
They are also taking measures to ensure that jobs and income are
protected during that period; that there is access to a virtual
hospice on-line, which includes chat rooms, an on-line nurse practitioner,
on-line consultants—all as part of a package to help people
at what is a very difficult, and also a very stressful and demanding
time. I was wondering—and I presume that this will be off-the-cuff
as you are not that familiar with the details—do you see
these areas of policy that the Canadians are legislating for in
Canada relevant or possible to bring forward here in the UK and,
in particular, and most relevant to carers, the thought of six
weeks' paid leave?
Miss Johnson: I am not going to
comment on six weeks' paid leave—
Q289 Mr Burns: That was the question
though.
Miss Johnson: That was the question.
Q290 Mr Burns: Yes. Would you consider
six weeks' paid leave?
Miss Johnson: We are not considering
six weeks' paid leave at the present time.
Q291 Mr Burns: So I take that as
"no"?
Miss Johnson: I thought what you
were actually inviting me to comment on was the general thrust
of the Canadian—
Q292 Mr Burns: That may be my next
question. My initial question was would you consider six weeks'
paid leave for carers?
Dr Ladyman: Since I have the lead
on carers, perhaps I could answer in a more general sense. Certainly
the Prime Minister has just announced that he is very keen to
see that we do explore work-life balance issues for carers much
more thoroughly. We are about to engage in a series of consultations
with employers as well as with carers' groups. In fact, there
are to be two round tables in the next month or two, which I will
chair, to start teasing out these issues—with a view to
the possibility that at the end of 2006 we may wish—people
willing and returning the correct government at the next general
election—to legislate on extra rights for carers in the
workplace. So the answer is not entirely no; the answer is a maybe.
Q293 Mr Burns: There may be. We will
know more about whether it is a maybe or a yes or a no before
May of next year?
Dr Ladyman: I am sure that would
be the case.
Q294 Mr Burns: I think so too.
Miss Johnson: We look forward
to all political parties doing exactly the same thing!
Q295 Mr Burns: On the general points
of the ideas with which the Canadians are moving forward—the
on-line help with the nurse practitioner, the chat rooms to give
people support and to make them feel that they are not isolated,
that sort of help and encouragement—do you think that in
principle there could be a role for that sort of facility and
service here for carers, or is it something that should be considered,
while you are having your round-table meetings, as part of a package?
Dr Ladyman: It comes back to the
comment I made right at the start. I believe that carers are fundamental
to all the things that we have to drive forward, in social care
and in palliative care. I would not limit our choices to anything.
We have started a consultation on end-of-life choices, and carers
have to be a key part of that. If, during the process of these
round tables, we identified a need to improve services for carers
who are helping somebody at the end of their life, and that they
will require a different pattern of care support than, say, carers
who are looking after somebody who is long-term disabled or who
has a long-term condition, then we have to open our minds to the
possibility of it.
Q296 Mr Burns: Can I ask you one
question not related to Canada? Are you concerned that it would
seem that more and more carers in this country are older and older,
or are very young children looking after a family relative? There
seems to be a huge gap in the middle.
Dr Ladyman: Yes, you are absolutely
right. It comes back to the issue I started off with when I said
that I was going to be controversial, and suddenly you all agreed
with me. Maybe I was not being controversial: just outspoken.
It is part of this mindset that we have got into as a nation,
as a society: that work is everything. Between leaving school
and retiring, work takes priority over everything in our lives.
Quite often where, in earlier generations, earlier times, we would
have said, "Okay, a family member now needs care and that
has to be my priority", we do not do that any more. I am
as guilty as anybody about this. We all leave university; we fly
the nest and go to the other side of the country to follow our
careers. We never stop for a second to think that we are leaving
our parents behind, several hundred miles away; that sooner or
later they may need care and we will not be there to provide it.
We just assume that, somehow, some mechanism will be put in place
to deal with it. That is part of our attitude to work; it is part
of our attitude to society, and it has to change. I do not have
a clear idea how we change it. It is something that I hope the
vision for social care will start to explore. I hope that it is
something that the Committee will suggest ideas about.
Q297 Mr Jones: Minister, you tempt
me into controversial territory.
Dr Ladyman: That is always my
hope!
Q298 Mr Jones: Given what you have
just said, how does that attitude coincide with government programmes
in order to get young mothers into work?
Miss Johnson: Are you not bothered
about young fathers going into work?
Q299 Mr Jones: Single parents into
work or parents into work, when children are left.
Dr Ladyman: I think that there
is a range of things that can be done which can help carers marry
the balance between work and caring.
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