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Mr. Andrew Robathan (Blaby) (Con): On a point of order, Mr. Deputy Speaker. In a written parliamentary answer to my hon. Friend the Member for Meriden (Mrs. Spelman), the Deputy Prime Minister admits a serious error. He states that he has

Could you guide me on this matter, Mr. Deputy Speaker, which involves a great deal of money and the non-payment of council tax on the part of a Minister who has of course presided over a rise in council tax? Do you believe that a written answer is a sufficient apology to the House, or should the Deputy Prime Minister come here in person to apologise?

Mr. Deputy Speaker (Sir Michael Lord): This is the first that I have heard of the matter that the hon. Gentleman raises. It is now on the record and other people will have to make up their own minds about how important it is, and how it must be dealt with.
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Animal Welfare Bill

6.2 pm

Mr. Mark Todd (South Derbyshire) (Lab): I present a petition from residents of South Derbyshire and others.

The petition states:

To lie upon the Table.

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Care of the Dying

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Watson.]

6.3 pm

Angela Browning (Tiverton and Honiton) (Con): I have brought this debate on the care of the dying to the Floor of the House for two reasons. First, I am concerned about some recent constituency casework. The second, more specific issue is the Government's anticipated White Paper on health and social care outside of hospital.

In discussing this very sensitive issue, a lot of emphasis is placed on where people die and on enabling such people and their families to choose where that end takes place. In response to a parliamentary question that I tabled in December, the Office for National Statistics identified the last four years' records on where people die. It is clear that the vast majority die in hospital; indeed, in 2004, some 57 per cent. died in hospital. Approximately 5 per cent. died in hospices, some 18 per cent. died in their own home, and 16 per cent. died in residential or nursing homes. It is clear from the past four years' statistics that under each of those headings there is a degree of flatlining.

We often hear that, naturally, people would choose to die at home—in familiar surroundings, in their own bed, and ideally with their loved ones around them. I think that that is probably what we would all choose if we could focus long enough on our own demise. As I said, this is a sensitive and uncomfortable subject.

I am concerned about the level of support that would be available to people who choose to die at home. There is a dilemma, which I want to flag up in advance of the forthcoming White Paper, about not only where people die but how they die—the circumstances of their death.

I pay tribute to all the people all over the country, professionals as well as those in the voluntary sector, who care for people whose days are ended by cancer. Anyone whose family has been touched by that disease—and most of our families have been—will know about the skills and care needed, particularly in the final weeks.

The vast majority of people, however, die from other causes, and that is what I want to focus on tonight. The British Heart Foundation says that about 26 per cent. of people die of cancer-related illness, 19 per cent. of coronary heart disease, 14 per cent. of respiratory disease and 11 per cent. of cerebrovascular disease. There are also many people who die simply because they are very elderly and frail, and their bodies, for one reason and another, are shutting down. I shall talk about those people in a minute.

I want to put on record the views of the Parkinson's Disease Society, which says that

I can confirm that, because my late mother had Parkinson's disease in the last seven or eight years of her life. The society goes on to say that death for Parkinson's sufferers

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That would almost certainly apply to a wide range of people who succumb in later life to other degenerative conditions, too. Many such people simply fail, and the body closes down.

The figures provided by Lynn J et al. reveal that in an average year the average general practitioner in England and Wales can expect to deal with five to seven patients who die from organ failure, five patients who die of cancer, between one and two sudden deaths, and six to seven people who die purely of frailty or dementia.

The vast majority of people do not, therefore, "tick the box"—for want of a better expression—for what is often euphemistically called palliative care, but is not always clearly defined until a decision has to be made, in someone's final days and weeks, about whether they qualify for what many of us would understand to be palliative care.

Dying is not a precise science, and I have every sympathy for the professionals, especially doctors, because it is not always easy to predict how long a death will take once it becomes evident that somebody is dying. With some conditions, such as cancer and other diseases, we have, from data and experience, life expectancy tables. When people reach the end for other reasons, however, it can be quite evident that the person is dying, but, depending on the circumstances of the individual, it can take a matter of days, or a week or two, or even four to six weeks. It is difficult for clinicians to give that sort of information, but once a patient or a patient's relatives have been told that the patient is dying, it is extremely important that they have the support that we would expect, regardless of the diagnosis or the condition.

I urge the Government to address that challenge when they bring forward their proposals. There is a need in many cases, as we know from such diseases as cancer, for pain control. There is also a need to consider the patient's mental stability. I do not think we always appreciate the sheer stress that patients undergo when aware, if not that they are dying, at least that significant changes are taking place in their state of health and their body, and that in itself can create great anxiety in the final days and weeks.

There is a need for support for the immediate relatives and carers—if, indeed, they are there. We must not always assume that there are immediate relatives and carers. Many very elderly people—and people, we know, are living much longer—actually have nobody there when they reach that point in their life. How important it is that the statutory services providing care take on an additional responsibility for the well-being of those patients.

There are also the physical needs of the dying. That may sound rather self-apparent, but those needs are intensive. Patients need intensive care and attention. The House has been involved in the administration of food and water, which is a very important issue. I do not intend to reopen it as my views are on the record, but we should seek nothing less than the very best standard of continuing to provide fluid and nutrition, and that will often mean moving from mashed food to sieved food to pureed food to liquid food. I am not necessarily talking about artificial administration of food and liquid, but that administration is time-consuming, requiring proper
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assessment of the patient. Where it is done well, as I have seen it done, it is commendable. What is worrying is that that does not happen often enough. It is what is needed.

As far as comfort is concerned, someone confined to bed needs to be turned regularly to avoid pressure sores, and that requires two people to turn the patient. Pressure sores are a serious matter: I always think the name belies what they are. I have seen pressure sores in elderly people at the base of the spine when I could actually see the spinal bone through the large, egg-shaped hole; that is a pressure sore. The seriousness of those sores and the need for careful hygienic handling, daily packing of the wound and careful and sensitive treatment require a lot of intensive nursing care. There are obviously also issues of hygiene and incontinence. People who are dying actually need 24-hour care, wherever they are dying.

I have carefully studied the Government's end-of-life programme and read of the adoption of the gold standard framework, which I totally support and which I know has begun to be rolled out to all dying patients, with money to help that happen. I commend the Government for that, but I hope that when the Minister brings forward his White Paper we shall see that being adopted as a universal standard throughout the country. In many debates to do with health care we talk about lotteries. In fact, no lottery is more serious than that for the patient who is dying.

I also want to mention what happens in hospitals, as I was very surprised at the end of last year to receive reports about the fate of several elderly patients. Their relatives were told that those elderly people were dying but, at the same time, that they had be moved out of hospital and into nursing homes. That represents a new type of bed blocking, and I was shocked by the case of a constituent whose mother had cancer. He and the hospital staff had quite a robust discussion about the relative costs of hospital and nursing home beds.

We all know that there is a shortage of nursing home beds. When a person is told that his mother is dying—and when that person cannot nurse her at home—it is wrong to expect him to chase a suitable place in a nursing home. My constituent told me in a letter that he and his sisters were given a three-week ultimatum, and reached the point where they were praying for their mother to die before they had to move her out of hospital.

The lady in question did die in hospital, and there was no complaint at all about the care that she received there, but it is wrong and callous to expect relatives to begin searching for a nursing home at such a sensitive time. Moreover, I must tell the Minister that I have had to deal with more than one such case.

I turn now to the definition of palliative care. That term is used in respect of a minority of patients, and I hope that the matter will be addressed in the forthcoming White Paper. In a written question on 15 December, I asked about the guidance that is given to primary care services in respect of people dying at home. However, the response that I got had to do only with the improved care being given to people with cancer.

The White Paper is likely to say that the Government want to work with the private and charitable sectors in this matter. That is natural, but I draw to the Minister's
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attention what various organisations have had to say on this topic. The Marie Curie Fellowship Association told me in a letter that it had urged the Government

The British Heart Foundation said that it would

Finally, the NHS Confederation produced in November a very good report on improving end-of-life care. It recommended:

That is what I am seeking from the Minister tonight.

6.19 pm

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