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18 July 2007 : Column 132WH—continued
“A society which shuns the dying must have an incomplete philosophy.”
I am sure that all hon. Members would agree with that.
We greatly appreciate the work done by the voluntary sector, which provides some three quarters of the available specialist palliative care services. We are indebted to all hospices and charities for the work that they do in supporting not only people with life-threatening illnesses but their families, carers and friends. As centres of excellence, hospices have for several decades shared their knowledge and expertise with local NHS staff. For example, during the £6 million programme to improve the training of district nurses in the principles and practice of palliative care, many of the participants received their training through programmes run by local hospices, and clinical placements based in them.
The Bradford and Airedale palliative care co-ordination service is a good local example of the partnership between hospices and the NHS. The service takes the lead in planning and developing integrated palliative care services, which include continuing education for health and social care professionals in the important area of end-of-life care. Manorlands hospice is one of several local providers that deliver continuing education. As part of a local network of educators, it shares its expertise with other professionals, formally and very often informally. That important work is not often discussed, so it is important that I should mention it today.
My hon. Friend spoke of high-quality care at the Marie Curie hospice in Bradford and at Manorlands. Sadly, she had personal experience of receiving that care. Some patients receive excellent care at the end of life, but, unfortunately, many do not. In a recent Healthcare Commission report on complaints about the NHS, 54 per cent. of hospital complaints were about care surrounding death.
Health and social care professionals often do not discuss death and dying with patients. I am pleased to have responsibility for maternity services in my new role. The first few minutes of life are very important, but I would say that the last few minutes are equally important. If the last part of life is planned for with properly trained staff and professionals and the wider community, it can often become a different experience.
Patient preferences for care are often not elicited. Their care needs are not always adequately assessed and care is not always planned or reviewed. Recent surveys of the general public have shown that most people’s first preference is to die at home. Patients need to be offered that choice. My colleague the Under-Secretary of State for Health, Professor Ari Darzi, is reviewing the pathways right the way through from birth to end of life. The end-of-life strategy aims to offer patients a choice. It will deliver increased choice to all adult patients, regardless of their condition, about where they live and die, and provide them with support to make their choice possible. For the first time, a strategy for end-of-life care services has been developed. It will be key to helping commissioners and providers bring about improvements in end-of-life care services at a local level.
I am so pleased to learn that Sue Ryder Care at Manorlands is represented on the working group that is currently developing a strategy. It is anticipated that the advisory board and working groups will report to Ministers with their recommendations by the end of 2007. I welcome my hon. Friend’s contribution to that strategy, and she must feel that it is open for her to do so.
To support the implementation of the strategy, an operating framework highlights the importance of PCTs undertaking baseline reviews of their end-of-life care service. Guidance to PCTs on the reviews highlights the importance of engaging with all stakeholders, including local service providers, patients and carers. Leadership is absolutely essential from the people who know best—from the hospice movement and those involved in the wider social package. They must encourage PCTs and chief executives fully to engage their community and to consult on this vital issue. I am sure that Members of Parliament can also play an important role.
On the NHS cancer plan that my hon. Friend mentioned, £50 million per annum for specialist palliative care for adults, including hospices, has been delivered. More than half the new money went to the voluntary sector, mostly to hospices. That has funded 44 new palliative medicine consultants, 172 new clinical nurse specialists, and 46 new specialist palliative care beds. The plan has increased NHS funding for specialist palliative care by about 40 per cent. In 2004, funding for adult hospices averaged 38 per cent., which means that expenditure was up from 28 per cent. in 2000. Progress has been made, but there is much more to do. The NHS cancer plan has contributed to a 15 per cent. increase in all funding for specialist palliative care compared with 2000 levels.
Manorlands has provided high-quality specialist palliative care to people in Airedale, Bradford and Craven for more than 30 years, and it now cares for more than 600 people a year. My hon. Friend raised the issue of funding and I understand that funding for hospices is a major concern for voluntary organisations. The average funding figure for adult hospices is 38 per cent., and I am pleased to say that the figure for Manorlands is 41 per cent., which is of course above the average. It is essential that the primary care trust works with the hospice to negotiate the funding, and I would be very pleased to give any assistance that I can to my hon. Friend in achieving that.
Good commissioning must acknowledge what the voluntary sector has to offer. Likewise, the voluntary sector must engage with commissioners to make them aware of what they have to offer. As I mentioned at the start of my contribution, the educational role that they play could be put much more into the forefront of their minds. The emphasis should therefore be on effective negotiation between contracting partners when contracts and service-level agreements come up for renewal.
How do we put a cost on end-of-life care? The end-of-life care strategy is examining the true cost of providing end-of-life care. That figure will estimate the cost of the services provided across the board by both the NHS and the voluntary sector in the last three to six months of a patient’s life. As I am sure hon. Members realise, that is not easy to do, but, with proper negotiation on an end-of-life strategy that looks at the last three to six months, I believe that it is possible. That figure will provide a base from which to consider future funding needs for end-of-life care services in the NHS and in the voluntary sector.
The local primary care trusts fully acknowledge and recognise the vital contributions made by hospices. Bradford and Airedale’s funding for this year has not been finalised, but I am assured that it will be consistent
with last year, plus an inflation uplift. North Yorkshire and York primary care trust is reviewing the way in which it allocates funding.
When we consider the issue of hospice care we must look at the whole multidisciplinary team. My hon. Friend stated that she used almost a hospice at home for John. The multidisciplinary team offers a range of services. Some patients are able to go home for weekends; others stay for one or two weeks to enable their families to have a rest or a holiday. Convalescence is offered to people who have undergone radiotherapy and chemotherapy treatment. The community team takes its specialist palliative skills to patients at home, provides support to carers, and enables the patient to live as full and active a life as possible. When I last practised in the late 1980s and early 1990s, my experience as a community nurse showed that changes in technology allow pain control to be managed at home, and that that makes a huge difference to quality of life. Effective and good pain management enables someone at the end of life to communicate with their family, and to continue to work, in many cases, almost up to the end. The skilled multidisciplinary team is fully aware of how to carry out very specialised pain management.
A local GP from my hon. Friend’s area has said:
“Local GPs in Airedale value the support given to our patients by Manorlands. Their staff are fully integrated into primary health care teams' working and together they enable us to offer a high standard of care to patients”.
GP services are vital if a patient is to have the right to come home. Many patients do not have that right because GP services in their local area do not meet the demands that that would create. Caring for someone dying at home is highly demanding work. Again, I pay tribute to the absolute professionalism of staff—from the voluntary sector through to the highest consultant
—some of whom also feel that palliative care should be delivered at home and are willing to go to patients’ houses.
We are conducting a consultation to establish the future needs of the local community. I am aware that the hospice is currently conducting that consultation and is considering what services and facilities will best meet those needs. It is commendable that the community will have an opportunity to have a say in how the service can change and meet future demands. Hearing the views of people, involving partners and focusing on outcomes is essential to our reform agenda. That means good commissioning, and good commissioning must acknowledge what the voluntary sector has to offer. Equally, it is essential that in every community and every part of the country, the voluntary sector engages with commissioners to make them aware of what they have to offer. Yes, devolved decisions to primary care trusts is the way forward, but that does not mean that we cannot have leadership from my Department to encourage PCTs and chief executives to engage in good commissioning.
I shall end my contribution with another reference to Cicely Saunders. She had courage, and her courage was that of the visionary. She saw beyond the limited vista of the medical establishment to pioneer a movement that has revolutionised the way that terminally ill people are cared for. Hospital acute wards are not the place for people to have the last few weeks, days or hours of their life. A proper area where palliative care is delivered with dignity, and with respect not only to the person concerned but the family, is essential for the future. I am encouraged by other hon. Members being here today with my hon. Friend, and I know that we will work together on an end-of-life strategy. I look forward to those discussions with her.
Adjourned accordingly at twenty-eight minutes past Five o’clock.
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