Palliative Care — House of Commons, 2015-11-04
Topic: Health
Benedict Gummer (Conservative, Centre-right): I agree completely with the hon. Lady. I was just about to turn to the very useful intervention that she made earlier, in which she said that palliative care is a mark of the integration of the health and social care sectors. It is no coincidence that one often sees good palliative care where there is good integration of health and social care. In a sense, the state of palliative care is a proxy for where care is well integrated and where it is not. That is why it should be seen as part of the larger challenge of achieving successful integration, on which there is a good deal of cross-party agreement My hon. Friend the Member for Lewes mentioned the fact that many people do not die where they would choose. She will be aware of the Choices survey, which was launched by my predecessor in the coalition Government, the right hon. Member for North Norfolk (Norman Lamb). It has reported, and the Government have committed to replying to it. She can take that as an indication that there is policy to come, and that we will study carefully the things we have set up. We intend to ensure that people have greater access to the services they require to ensure that they can die where they wish. We made that commitment in our manifesto—we were very clear about it—and we intend to deliver on it, as we intend to deliver on the rest of our manifesto My hon. Friend was entirely right to point out that that will require changes in services where they are not good. That will require commitments on palliative care nurses and the spreading of training. They have been achieved in Airedale, but have not been achieved in other clinical commissioning groups, where care is sometimes significantly lacking. There is much to do in some areas of the country. If I may use Bevan’s words, it is about universalising the best. We know what the best looks like. We now need to ensure that we spread it across the rest of the country My hon. Friend was right that palliative care has, unfortunately, in some cases been associated with cancer care. That is not how it should be seen. She will be aware in great detail of the European Partnership for Action Against Cancer system, which is being used to ensure that cancer patients can indicate their wishes for the end of life. It can also help clinicians to manage that end-of-life period. The EPAAC system was originated and developed specifically for cancer patients, but we intend to roll it out for patients no matter what the cause of their death My hon. Friend mentioned the need to provide services 24 hours a day, seven days a week. Without wanting to state the obvious, that is one reason why we want to get a seven-day NHS working. When people need the NHS—whether they need medical attention that will save their life or pain relief that will mean that the end of their life is bearable—it cannot be right if treatment is deferred to a Monday because we do not have services available on Saturday and Sunday. That is the crux of what the Government are trying to achieve across our NHS reforms: we want to achieve a truly seven-day NHS Briefly, on the Bill introduced by Baroness Finlay in another place, I cannot disagree with the general sentiments of the proposal. The degree of variability that we have is obviously wrong and we must put it right. It should be right, in a sense, to say, "Let us legislate in order to make it so." I have reservations about the Bill—I have made them clear to Baroness Finlay—but I should like to outline them to explain why I believe it may not achieve what it wants to achieve, and why, on a wider point, it might be counterproductive If enacted, the Bill would be the first instance in the history of the NHS that means we would make specific clinical demands on clinical commissioning groups about a specific clinical area. To take an analogy, we have not had a cancer services Bill that demands things of CCGs on cancer services. The Bill would therefore set a precedent, which requires very careful consideration. My current judgment, and that of the Secretary of State, is that we do not want to determine that demand from the centre in the manner in which Baroness Finlay wishes There are other instruments for achieving what Baroness Finlay wishes to do, such as the mandates to CCGs and to Health Education England. There are ways to achieve by similar means the same ends that she wishes to achieve, which is putting certain obligations on CCGs to ensure that they commission care in a way that we expect. We need to be careful about how we do it. Airedale is so good because it has come to that point by itself and developed its approach organically. Other CCGs around the country have come to equally good solutions in a different way I would not want to impose a solution from the centre that squashes the local innovation of good leaders. I think we can all agree that the NHS in the past has not been good at allowing staff locally to celebrate leadership and innovation. There are lots of brilliant people in the NHS who have great ideas, but they do not feel empowered to bring them forward. We need to be careful, therefore, about imposing solutions from the centre, either from the Department, NHS England or this place, that do not recognise the ability of local people to come up with local solutions. I have told Baroness Finlay that I want to develop policies that do what she wants to do but not by the means she proposes. I hope to empower local people to get to where she wishes to go, and I hope to do so in a manner that celebrates success and exposes failure, so that we can put it right, and universalises the best as quickly as possible, without taking a top-down approach, which might have the contrary effect We are in a better position than other countries because of the remarkable work of charities and voluntary bodies over the last few years, and we have now accumulated a mountain of evidence from charitable groups and Government. My hon. Friend pointed to the 2011 NICE guidelines, but there were also the five priorities outlined last year in "Priorities of Care for the Dying Person", and we now have the NHS Choices review, to which the Government will respond. We have enough paper evidence. We know what looks good, how to make it happen and that it needs to happen, and we know that many people die in circumstances that leave much to be desired. I point in particular to those who die in hospital. It is clear from the VOICES survey, which tracks the experience of families and individuals at the end of life, that people’s experience of dying at home and in community settings, especially in hospices, is generally much higher than in hospitals. Broadly—I generalise—half of people in hospital do not have an optimum experience of death We can change some things quite quickly, but we have got to this point because of the sustained effort over many years and the accumulation of evidence in a clinical area where Britain leads the world. I pay tribute to my hon. Friend and other colleagues with expertise in this area, to the many academics who have worked hard on this, and to the hard work of NHS England and its director of palliative care, Professor Bee Wee, who is a remarkable clinician. Over the next few years, as we fulfil our manifesto pledge, I hope that all parties can work together on this, calling on the experience of people from every part of the country—it was great to hear from the hon. Members for Torfaen (Nick Thomas-Symonds) and for Strangford (Jim Shannon), who shared their experience from other parts of the UK. If we can bring all this together, I think we can do something rather remarkable for people with no medical hope at the end of their life but to whom we should give the absolute guarantee that their care will be exceptional and will make what is never going to be a happy moment at least bearable and full of meaning for them, their families and their loved ones Question put and agreed to.