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Care of the Dying

I congratulate the hon. Member for Tiverton and Honiton (Angela Browning) on securing this Adjournment debate. I served with her on the Standing Committee considering the Mental Capacity Bill, and I well remember her contributions to our debates. What she said meant a lot to me, as I had to care for my own mother when she was dying from cancer. She was lucky enough to die at home, surrounded by her family. The goal at the heart of this debate is securing the best possible care for the dying, and that is of interest to many hon. Members. We need to bring the level of care for everybody up to the standards of the best, because—and it is important to recognise it—in some parts of the country care for the dying is excellent. That is in no small part due to the work of NHS staff and their counterparts in the voluntary sector. I wish to sketch out some of the progress that we have made in the past few years. I am grateful that the hon. Lady sought to widen the debate beyond those who are terminally ill with cancer to all people at the end of their lives. That said, I want to start with the NHS cancer plan, which was published in 2000. It made important commitments to improve the care of those with terminal cancer. It highlighted the need to ensure that people with cancer get the right professional support, as well as treatments. It included a commitment to develop a supportive and palliative care strategy and to invest an additional £50 million in specialist palliative care for adults. This investment was made to help tackle inequalities in access to services that had been such a problem previously. The plan led to important progress elsewhere. A good example is the £6 million that was invested over three years in training district nurses in the principles and practice of palliative care. That extremely successful programme has enabled nurses to gain more confidence in assessing what patients and families need if they wish to die at home. More than 10,000 nurses and other health care professionals have now participated in that programme. The third area of progress I wish to draw to the attention of the House is the National Institute for Health and Clinical Excellence guidance on supportive and palliative care services—an important document that sets out services that help patients and carers. I was glad to hear the hon. Lady highlight the needs of carers, because they are often overlooked, even in debates in this House. Although oriented towards cancer, many of the principles of the guidance apply equally to conditions other than cancer. The fourth area of progress is the NHS programme ““Building on the Best””, which was published in 2003. It set out a plan of action to enable people, regardless of their disease, to make choices about how they die, and to have access to high quality end-of-life care. Fifthly, we are about to introduce a White Paper on health and social care. We consulted the public and a number of stakeholders. I wish to record my thanks to organisations such as Marie Curie Cancer Care and the British Heart Foundation for the work that they did to help us get the White Paper right. The ambitions of the public were clear and confirmed our direction of travel, which is to strengthen services to increase help to people who choose to die at home. My right hon. Friend the Secretary of State will present that White Paper to the House in the not too distant future. I wish to add my analysis to that of the hon. Lady, before I highlight the progress that we can make. As she said, the majority of people state that they would prefer to die at home, given the right circumstances and support—an important caveat. However, only about 20 per cent. manage to achieve that, with 4 per cent. dying in hospices, 20 per cent. dying in care homes, and some 56 per cent. still dying in hospital. That must change. Palliative care provision is heavily weighted towards cancer patients. Some 95 per cent. of all referrals to specialist palliative care services are for people with cancer, but cancer accounts for ““only”” 25 per cent. of deaths each year. Addressing that inequality in care is an important challenge.