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Care of the Dying

The hon. Lady is absolutely right. The Minister for Local Government, my hon. Friend the Member for Oldham, East and Saddleworth (Mr. Woolas), is soon to present a report from the social exclusion unit about excluded older people. It makes the point that the descent of a number of older people into social exclusion is triggered by the death of a close relative, not just because of the depression that is induced but because of isolation. What are we going to do about that? The mandatory NHS national service frameworks are extremely important. The older people’s NSF sets out very clear standards and service models throughout health and social care; it is vital that those services work together in providing care for those who are dying. The long-term conditions NSF sets out in some detail the quality requirements for NHS treatment of those with neurological conditions. The reason those frameworks are so good is that they have benefited from the input of a number of organisations involved in providing palliative care: not only Sue Ryder Care, Macmillan Cancer Relief and Marie Curie Cancer Care but the National Council for Palliative Care, to name but a few. The end-of-life care programme is extremely important if we are to realise those ambitions. It is led by the national clinical directors for cancer and for older people and neurological conditions. It is backed by about £12 million of investment, and it is being taken forward by strategic health authorities and primary care trusts. It has a simple objective: to skill up staff for whom end of life is only part of their work load. It provides a number of tools: the gold standards framework, the preferred place of care and the Liverpool care pathway. The hon. Lady will be interested to know that about 23 per cent. of all GP practices have implemented one or more of those tools; 43 per cent. of hospital trusts have now implemented the Liverpool care pathway in one or more wards; and about 36 per cent. of hospices have implemented one of the tools. We need to make slightly faster progress in care in nursing homes, and there is a programme of work under way to help to achieve that. There is also more that we can do to strengthen bereavement support. The Government have published advice to support the development of improved local bereavement services. It is called ““When a patient dies”” and covers the support needed before death both by those who are dying and by their families and carers. As the hon. Lady says, there is often a need for a lot of emotional support for the person who is dying, as well as for their family, in order to make the appropriate preparations. Together with that, the Department has helped to establish the National Association of Bereavement Services for NHS professionals involved in providing bereavement support services. The Department is working very closely with the association to deliver a series of regional workshops for NHS staff based on the guidance. We shall also make further proposals to support carers in our White Paper on social care and health. As the hon. Lady knows, we have made substantial investment in providing more support for carers over the past few years. Recently, we confirmed that about £185 million would be made available, usually through local authorities, to support the work of carers. From visiting hospices and from people who work with the NHS, I know that respite care in local organisations is often what makes one of the most difficult points in people’s lives a little more bearable. As the hon. Lady knows, we made a manifesto commitment in May to double funding on palliative care, which will be extremely important in helping more people die at home. She is right to say that as part of our policy work we need to create a clear and widely encompassing definition of palliative care services. That will be important in helping to ensure that the implementation of our manifesto commitment is absolutely right. The hon. Lady teased out an important point: the commitment is applicable to all people at the end of their lives, whatever their age or condition. As she said, the commitment must be diagnosis-neutral, and implementing it regardless of age or condition is extremely important. I think all Members will agree that it reaffirms the Government’s dedication to improving the care available at the end of life. We shall have much more to say about the implementation of the manifesto commitment in the White Paper that the Secretary of State will produce. I thank not only the people who were involved in the consultation, but also some of the carers organisations, such as Carers UK, as well as organisations such as Marie Curie and the British Heart Foundation, which were involved in some of the policy taskforces. The hon. Lady probably knows that Marie Curie’s work with us, and that of other organisations, has been extremely important in helping us to understand how some of their learning, such as that generated by Marie Curie’s pilots in Lincolnshire, can be more widely disseminated in the rest of the country. When we add their experience to innovations such as the gold standards framework and the Liverpool care pathway, we shall achieve a good understanding of how services should be developed. The key now is action: how to ensure that those services are available to everybody, not just those who are lucky enough to live in the right areas. That will very much be the objective of the White Paper. In conclusion, I reiterate my thanks to the hon. Lady for giving us the chance to discuss this issue. Enabling people at the end of life to live and die in the place of their choice—in other words, the chance to experience a good death—should be the great aim not only for the NHS but for all who work in social care. The issue will be clearly set out in the forthcoming White Paper, as part of the Government’s agenda. We are committed to ensuring equality of access to high-quality palliative and end-of-life care, regardless of age or condition. Question put and agreed to.