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Palliative Care for the Terminally Ill

I beg to move,"That leave be given to bring in a Bill to require the provision of palliative care for persons suffering from a terminal illness; and for connected purposes." Palliative care is about enhancing quality of life and enabling patients to live as actively as possible until they die, naturally and peacefully and, whenever possible, with their families around them. I am proud of the fact that the UK leads the world in palliative care, but the reality is that we are not doing enough because the service remains underfunded. The all-party parliamentary group on dying well was launched on 10 January to ensure that we all have the opportunity of a good death and that we die with dignity, by pressing for better and more widely available palliative care, by promoting greater support for friends and family members who care for the dying, by opposing euthanasia and assisted suicide, and by encouraging debate and promoting understanding of how people can achieve comfortable and natural deaths. There is strong objection to the recent attempt by the Voluntary Euthanasia Society to rename itself Dignity in Dying—a name synonymous with the hospice movement and with palliative care. The chief executives of Marie Curie Cancer Care, Help the Hospices, and the National Council for Palliative Care said yesterday:"““We deplore the misleading use of the phrase Dignity in Dying as the new proposed name and trademark for VES, an organisation whose clear intent is the promotion of euthanasia. We urge Alan Johnson, the Secretary of State for Trade and Industry, and the Charity Commission to ensure that this is prevented.””" They added:"““We believe the development of excellent palliative care at the end of life in the last decade has ensured that hundreds of thousands of people have experienced a dignified death.””" The quality of palliative care in Britain has made huge strides during the last 10 to 20 years, but its quantity and distribution have not kept pace. As a result, there is something of a postcode lottery for the terminally ill. Inadequate funding is allocated to palliative care in the NHS and there are not enough trained specialists in practice. Two recent parliamentary reports drew attention to these shortfalls and the Government have indicated that they are investing more money in palliative care. For example, in 2003–04, the NHS cancer plan promised an extra £50 million per annum specifically for specialist palliative care. That addition is welcome, but it is thinly spread across the country. Progress is slow and not all the resources are reaching front-line specialists. In a recent Adjournment debate initiated by the hon. Member for Tiverton and Honiton (Angela Browning) on care of the dying, the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Byrne), reaffirmed the Government’s commitment to"““ensuring equality of access to high-quality palliative and end-of-life care, regardless of age or condition””.—[Official Report, 12 January 2006; Vol. 441, c. 544.]" I welcome that commitment, but much more needs to be done. According to a survey commissioned by Marie Curie Cancer Care, 90 per cent. of people believe that the Government have responsibility for maintaining and improving the standards of care for terminally ill people. My Bill seeks to oblige the Government to meet that responsibility. In the same Adjournment debate, the Minister highlighted the fact that palliative care was ““heavily weighted”” towards cancer patients. The National Council for Palliative Care estimates that, while 95 per cent. of patients using hospice or palliative care have cancer, 300,000 people with other terminal diseases are excluded. It is a fact that cancer patients have access to the most and the best palliative care. Yet even for those with cancer, the provision is far from satisfactory. According to Marie Curie Cancer Care, more than 155,000 people die of cancer every year, yet Help the Hospices points out that there are only 3,250 hospice beds available, and that 2,489 of them are supplied by the voluntary sector. Half of all patients diagnosed with motor neurone disease die within 14 months of diagnosis, yet a survey carried out in 2005 found that only 39 per cent. of such patients were referred to specialist palliative care services. Is it any wonder that people take fright when diagnosed with MND? My Bill will seek to broaden the scope of palliative care so that it encompasses all those with a terminal illness. This is an ambitious aim, but it can be achieved with sustained Government investment and support. Only last December, the NHS Confederation report highlighted the pressing need to improve end-of-life care for the terminally ill. The report pointed out that 56 per cent. of terminally ill patients would prefer to die at home, but that only 20 per cent. do so. Another statistic showed that only 11 per cent. of people want to die in hospital, yet 56 per cent. spend their final hours there. Inconsistent community provision and ineffective co-ordination between service providers affect people’s ability to die where they choose. Unless we get to grips with the problem, the situation will get worse. According to the NHS Confederation, care of the dying is the cause of repeated complaints to the health service ombudsman. As far as the NHS Confederation is concerned, all that points to an increased need for integration of ““health and social agendas””. Just as pregnant mothers have birth plans, there should be advanced end-of-life care plans, to be based on a full assessment of each patient’s needs, including the need for good-quality palliative care. Good examples of such plans are already in place, including the gold standards framework, the NHS end-of-life care programme and the Liverpool care pathway. I hope that the Government will use their forthcoming White Paper on health and social care outside the hospital to show how they will meet the five key recommendations in the NHS Confederation report. Palliative care does not require expensive treatments or technology, because its essence lies in specialist knowledge of how to use pain-relieving drugs and how to give holistic care to ease the dying process. A relatively small refocusing of NHS resources could bring disproportionate benefit compared with other branches of medicine. Only a minority of us will need cardiac surgery or neurosurgery, but one in two of us will be in need of good palliative care when we die. Marie Curie Cancer Care points out in its ““Dying at Home”” report that every pound invested in home palliative care services will free up £2 in the national health service. By extending palliative care to all terminally ill patients, the Government would save the NHS money. That is an attractive proposition, yet, despite increased funding commitments, the number of cancer patients dying at home has remained the same, and 80 per cent. of the resources allocated to specialist palliative care are allocated to hospital-based care. A Help the Aged report found that older people were"““less likely than younger people to receive support at home, in hospital or in a hospice, or to receive attention from GPs or district nurses during the last year of their lives. Older people are often described as the ‘disadvantaged dying’.””" Children are at a disadvantage, too. There is an acute shortage of paediatric palliative care medicine consultants. That is not surprising, when one considers that children’s hospices receive only about 5 per cent. of their funding from official sources, while adult hospices receive 30 per cent. from the same sources. Comprehensive palliative care legislation should be our priority. Legalising euthanasia or physician-assisted suicide would undermine the values and ethos of palliative care, a field in which Britain has led the world. For that reason, my Bill will specifically prohibit the wilful killing of patients. It will ensure that everyone has the right to a good death, regardless of age, diagnosis, ethnicity, background or postcode. I commend this patient-centred Bill to the House. Question put and agreed to. Bill ordered to be brought in by Jim Dobbin, Mr. Frank Field, Dr. Brian Iddon, Mr. David Crausby, Mr. Lindsay Hoyle, Mr. Iain Duncan Smith, Mrs. Claire Curtis-Thomas, Paul Rowen, Mr. David Amess, Mr. Julian Brazier, John Robertson and Mr. Joe Benton.