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Westminster interest in end of life care continues following estimates day debate

Author: Tom Moran
03 March 2016

18 MPs made speeches on end of life care in an estimates day debate on Wednesday, continuing the recent interest in the sector among politicians.

Introduced by Dr Sarah Woolaston, the Conservative MP for Totnes and chair of the health select committee, the debate featured calls on the government to explain how it will respond to last year’s report, 'A Review of Choice in End of Life Care' (known as the Choice review).

Wednesday’s debate adds to the increased interest in end of life care being shown in Westminster since the defeat of Rob Marris’ Assisted Dying Bill last September. In October, peers took part in a long House of Lords debate on Baroness Finlay’s Access to Palliative Care Bill, which moved on to committee stage last month.

The debate comes less than a week after a coalition of seven leading end of life care charities warned that end of life care in England is "on the brink" following a high number of failings in caring for dying people in the year since the Choice review. The charities called on the government to fully implement the recommendations in that review, and outlined a strategy to achieve it.

That call was echoed by many of the MPs who spoke in yesterday’s debate. Woolaston began the debate by noting that the UK had ranked top in the Economist Intelligence Unit’s Quality of Death Index, but explained that instances of poor care were plain to see across the country.

Woolaston focused her speech on four key areas, explaining problems with the variation of end of life care, with communication, with patient choice, and with funding, before calling on the parliamentary under-secretary of state for health Ben Gummer to address these areas.

"[I am] asking the minister to be truly ambitious. I think that we can achieve seven-day, 24-hour access to specialist palliative care in all settings, and that we can address variation and give people choice and control at the end of their lives," she concluded.

"It would be an extraordinary achievement for the government to go further. We should not rest on our laurels because we are leading the world; we should say that we lead the world not just for some people, but for everyone."

Many MPs paid tribute to the hospice movement as a whole and to their local hospices, emphasising their importance within communities, while citing the stark difficulties in funding that they face.

Liz McInnes, Labour MP for Heywood and Middleton, explained: "NHS and local authority funding for hospice care varies considerably between localities, and a variety of commissioning and contracting practices exists. More than two thirds of hospices had their funding from local CCGs frozen or cut in 2014-15, and more than eight in 10 hospices do not think they are funded fairly and sustainably by the NHS and local authorities."

She argued that greater investment in hospice care would reduce the number of people who die in hospital, relieving pressure on the NHS and improving experiences for patients and families. McInnes was backed by Conservative MP for Lewes, Maria Caulfield, who is a former nurse.

"We must invest £400 million annually in NHS community services to move end of life care out of hospitals – where most people do not want to die – and into the community, and we need roughly £100 million each year for local social services to provide the social care to back that up," Caulfield said. "That would deliver a saving of £370 million for the NHS and the acute services that are now picking those people up, but from my experience I think the savings will actually be much higher."

Speaking at the end of what he called a "fantastic debate", Gummer pledged to take all the points made by MPs into consideration but did not elaborate on the government’s plans to react to the recommendations in the Choice review.

"As I have made clear publicly, we will respond in short order to the Choice review, but I want to get this right. It is important that we make the content of the response as good as possible, and I do not want to compromise on that," he said.

The lack of firm commitments has frustrated the coalition of end of life care charities. "The minister agreed that the current level of variation, which really means that many people are getting inconsistent and poor quality care, is shaming. It is therefore deeply frustrating and worrying that, over a year after the Choice review published its recommendations, the government is unable even to say when it will respond," Claire Henry, chief executive of the National Council for Palliative Care, said on behalf of the coalition.

"NHS England and the Government need urgently to agree a comprehensive plan of action, and get on with implementing it. Every day they delay means more people will be dying without the care and support they need."

She claimed that the government could be "left in no doubt" over the strength of feeling that members of all parties shared over the issue.

Jonathan Ellis, director of policy and advocacy, at national hospice care charity Hospice UK, added: "This debate shone a spotlight on several critical issues that urgently need to be tackled to improve end of life care in this country. In particular, the dismal variation in the care that people receive and the lack of training for medical staff caring for people at the end of life, which both contribute to poor quality care.

"There was widespread recognition by many MPs of the enormous value of the hospice sector in providing high quality end of life care, especially through their day and home-based services, their support for family carers and sharing their expertise with the NHS. Hospice care has a great deal to offer in helping to improve end of life care across all settings.

"Following the concerns raised in the debate and the strong cross-party support for changes to improve end of life care, it is clear that the status quo cannot continue. We need a step-change on end of life care provision and the Government must act, without further delay, to implement the recommendations of the Choice review."

The full text of the debate is available on the UK Parliament website.

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