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St Luke's Hospice, Basildon

Volume 79: debated on Friday 24 May 1985

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12.30 pm

There can be few hon. Members who have not at some time during their lives known someone who has died from cancer. It might have been a friend, a relative or a loved one. We know that cancer shows no respect for age or circumstances. It affects the young and old alike, the poor and the wealthy. When it strikes, the consequences can be devastating, not just for the person afflicted, but for those trying to give support.

The word "cancer" has such connotations that some people are even reluctant to use it. The very thought of it or the eventual diagnosis can strike terror in the hearts of the bravest people when they feel ill. I understand such reactions, for, while many people say that they do not fear death, I do not number among them.

Fortunately, as medical science advances, the treatment of cancer patients improves all the time. More lives are saved, but the treatment of cancer still occupies much of the time and resources of a substantial section of the medical profession. Despite the billions of pounds poured into research by Governments, the World Health Organisation and drug companies, cancer is still the second most common cause of premature death in developed countries.

I do not intend to go into the difficulties of clinical research, interpretation of clinical trial results, alternative medicine claims or the priorities governing treatment and new methods of prevention. These deserve an entire debate. I hope that my hon. Friend the Under-Secretary of State will say something about the Government's position in trying to find a cure for this disease, about the further plans that the Government might have and about the breakthroughs, if any, that have been achieved.

I wish to confine most of my remarks to the case of terminally ill patients, and especially to a project started in my constituency of Basildon—St. Luke's hospice. The three alternatives for the terminally ill are to remain at home, to enter an acute ward in a hospital or, if there is one in the area, to enter a hospice. Nowadays, the cancer care group operates in the home as a team involving the family, the GP, district nurse, social worker, therapist, health adviser and a religious figure such as a priest or chaplain. However, the strains placed on a family and the patient during the illness may lead to the breakdown of a family.

The deceased should be able to leave the fondest of memories behind. The range of emotions exhibited by cancer patients may leave nothing but discord, which is a sorry state in which to leave a family. Self-imposed isolation from the family, fear of dying, anger at other people's perceived interference, frustration at the dependence needed on others or depressed indifference may separately or together shatter a family, to say nothing of creating more pain for the patient.

It is difficult to express in words the heartbreak that is felt when people see their loved ones deteriorate before their eyes, sometimes within a short time and sometimes in a humiliating manner.

An acute ward in a hospital is an alternative. The modern cancer team in a hospital is well trained to care for the terminal patient. But on a busy acute ward, the amount of personal attention that can be given to each patient is bound to be limited. The number of consultants with knowledge of the use of drugs to avoid pain, rather than of drugs which temporarily alleviate pain, is limited, this being a highly specialised area.

Privacy is also difficult to find in many hospitals. Most people prefer to spend their last days nestled in the family circle, rather than in a hospital, no matter how efficient, kind and understanding the staff around them.

The hospice movement grew out of dissatisfaction with the standard of hospital care provided for the terminally ill. In the intervening years, the standard has improved enormously. Nevertheless, the hospice movement offers a halfway house between the immense difficulties of caring for a terminally ill patient at home and the efficient, but less personal, care provided by many hospitals.

Hospices provide the buildings and teams for the specialist care of the terminally ill. Hon. Members are aware of the immense sums required to build and maintain a separate specialist institution. Indeed, 82 hon. Members have the privilege of having hospices in their constituencies. They will be aware of the great assistance that these teams can give. St. Luke's hospice will be directed towards the laudable aim of controlling pain. The staff will have special training to enable them to do that.

Hon. Members will be aware that there is more to pain than physical pain. Although the hospice movement has pioneered the use of drugs with the minimum side effects to control pain, far more is involved. The knowledge of death through cancer brings fear with it—fear of pain, loss of self-control, sanity, dignity and independence, and fear of death itself.

Hospices not only stop pain, but have the trained staff to help with the spiritual and emotional needs which are evident at that time. It has been shown that emotional difficulties, especially of the kind generated in the family circle, create pain. The assistance given in this area adds a complementary dimension to the use of drugs, radio therapy, nerve blocks and so on. By removing the emotional pain, it is sometimes possible to reduce the amount of physical treatment that is needed. The patient can thus lead a fuller existence by being awake and alert in the last few weeks.

Hospice staff try to create an atmosphere in which the patient and the family can express their fears and hopes, sort out practical and emotional problems and use their time together for mutual benefit. Hospice support of families is vital. The guidance and counselling of an experienced team can be effective enough to ensure that patients spend their last few days in the companionship of their families.

As late as 1979, it was estimated that 28 per cent. of cancer patients died in severe pain. There is no need for that. We possess the knowledge to enable people to retain a high quality of life to the bitter end, and St. Luke's will help to perform that function in Basildon.

The project, inspired by a hard-working committee and, in particular, the Cox family, has resulted in children, women and men from all walks of life, and from different circumstances, joining together with the one selfless and compassionate aim of building a hospice, not as a memorial to the dead, but to help the living.

I am extremely fortunate to represent a constituency with such good community spirit and where blatant acts of generosity are evident, even though it is not an especially wealthy part of Essex. Nevertheless, the hurdles are enormous. Nearly £500,000 will have to be raised during three years. Basildon development corporation has allowed the freehold of the site at Fobbing Farm to be bought for the lowest figure that the district valuer would accept. It has tried to help as much as possible. The design team of architects, surveyor and engineer have offered their services at reduced rates. but the building will present a problem.

The cost includes an estimated £58,597 of VAT. If that tax could be lifted, the organising committee would be enormously relieved. I realise that this is not the Minister's responsibility, but will he have a word with the relevant Minister to see whether anything can be done? I am pleased that the building has a chance of being accepted for grade II listed status, which would give some relief from VAT and other advantages, although it would render the building subject to certain building controls.

The advantages to the National Health Service of a hospice are extensive. A significant number of beds in acute wards are saved and. by acting as community teams, hospices enable people to stay at home or in the hospice and give them help to enable them to face their last days with dignity and courage. Hospices are an impressive addition to health care. The quality and care is unquestioned, and the standards that they have set are high and compassionate. Good terminal care is a challenge to all with responsibility for the dying.

When Dame Cicely Saunders established St. Christopher's hospice in south London in the 1960s, it was in in-patient unit where patients could be cared for during the final weeks of their lives. Recently, however, hospice activity has been concentrated on supporting patients in the home. The in-patient unit is regarded as providing back-up support and, where necessary, intensive nursing care.

Hospices' main achievement in pain control has been the demonstration of the benefits of administering analgesics regularly before the patient's manifest need for them arises. The in-patient unit, the home care service and the symptom control team contribute to the work of a hospice. There were only 12 in-patient units in the United Kingdom in the mid-1960s. Their number has grown to nearly 70. There are also about 90 home care services and 11 symptom control teams. I am pleased to learn that other hospice facilities are being planned.

Patients in the terminal stages of cancer are often told that nothing more can be done. That is seldom true with advanced cancer. An interested and sympathetic doctor using a small number of well-established drugs can relieve pain in most cases. No cancer patient should be allowed to die suffering. Pain can be relieved entirely in the majority of cases and controlled satisfactorily in the rest. Terminal care should begin when any attempt to cure the disease is deemed inappropriate and all professional skills must be devoted to the relief of physical, emotional, social and spiritual distress.

No doubt the film about Bob Champion and his remarkable determination to beat the disease, and eventually to go on to win the Grand National, will inspire many fellow sufferers. His story provides a moving account of his emotional battles and has a fairy story ending. However, not everyone can be a Bob Champion, so hospices are essential.

I said earlier that a substantial amount of money was needed to finance the project. My constituents have set about their task in an enthusiastic, enterprising and original fashion. A few weeks ago, I was privileged to be present at a major fund-raising event in our town centre in aid of St. Luke's hospice. People bought bricks for £1 each to build the hospice and then formed a human chain to move them to the site where it will be built. The spirit of people was wonderful and the dedication service that evening was a joyous occasion.

I am proud to give whatever assistance I can to St. Luke's. It will be built with the minimum financial assistance that the Government might feel able to give, and fundamentally from the generosity and belief of the people of Basildon.

I am not really asking the Government for financial assistance. However, if the Minister has any suggestions about how the money can be raised, we would obviously be delighted to hear them. If he knows of any European fund to which we might be eligible to apply, that would be helpful. If there is anyone listening to the debate, or who hears about the project, who might be able to give us physical, financial or practical assistance, we would be delighted.

Whatever difficulties the organisers of the project face, everyone is determined that the hospice will be built quickly, inspired as they all are by the words of Dame Cecily Saunders:
"You matter to the last moment of life, and we will do all we can, not only to help you to die peacefully but to live until you die."

12.46 pm

The Parliamentary Under-Secretary of State for Health and Social Security
(Mr. John Patten)

It was entirely characteristic of my hon. Friend the Member for Basildon (Mr. Amess) to end with that very moving quotation from Dame Cecily who did so much to get the hospice movement going in the 1960s. It has been an inspiration to all those involved — whether in the residential sphere or in the increasing area of activity concerned with helping people in their homes and counselling those who look after them.

My hon. Friend's speech was also characteristically lucid, and certainly very moving in parts. His interest in health affairs is already noted in the House. He has been the first to criticise—heartily supported by me—some of the scandalous suggestions and slander against the National Health Service in his area from the hon. Member for Holborn and St. Pancras (Mr. Dobson) —who is not in his place today—and the hon. Member for Peckham (Ms Harman). They have done a great deal to lower morale in that area, and by knocking the service they have caused great upset among the staff. I advise those who gratuitously look for publicity for cheap political ends to pick their targets with rather more sensitivity than that shown by the hon. Member for Holborn and St. Pancras, as I shall tell him the next time that I speak from the Dispatch Box, and as, indeed, I have told him before.

My hon. Friend appreciates that a number of his points do not fall within my ministerial capacity. For example, the question of VAT on charities is a matter for my right hon. Friend the Chancellor. I know that it is a useful defence for Ministers to say that certain matters are not for them but their right hon. Friends, but I shall not say that about the EC. I think that I can give my hon. Friend some advice, even though it is a matter for my right hon. and learned Friend the Foreign Secretary.

The two EC funds that we considered as possibly able to provide help for the project do not, alas, appear to be applicable. Therefore, subject to any further advice from the European Parliament, I do not think that anything can be done there.

In the brief time available, I shall try to reply to the important points that have been raised. I shall do so on three levels. First, I shall comment on hospices, and the hospice movement nationally. Secondly, I shall try to answer some of the important questions that my hon. Friend asked about cancer. Thirdly, I shall say something about Basildon. My word, what spirit there seems to be in Basildon! What effort is being made by the local people! They have not gone cap in hand to anyone, but are determined to do everything themselves. I have some experience of that in my area of Oxford, where a hospice has been similarly helped and where similar spirit has been shown.

Those organising the appeal—the Cox family, and Mrs. Cox in particular, as well as all those who have given money and who have formed a human chain to shift bricks and so on—have demonstrated the strength of voluntary giving in this country, which links prople of all political parties at all times. Such giving existed before the NHS came into being and it has carried on since then. It is a compliment to Basildon that it should have approached the issue in that way.

I should not like to give hon. Members the impression that the NHS does not wish to take care of the terminally ill. Much of the initiative has come in the past from local voluntary groups. Indeed, in the health and social services, such groups have often proved to be the seed corn from which much bigger statutory services have developed. Although we welcome that process, we have been conscious from time to time that services have developed in an unplanned way. Whether funds are raised for a hospice, for a body scanner or for any of the other items that we learn about with such pleasure in the press, consideration must be given to the proper national planning and provision of health services. That is why I welcome the growing spirit of co-operation that has been seen in Basildon and in the country as a whole between the voluntary sector and local health authorities in order to ensure that the right services are provided at the right time with the money that has been raised. I am very pleased to see that going on in Basildon in just the right way.

We believe that adequate terminal care should be provided by every health authority. It can be provided in several different ways, but we would encourage every health authority to enter into a constructive partnership, where possible, in order to achieve that end. We certainly do not say that good terminal care should be available only in hospices.

I must return to a theme that has come up from time to time in our Adjournment debates when we have kept each other company at all times of the day and night. I refer to the feeling among some hon. Members that large hospitals cannot give sensitive care either in maternity wards or in wards for the terminally ill. I do not believe that that is so. Maternity wards in large hospitals can be homely and agreeable places that have devoted staff encouraging mothers-to-be. It would be inappropriate, to put it mildly, to suggest that our nurses, doctors and ancillary workers, who play such an important role in our NHS hospitals, cannot give the care and attention that the dying deserve. They often do so, and I am happy to say that many people write in to thank those involved.

We welcome the co-operation given by the hospice movement. We want to encourage it and to see it grow and develop in partnership with the NHS. But my right hon. and learned Friend the Minister for Health and I are convinced that with good guidelines and good staff training there is no reason why that same quality of care and attention cannot be given even in our largest, perhaps 1,000-bed, hospitals.

My hon. Friend alluded to support for cancer research. Alas, I am not able to report any further great developments on that front, but I remind my hon. Friend that the DHSS and the Department of Education and Science allocate substantial funds to the Medical Research Council, which in turn allocates an equally substantial amount directly for cancer research. The Medical Research Council is spending about £19 million on cancer research this year, the largest allocation of its funds to any area of research. Therefore, more money is going from the MRC, drawing upon the funds of the Department of Health and Social Security and the Department of Education and Science, to this area of research than to any other area.

The voluntary sector has a role to play in cancer research, a role which I do not wish to underestimate. This is another very good example of how the voluntary sector can support and supplement the health services. About half of the expenditure upon cancer research comes from non-Exchequer funds. The Imperial Cancer Research Fund and the Cancer Research Campaign are major contributors. They have provided £4 million and £19 million respectively for the research budget, a formidable amount of money. Our experience is shared with other western countries and with the United States where these problems are being tackled head on.

On the particular problems of services for the terminally ill in Basildon and Thurrock, the North-East Thames regional health authority shares our view about local NHS services for the terminally ill. In its strategic plan it says that every district health authority should establish medical and nursing staff training for the care of the dying. That is critical. The NHS has a formidable job to do here. It also says that it should set up, either independently or in collaboration with an adjacent district, a home care service which operates outside the hospital or hospice with a pain relief clinic. I have visited such clinics and know about the extraordinary work that is done there. It also proposes that small in-patient facilities should be allocated, either hospital-based from the acute sector or using the services of a voluntary hospice.

I welcome these proposals. It is clear that what is being done for those who, alas, are terminally ill will increasingly be done in the community. This does not mean that it will be a cheaper option. In staffing terms, it may be considerably more expensive. As my hon. Friend the Member for Basildon said with such crispness, the majority of those who are terminally ill would prefer, wherever possible to be in their own homes with their families. But their families need support from nursing staff, social workers and others to deal with the problems which sometimes arise during the last few weeks —resentment, fear and all the other emotions which my hon. Friend so clearly described. By the better training of hospital staff and the better development of community-based services we shall mount a much more concerted twin-pronged attack.

I am glad that in Basildon and Thurrock the health authority is actively looking at ways to improve its care of the terminally ill. For this purpose it has set up a working party. I understand that at its June meeting the authority will be considering a report from the working party. I have not seen the report, but I understand that it makes a number of recommendations about the development of these services. I am advised that it says something about encouraging voluntary activities and closer links with the hospice movement. I hope that June will be an important month in, the development of these services in the Basildon and Thurrock area.

We acknowledge the major role played in the past by the hospice movement and the role that it will continue to play in the care of the terminally ill. We recognise that the NHS also has an important role to play in the planning of these services. We never want voluntary effort and funds to go astray, to be spent in an unnecessary or inappropriate way or to be wasted because of a lack of planning.

The boot is on both feet. The health authority must ensure that it is open to voluntary organisations, and must give them a role. Equally, voluntary organisations must ensure that they do not go off at a tangent. They must let health authorities know what they are doing and they must co-operate. In the past there have been criticisms of health authorities for not taking voluntary organisations into account. That must stop. If any hon. Member has a complaint about that, he should let us know because health authorities have a positive duty to take into account voluntary organisations' fund-raising activities in planning future developments. Nevertheless, it is for the authorities to decide how services should be provided.

Clearly. things are moving fast in Basildon. There is good co-operation between volunteers and the local health authority. I hope that it will not be long before the long-awaited plans come to fruition.