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Care of the Dying

Volume 538: debated on Tuesday 17 January 2012

Motion made, and Question proposed, That the sitting be now adjourned.—(Michael Fabricant.)

Good morning, ladies and gentlemen. It will not have escaped your notice that a considerable number of hon. Members are present, and a significant number have indicated in writing that they wish to speak. Who gets called, other than in what order, is beyond my control. We have an hour and a half for this debate. The Front Benchers will traditionally want not less than 10 minutes each, so, if you do the math, as they say, it is up to you. If hon. Members confine their remarks to three minutes a head, we will get everybody in; that is, of course, other than the person who initiates the debate. If hon. Members take an inordinate amount of time, I have no power to curtail the length for which they speak, other than to say that they may not get called again in the near future. Please try to exercise some control, and we will endeavour to ensure that everybody gets heard. Those with less experience might like to pay attention to the fact that it is sometimes possible to make a point in an intervention, rather than in a formal speech.

I welcome the opportunity to talk about care of the dying. It is marked that so many hon. Members are attending the debate on a subject that so many people in our constituencies would rather not talk about.

Last year, a ComRes poll found that 67% of people are scared of being told that they are dying. More significantly, 83% are scared of dying in pain. As a nation, we need to get better at talking about dying, death and bereavement, but Parliament can take a lead in breaking the cycle that can result in a lack of care. With the public reluctant to discuss end-of-life care, many professionals do not feel confident to deliver it. Services are not available to everyone who needs them. The aptly named Dying Matters coalition, across the public, voluntary and private sector, should be commended and supported when it has its annual awareness week in May.

Too often in health care, dying equals failure rather than a normal process. This attitude ignores those who will not respond to treatment, but who can still be cared for significantly. Although death may be a tragic inevitability, palliative and hospice care can ensure that the remainder of life is still worth living. We have an opportunity today to show the mark of a civilised society and care for the vulnerable and largely forgotten—the dying.

The growth of palliative care, not legalisation for assisted suicide, should form the central debate about care for the dying. As a country, we must do all that we can to allow the terminally ill to live a dignified life until death, to make the intolerable tolerable and to replace hopelessness with hope and desperation with serenity. Too often, this essential part of health care is forgotten, or simply shrouded by the more high-profile issue of assisted suicide. Reading media reports this year, one could be forgiven for thinking that that is the only option for those suffering with terminal illness. Rather than legislating for an abrupt end to life, we need to find better ways to help care for the dying.

The good practice of palliative care, which hon. Members will no doubt illustrate this morning with constituency examples, makes the point that we in this country believe that life should be treated with dignity at every stage through to death. Some 50 years ago, Dame Cicely Saunders, founder of the modern hospice movement, said:

“You matter because you are you, and you matter to the last moment of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”

What a refreshing contrast from what we have heard recently from those advocating assisted suicide. Take the chilling words of Baroness Warnock, who said:

“If you’re demented, you’re wasting people’s lives—your family’s lives—and you’re wasting the resources of the National Health Service.”

Suggesting that we have a “duty to die”, she said:

“I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”

Well, that is not a future I want to be a part of, and I am sure many of those present today agree. [Hon. Members: “Hear, hear!”] If we adopted the law of Oregon, the trickle of people wanting to be killed in places such as Dignitas would become a flow—some estimate that more than 1,000 people a year would take that path.

Does my hon. Friend agree that one of the most worrying things is that, if what he is talking about is introduced, many older people may feel that they are a burden and that they should bring an end to their lives?

Indeed. We need to retain the present law, which continues to provide a strong deterrent to the exploitation of vulnerable people, while giving prosecutors discretion in hard cases. Parliament has agreed, through a detailed Select Committee inquiry and three votes in the past six years, to retain that protection. We have to recognise that it is easy, in the comfort of Parliament, to make fine-sounding points about terminal illness. I recognise that there are no easy answers for those who feel they are not valued and who may feel that they may be wasting resources or are a burden on their family or society. However, they are the very people who most need the protection of the law and the provision of good-quality palliative care. How do we best safeguard their dignity and autonomy?

When we talk about dignity in the context of a health debate, it can all too often be restricted to privacy and physical care, but palliative care recognises a wider, proper understanding of dignity. Good palliative care recognises the social, emotional, spiritual and psychological needs that put an embrace around a terminally ill patient, rather than the proposed arbitrary, so-called safeguards that put a straitjacket around patients and doctors. For example, the prognosis for a terminally ill patient is notoriously difficult to determine. The best safeguard is through specialist palliative care that helps a patient live with uncertainty. Take the case of a motor neurone disease sufferer who wants to end his life but, unknown to his GP, has developed fronto-temporal dementia and whose thinking has become distorted. Such a condition could only be noticeable if someone knew that patient very well before the illness. The best safeguard to help the patient live with those fluctuating moods and thoughts is specialist palliative care. The proper way to empower patients’ choice and protect the vulnerable is through driving up palliative care standards, not new legislation.

In 2010, the Economist Intelligence Unit ranked Britain, rightly, as top of the league of countries for the provision of end-of-life care. Much of the credit is no doubt due to the expansion of local charitable hospices that provide more than £700 million of care, the majority of which is donated by the communities that they serve. Additionally, more than 100,000 people donate their time to local hospices each year.

I congratulate my hon. Friend on securing the debate. The fact that there are so many hon. Members here at 9.30 on a Tuesday morning shows what an important subject this is. He talks about local hospices. The Rainbows children’s hospice, which is in my constituency, now looks after young adults with life-limiting conditions as well. In this debate, we will perhaps focus on older people, but we should not forget children with life-limiting conditions. One point that the hospice has made to me—I think that my hon. Friend is coming on to this—is the fact that we need to integrate both health care and social care. Rainbows children’s hospice would like to see more of that from the Minister.

I am grateful for that point. Integration is needed, and we see that in the context of hospices and palliative care. We hope for that future in the reforms that are going through Parliament.

Although we should be proud, rightly, of individual examples in our constituencies, we should not rest on our laurels. We need to build on that solid foundation, because far more can be done. End-of-life care is not available to everyone who needs it. In fact, the palliative care funding review found that 92,000 people die in England every year without access to the services that they need. That figure equates to nearly 500,000 people during the term of this Parliament, and 700 people in each of our constituencies dying without the good palliative care services that they deserve.

Nationally, hospices receive about a third of their funding from the NHS, but that can vary substantially across the country. Indeed, in my constituency in Enfield, the NHS contributes less than 20% of what the hospice spends on care for Enfield patients. One of the biggest issues facing the terminally ill is where they will die. Currently, more than half the people who die in England do so in hospitals and just 20% die at home, although various studies have shown that two thirds of people would choose to die at home.

In Enfield, there are excellent palliative care services. I pay tribute to Nightingale Cancer Support Centre and North London hospice, which provides a community service providing care in people’s homes alongside an in-patient unit. In Enfield, the North London hospice community team are able to ensure that only 28% of people cared for by the hospice die in hospital.

According to the Minister, the Government should consider allocating national resources to continue to promote and extend palliative care. I look forward to hearing from the Minister about the progress in implementing the new per-patient funding system for hospice and palliative care providers, which will provide incentives to enhance services within community settings.

I will conclude in a moment, because a large number of colleagues want to contribute.

Jean Rostand, the French biologist, said:

“For my part I believe that there is no life so degraded, debased, deteriorated, or impoverished that it does not deserve respect and is not worth defending with zeal and conviction. I have the weakness to believe that it is an honour for our society to desire the expensive luxury of sustaining life for its useless, incompetent and incurably ill members. I would almost measure society’s degree of civilisation by the amount of effort and vigilance it imposes on itself out of pure respect for life.

I look forward to hearing hon. Members demonstrate that respect for life, for the dying, today.

May I congratulate the hon. Member for Enfield, Southgate (Mr Burrowes)on obtaining this debate? I agree with the bulk of what he said. There is something drastically wrong with a society that can contemplate legalising something that is, to my mind, murder. A change in the law would inevitably define the value of a life as dependent upon physical or mental capacity.

One of the greatest regrets of my life is that I was not present when either of my parents died. They did not die at the same time: both died in hospital and there was a period between each of them dying. One of the greatest privileges that can be afforded to a caring person—to us as human beings—is to be present at that moment when the last great adventure begins, when life slips away. A great strength of the Marie Curie hospice in my constituency is not that it exclusively treats the individual who is facing that last great adventure, but that it offers care and concern for the family, so that they can be included in that process.

Surely, we all deserve dignity in our death, whether or not that happens, as I think most of us would like to experience it, in our own home. Certainly, hospices provide the most extraordinary care. I agree with the hon. Gentleman that, regrettably, neither this Government nor the previous one took on board sufficiently the importance of hospices by financing them to the degree they warrant and deserve. As the hon. Member for Loughborough (Nicky Morgan) said, we are not simply discussing those who are elderly and facing death: this also applies to children and young people. The particular approach that hospices and palliative care can provide is of paramount importance.

I am somewhat shocked at the idea that hospices are somehow irrelevant, which is argued by some who seem to believe that advances made in medical science have, during our period on Earth, ground to a halt. I remember, because I am quite old—[Hon. Members: “No!”] I am sorry, but I am. The most frightening diseases when I was a child were cancer, and consumption—tuberculosis—which was deemed an absolutely incurable illness leading inevitably to death. We hear that its incidence has increased, but we do not hear much about it being an absolute death sentence.

We should all support the advances being made in medical science and research, not only in curing illnesses but in preventing their onset. In this instance, it is paramount that our society turn its face away from what could become legalised murder, and argue and press the case for increased funding, increased support for palliative care and, most markedly, support for hospices.

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on the strength and spirit of his speech. I also congratulate the hon. Member for Hampstead and Kilburn (Glenda Jackson) and very much agree with what she said. I was privileged to be present at my father’s death. My mother will, hopefully, shortly celebrate her 100th birthday.

All hon. Members came into politics because we care about life. We did not come into it to legislate about death. This is a sensitive and serious issue. One of our former colleagues is not in great shape at the moment. If he were able to attend he would support what my hon. Friend the Member for Enfield, Southgate said.

When I was Member of Parliament for Basildon I was privileged to lay the foundation stone for St Luke’s hospice. My hon. Friend the Member for Loughborough (Nicky Morgan) mentioned hospices in her constituency. In the area that I represent there is Fair Havens hospice and Little Havens hospice for children. I agree with the views of my hon. Friend the Member for Enfield, Southgate on what Dame Cicely Saunders said.

Britain is the world’s leading provider of end-of-life care. We are the only nation to offer palliative care as a specialist, medical discipline in its own right.

Does my hon. Friend agree that, when Government budgets are under a great deal of stress and the amount of assistance received from the NHS by hospices such as his and the Pilgrims hospice in my constituency is being decided, it would send exactly the wrong message to those splendid hospices and to those making budgetary decisions in the NHS if the House decided to allow assisted suicide?

I agree with my hon. Friend. His local hospice does splendid work.

Hospice workers require four years’ intensive training in order to practise. As a result, our hospitals and hospices are staffed by teams able to offer first rate end-of-life care when it is needed—all hon. Members will be familiar with the wonderful quality of care in our hospices—which puts Britain at the scientific forefront of palliative medicine, meaning that the care we can offer will only improve as advances are made. If we can offer this world-leading end-of-life care, why are we looking to euthanasia as an alternative solution?

We can do even more with end-of-life care than we are doing at the moment. We should seek to provide appropriate care to everyone who needs it, as the hon. Member for Hampstead and Kilburn said, no matter who they are or where they are. Figures suggest that 700 people in every constituency die without access to the appropriate services they need. Of course, this needs to change.

We need to help more with planning difficult situations. Understandably, thinking ahead can be traumatic for patients and families. None of us—I am the world’s biggest coward—wants to face the consequences of death. We must therefore do all we can to ensure that the end-of-life support received runs as smoothly as possible. We should focus on personalisation and integration.

Care needs to be developed throughout the community, so that the dying can spend those precious last moments in their local area, not in hospital.

We have already heard about the difficulties of legalisation in Oregon.

I could say much more, but I will not. I simply applaud the words of Dame Cicely, who said,

“Hospices are places where people come to live, not to die.”

Once again, I congratulate my hon. Friend the Member for Enfield, Southgate on providing the opportunity for us to debate this important issue.

I congratulate the hon. Member for Enfield, Southgate (Mr Burrowes) on bringing this matter to Westminster Hall; the number of Members present is an indication of its importance. Perhaps not coincidentally, we are about to recognise a memorial to the holocaust, to the 6 million Jews killed, as well as to all those people who were “socially unacceptable” or “mentally unstable”, according to the Nazis, who way back in that time took a decision to murder people whom they felt were not capable of contributing to society. I want to make some comments about that in the short time I have.

Cancer is a big killer. I can remember clearly what it meant for my own family when my father had it, on three occasions. He survived it, which I believe was because of his faith in God, as well as the medical profession and what it can do. Not everyone survives, however, and nor is cancer the only condition that can be terminal and need extensive care. Numerous other horrific illnesses include multiple sclerosis, lupus and HIV/AIDS. Some people classify those with such conditions as on the dying pathway, but, along with other speakers, I congratulate the UK on being top in the world for good palliative care, which is something to be incredibly proud of. However, sometimes palliative care is not the next step, and some steps might well be missed by those who are looking to make a diagnosis rather than to treat an illness long term. Some suffer from incurable illnesses, but others are simply elderly and infirm and need care, dignity and a programme tailored to their requirements. The word “dignity” has been mentioned by every speaker so far, and that underlines the issue clearly for me. People need dignity when they are not well.

I recently visited an occupational therapist whom I had met during my 26 years as a councillor. I got to know her well, and she was diagnosed with cancer. The hon. Member for Hampstead and Kilburn (Glenda Jackson) commented on the work of the Marie Curie centre, and I had the opportunity to visit that lady at such a centre in Belfast. She had an aggressive strain of cancer, with six weeks between her initial diagnosis and the end of her life—the disease struck quickly and hard. I and her family could not but appreciate the good work done by the Marie Curie people. At a time when she needed help most, they made her life that wee bit more comfortable—if that is the word to use—and helped her family.

No one living in the UK can be unaware of the need for efficiency savings, but in some areas we cannot afford to cut, and palliative care is one of those. Health is a devolved matter in Northern Ireland, and the health service has said in its palliative care strategy:

“The vision of this Strategy is that any person, from diagnosis to the advanced non-curative stage of disease, lives well and dies well irrespective of their condition or care setting. This requires a philosophy of palliative and end of life care that is person-centred and which takes a holistic approach to planning, co-ordinating and delivering high quality reliable care enabling patients to retain control, dignity and crucially, choice in how and where their care is delivered to the end of their life.”

It is about the people who are ill and who need care at the right time and in the right way. The hon. Member for Enfield, Southgate mentioned personal beliefs, cultures, the practices of patients and so on, and I would hold to what he said in his introduction. It is about the practices of patients and their families and carers, and recognising the contribution that good palliative and end-of-life care can make to the quality of their lives and the lives of the people around them who have to sit back and watch their loved ones die.

The NHS is supported by many charities, and one is the Northern Ireland hospice. It was established in 1981 and provides palliative care for adults—the majority of whom have had a cancer diagnosis—although there are young people there as well. The service began in Somerton house for in-patients but developed to provide specialist community nursing services, a day hospice and hospice at home—the point is that the service can be at hospital or at home, and it supports the family. Everyone knows of the tremendous work of the Macmillan nurses—personally, in many cases, and as elected representatives—and although the people of Northern Ireland continue to give generously, that is not enough to sustain the high level of care and training.

It is important for us to remain top of the world in palliative care, not because we want to show off or show our prowess, but because we want those who are dying before their time to have the best care in order to ease their way, and to ease the pain of their families. We can show what sort of a society we are by the way we treat our vulnerable people. Along with everyone else present, I support the intention behind the debate, and I hope we can assist the people who need it most: the elderly, the infirm and those who are ill and dying.

I do not intend to refer to the policy of the Director of Public Prosecutions in cases of encouraging or assisting suicide or to the report of the Commission on Assisted Dying because I note that my hon. Friend the Member for Croydon South (Richard Ottaway) has been given a debate by the Backbench Business Committee. Hopefully that debate, in which I suspect that many hon. Members present today will seek to catch Mr Speaker’s eye, will give us the opportunity to make our views known on those matters.

I fully endorse everything said so far today in the debate initiated by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), so I hope not to repeat anything. However, it is important for us to recognise that we will all die. As a society, we need to talk much more about dying and the care of the dying. As the psalmist says:

“The days of our age are threescore years and ten; and though men be so strong, that they come to fourscore years: yet is their strength then but labour and sorrow; so soon passeth it away, and we are gone.”

All too often in modern medicine death is seen as a failure in some way, but supporting those who are dying is an important part of modern medicine.

Three crucial things, therefore, ought to happen for anyone who is dying. They should be informed and fully know and understand, as far as possible, what is happening with their medical treatment. So far as is possible, they should be relieved of pain and should be able to die where they would most like to die. Most people, when asked, say that they would like to die at home, yet home hospice services in this country are pretty noticeable by their absence. I agree with the comments of hon. Members so far: we do have exceptionally good palliative care in this country—where it is good it is very good—but all too often it is mediocre.

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing the debate. A lot of people present are passionate Christians and see the subject from a religious standpoint. I speak as someone who was given warning of death on 26 April, before my operation last year, and with respect I take the view that, of the choices faced by individuals, one is the choice of their death—when they would choose to go. Does my hon. Friend the Member for Banbury (Tony Baldry) accept, as a matter of both law and faith, that that choice belongs to us?

I want to resist the temptation to be drawn into a debate on assisted dying, because many people present want to talk about palliative care, but I state simply that the only person who should determine when we die is the Almighty—it is not us. If we get into a situation in which we pick and choose who dies and who lives, it is a slippery slope. However, I will wait until the debate to be initiated by my hon. Friend the Member for Croydon South before I develop those arguments.

On the need to enhance palliative care, I hope that much more emphasis can be given to junior doctors in particular. I understand that at present they get comparatively little training on palliative care and, given the pressures that junior doctors are under, they often feel that if a patient dies they have somehow failed that patient. They might not have: patients die, and it is a fact of life that people will die. Every hospital trust should have a clear policy on palliative care and on how to enhance it. We should never forget the role of hospital chaplains. People approaching death often need spiritual support as well as medical assistance. Spiritual support is no less worthy and necessary.

We should never underestimate the role of hospices. Hon. Members have referred to hospices in their constituencies, and I have the excellent Katharine House hospice in mine. However, we must try to ensure that they are better integrated in support of NHS palliative care services. Many moons ago, in the mid-1980s, Jack Ashley and I set up the all-party group on hospice support, which is now the all-party group on hospice and palliative care. Even then, we were concerned about the varying amount of support from the NHS to local hospices. I hope very much that NHS commissioners will, whenever possible, see local hospices not just as a resource in developing excellence in palliative care, but as an invaluable resource to help those who are dying and those who are terminally ill. I suspect that the voluntary hospice movement still needs to be much better integrated in supporting the NHS and those who are terminally ill. I hope that the introduction of new forms of commissioning will enable that to be done much better. How we support those who are dying is a measure not just of the NHS, but of us as a society, and we should be judged by how we care for those who are bereaved.

I support all that has been said by those hon. Members who have spoken today. I want to touch particularly on the importance of how we can develop the excellent hospice care that already exists in our country today. Dame Cecily Saunders has been quoted. She said that the hospice movement should have three components: care, research into good care and education of professionals and the community in care and end-of-life issues. Communities today need hospices to operate at that level not just within their buildings, but outside. Fantastic care is given in hospices, but to a relatively small number of people.

In Cheshire, for example, St. Luke’s hospice, which serves my constituency, has just 14 beds, but through various initiatives, it has a far greater beneficial impact on the wider community. I should like to share some of the initiatives that St. Luke’s is developing. It has recently been invited to share those initiatives with the all-party group on dying well. To give confidence and skills to others to share well the care of family members, it has a community outreach programme, and I will refer to one of those programmes in my constituency.

The village hall in a village near Alsager opened its doors one day a week, but that is now being extended, so that those who are not within the hospice may come for day care. Nurses from the hospice spend a day at the village hall, and a group of volunteers cook lunch for the community’s elderly residents, who are often in some difficulty with their physical and mental capabilities. They can have counselling in a private room, a massage, treatments such as manicures and pedicures and engage in hobbies. I saw some wonderful art work that they had done over a period of months. They are provided with an excellent lunch, preceded by a small glass of sherry if they want it. There is much laughter and much support, and that enables the people who visit the centre not only to remain in their communities, but to have their lives enhanced and supported by the work of the hospice, augmented by a substantial number of local volunteers. In turn, those volunteers go into those people’s homes.

I am grateful to my hon. Friend for describing the innovative care that hospices in our local communities provide. In my constituency, Katharine House hospice does the same. I want to draw her attention to the community lodges that the Douglas Macmillan hospice has set up in an area near her constituency. They allow families to come together and to support their loved ones in a lodge as they are dying.

My hon. Friend is absolutely right. As Siobhan Horton, the director of St. Luke’s hospice said:

“Hospices need to actively transfer their enormous expertise in health and social care more broadly to ensure more benefit from high quality care”

for more people. St. Luke’s also provides education for all those in the Cheshire area who are involved in hospice work. I have visited the hospice. The ground floor contains 14 beds, and the first floor is a resource centre with a library, and advisers to inform and enable carers and professionals to extend their expertise throughout the Cheshire community and beyond. Hospices can do that excellently, because of their unique expertise, not only in this country, but throughout the world.

Another project that St. Luke’s is undertaking is to develop a public health approach to end-of-life issues, so that ageing well and dying well are part of living well. It is working with the local community to improve communication with family members who are coming to the end of their lives, to resolve outstanding issues, to reduce regrets, to open up conversations that others may be reluctant to engage in, to work with family members and to encourage the engagement of their wider community in supporting the family and individuals who are struggling to support themselves towards the end of a life in the family. The aim for all who are supported in that way is a good death. I think that we all have that aspiration: a death within the loving embrace of our family and local community. St. Luke’s is undertaking serious research into that, and I look forward to hearing more about its developing public health approach to end-of-life issues.

I want to touch on the work that St. Luke’s is doing in connection with care homes. It has been involved in care home education for many years, and although it believes that some care home care is excellent, it also believes that much expertise can be shared both ways. It is considering how to have a closer, more supportive relationship with care homes locally and is commissioning a report on strategic planning and what sort of relationship and support would make a positive difference to care home delivery of end-of-life care. Let us support such innovations and others throughout the country to develop the excellent work of the hospice movement here, of which we can all be proud. I look forward to hearing from the Minister how the country and the Government can continue to support and promote the extension of the excellent palliative care in this nation.

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing this debate. I have known him as a good friend for nearly 30 years and his values have remained the same over that time.

I welcome this debate because I feel that we need to move the focus of the discussion away from assisted dying and towards quality of life. I became involved with this issue not by accident but through involvement with my local hospice, St Clare. It is one of the most wonderful community organisations with which I have ever had the privilege to be involved, both as a parliamentary candidate in Harlow for many years, and as its MP. St Clare is dedicated to promoting quality of life and care, and it has taught me much about the important role of palliative care and how it needs our support.

I should like to make several brief points, the first of which concerns equity of funding. St Clare hospice in Harlow receives 24% of its funding from the local primary care trust, although other nearby hospices in other PCTs, such as Farleigh hospice or St Francis hospice, receive around 40% of their funding from the PCTs. I welcome the figure of 40% and do not deride it, but it is important to have greater equity of funding. There is also a cliff-edge issue: 70% of charitable hospices have agreements with their local PCT that last for just one year. We need longer-term agreements, so that hospices can plan ahead.

Although we often talk about the big society, the hospice movement existed before that was even mentioned. It has pioneered the big society for many years, and 157 charitable hospices in the United Kingdom receive the bulk of their funding from private and community sources. More than 100,000 people donate their time to local hospices. St Clare hospice has 500 volunteers, and on one occasion, I was pleased to work there as a receptionist. Given what the Government are trying to accomplish in many parts of the public sector, hospices deserve more recognition for their role as part of the big society. They are models of how charitable institutions can raise extra funds, invest in services and train the community, without resources coming simply from higher taxes.

I support everything that has been said so far about doing whatever we can to preserve life. Funding has been mentioned, as have the community and voluntary sectors. Medway contains the Wisdom hospice, where £539,000 is raised annually by the voluntary and charitable sectors. That is a great example of how communities want to preserve and support palliative care.

My hon. Friend makes a good point that is exactly right; his constituency is lucky to have him serving it so well.

I want to highlight bereavement counselling services. St Clare offers such a service, and about 40% of families that become involved with it receive bereavement counselling. That is a huge extra cost for something that the hospice does not have to provide but nevertheless offers as an extra service. Hospices receive little recognition for their work on bereavement care, and a UK study has shown that such care is often overlooked. In 2010, more than half of hospital maternity units still lacked dedicated bereavement support, thus leading families to turn to their local hospices. In 2007, an Oxford university survey of bereavement care in 10 Marie Curie hospices around the country showed that, although there are some great services, such care is patchy or non-existent in other areas. That is why hospices such as St Clare that go above and beyond the call of duty in the bereavement services that they offer deserve recognition and extra financial support.

To conclude, I should like to comment on the remarks made by my hon. Friend the Member for Hexham (Guy Opperman) who is no longer in his place. I have huge respect for him, but he mentioned choice in death. The problem with assisted dying and the move towards euthanasia is that people will be pressured into making choices. That is why I am passionately against any move towards assisted dying.

I congratulate the hon. Member for Enfield, Southgate (Mr Burrowes) on securing this debate, and I have been listening carefully to the hon. Member for Harlow (Robert Halfon). Is not part of the problem the fact that if this House eventually—sadly—legislates in favour of assisted dying, that would normalise the situation and mean that people and families who are vulnerable or in desperate straits may think, “That is normality; we will go down that route”? Does the hon. Gentleman agree that that is a dangerous route down which to go?

I agree passionately with the hon. Gentleman; we would be taking a hugely dangerous step were we to go down the road of assisted dying. We as a society devalue human life, whether through fiction, computer games or television, or in real life. I often wonder whether Harold Shipman would have got away with killing one patient after another if we as a society had not devalued human life in such a way. We need to move away from that in a big way and back towards dignity for the dying and strong support for palliative care.

This is a complex subject about which one could probably speak for around half an hour. I will try to confine myself to three minutes and make an important point that I do not think has been made previously. I do not want to repeat points already made by other hon. Members.

I should begin by declaring an interest. I am a board member of Living and Dying Well, which is an active and committed organisation that examines and publishes evidence-based research into assisted dying. There are many aspects to this debate, and I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) not only on his speech but on the measured tone in which it was delivered.

I have probably received more communication from constituents about assisted dying than on any other subject. Most of those who have contacted me disagree with my point of view; I am totally opposed to any change in the law. All those people, however, approached me on the basis of compassion, usually for an individual whom they know—I am sure that many hon. Members present, and others, know of people whose lives are coming to an end and who are living in such difficult circumstances that it is almost a blessing when that happens. Such circumstances have led people to feel that there should be a change in the law. We, however, are parliamentarians, and although I feel compassion for the individual and understand and respect the views of those who disagree with me, we as legislators have a duty of compassion to society as a whole. In my view, we cannot introduce laws that are geared towards individual cases and are dangerous and could lead to situations such as those already mentioned where pressure is put on individuals and suicide is normalised.

In a perfect world, every terminally ill person would be clear thinking and not suffering from a mental illness from which they might recover; every doctor would be professional and competent to make a judgment about the end of life; and every relative would be full of compassion and motivated by nothing else. Our society, however, is not like that. We live in an imperfect society, and our laws must allow for those imperfections.

A debate to be held next spring will consider assisted dying, and we will all be able to make a huge number of points and provide evidence. I would be deeply sorry if we move towards legalising assisted dying and I think that it would be a dreadful mistake, but we should leave that discussion until that debate. Let us recognise that, as parliamentarians, we have a duty first to make a huge commitment to social and palliative care—which as a society we have never done—and to help people at the most vulnerable stage in their lives. We should not go down the road of making things convenient by simply removing those who are most vulnerable and most need our care away from our society altogether.

Order. Six hon. Members still wish to speak. I intend to call the Front Benchers from 10.40 am. Again, please do the sums.

I became interested in end-of-life care in part from having been a hospital visitor at my local hospital for eight years, largely attending those who had no advocate, friends or family and who were nearing the end of their life. I continue to work on these issues with a number of organisations, including the Royal College of Nursing, Age UK and the NHS Confederation.

We have known for some time that older people, in particular, are poorly served in both a hospital and a community setting. To give a recent example, a constituent of mine, who had no continence problems but was bedbound following an operation in hospital, repeatedly asked for a bedpan and at the sixth time of asking was told to wet herself because it was nearly suppertime and no one was around to fetch the pan for her. By that time, she was so desperate for the loo that she did just that, despite how unnatural and unpleasant it felt, and she then had to sit in wet sheets until the meal was over. Only then did the nursing team come and change her whole bed—a procedure that took more staff and time than the simple act of fetching her a bedpan in the first place.

We have had a succession of reports, including from the Care Quality Commission and the Equality and Human Rights Commission, calling for the Government to act. I hope that my hon. Friend the Minister will today update us on progress. With my hospital visitor hat on, I would particularly like to know whether she believes that there are opportunities with the Centre for Social Justice “End Loneliness” campaign, which is focused on befriending and visiting, to consider the support and advocacy services that could be developed to support those who have no one else as they near the end of their life.

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing the debate. I am pleased that it has been focused on good-quality end-of-life care, rather than assisted dying, as that is the immediate issue. I am sorry that those two issues are often conflated or painted as an either/or. The Commission on Assisted Dying added its voice to the previous reports in relation to the patchy nature of good end-of-life care. It was highly critical of the practices at Dignitas and elsewhere, including Oregon. It highlighted the lack of research in the area that we are discussing. One of its key conclusions was that the Government must step up their drive to improve care in this area as a priority.

Poor-quality end-of-life care cannot be a reason for an assisted death. Indeed, one of the safeguards required by the commission’s model for assisted death in the UK would be verification that a terminally ill patient who requested an assisted death was receiving good care. However, the view that, if there were universal provision of good-quality care, there would be no demand for an assisted death is a false one. It assumes two things: good-quality end-of-life care can alleviate all pain and suffering, and the overriding motivation for seeking an assisted death is poor-quality care. Neither is true. Those who request an assisted death are often doing so because of issues about control and their identity, and we must recognise that even with very good care and advances in pain management, there will still be patients who are in considerable discomfort at the end of their life.

All in this place have great sympathy for those who wish to have an assisted death, whether or not we believe that they should be granted one. We have sympathy for the 400 people who commit suicide every year because of a terminal or chronic illness. We all know about the sale of suicide kits—those appalling suffocation devices, which often fail to kill and instead result in brain damage. I would like the Minister’s comments on whether we should be doing more to end that trade on the internet. We also know about the 160 people from the UK who have travelled to Dignitas. In my view and the view of the commission, that is a very unpleasant experience, and such people are often ending their lives very prematurely.

All of us have sympathy and compassion for the people to whom I have referred. Where we differ is in whether we think that measures to enable those people to have a good death, at the time of their choosing, come at too high a price for the rest of us. There are issues that are often discussed—safeguards, for example, are deemed too difficult and have not been thought through—and issues that are just as pressing but are not so often discussed, such as equality of access to such a death. Indeed, certain issues are barely debated at all. This is a difficult subject, but we should, as a Parliament, continue to discuss the plight of those people and their families, as their suffering is profound. I echo the comments of my hon. Friend the Member for Montgomeryshire (Glyn Davies); we should do that in the tone that he outlined.

Such suicides occur once or twice a day in the UK. These are a tiny minority of patients, a minuscale minority of Britons, but each of them, in my view, is entitled to a good and peaceful death.

I, too, congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing the debate. Bearing in mind your request for brevity, Sir Roger, I will be as brief as possible. I can only agree with much if not all of what has been said.

In considering what to contribute to the debate, I looked up a definition of palliative care. We tend to know what that means, but the definition that I came across last night is from the National Institute for Health and Clinical Excellence:

“Palliative care is the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments.”

That seems to sum it up. Who could not support that statement?

One reason for my participation in the debate is to pay tribute to the hospices that serve my constituency, as many other hon. Members have paid tribute to the hospices that serve their constituencies. My Cleethorpes constituency is served by St Andrew’s hospice, based in Grimsby, and the Lindsey Lodge hospice in Scunthorpe. Both are wonderful organisations that rely on the work of their dedicated and skilled staff and volunteers. I have visited both hospices in the past 18 months; indeed, I visited St Andrew’s only a couple of weeks ago. St Andrew’s also has a children’s unit that serves the whole of the county of Lincolnshire.

I am more familiar with St Andrew’s hospice because my father spent his last weeks in its care and my mother died on the day on which she was due to be transferred to St Andrew’s. My father received care and attention that can only be described as superb. He suffered greatly in the time until he arrived at the hospice, but he seemed to be pain-free during those last few weeks in the hospice. He was in surroundings that allowed me, my mother and other family members to feel reassured that everything possible was being done to give him all the support that was necessary. That was as long ago as 1988. St Andrew’s has progressed enormously since then. It is now in a modern purpose-built building. The drugs and methods of care available have evolved beyond anything that we could have imagined 24 years ago. The advances that are likely to be made in the next 24 years will improve the lives of people who are in their last days beyond measure.

Human life is to be valued. Anything that denies that diminishes society as a whole. I shall conclude by noting one of the contributions made to Lord Mackay’s Select Committee in 2004. It states:

“I would rather die in a country where euthanasia is forbidden but where doctors do know how to look after a dying patient in a humane manner than I would in a country where palliative medicine is ignored but euthanasia can be easily arranged”.

That is the sort of country that I want to preserve.

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on obtaining this very important debate. We have heard a lot about palliative care and the hospice movement and we recognise what a patchwork of provision there is in different parts of the country. I take on board the warnings from my hon. Friend the Member for Portsmouth North (Penny Mordaunt) that that should not be used as an excuse to make assisted dying easier. I will concentrate my brief comments on assisted dying. In doing so, I will be taking up the challenge offered by my hon. Friend the Member for Hexham (Guy Opperman), who talked about whose choice this was. It perhaps was inevitable that, in answering that question, my hon. Friend the Member for Banbury (Tony Baldry), as the Second Church Estates Commissioner, took the view that the Almighty should make the determination. I recognise that many hon. Members present are strongly Christian, but I think that we have to face the fact that we live in a secular society. I do not think that that answer—perhaps slightly tongue-in-cheek—will do as we go forward. My own view—this is perhaps strange, given that I am a legislator and a former lawyer—is that the law is not the right place to make these changes. The empire of the law should not necessarily stretch into this area, and that takes on board elements of ethics and the fact that I have some belief.

I have a great concern that a right to die will rapidly become a duty to die for elderly folk and disabled people. The way in which a society looks after its most vulnerable says much about it, and if we fail to look after such people, and allow the law to change, even in a relatively subtle way, whatever the so-called safeguards, that will be a dangerous step.

The reality is that much of this debate is happening in the context of tremendous funding problems in not only the national health service, but care for the elderly—an issue that has appeared across our newspapers in recent weeks. In a way, those funding problems and the issue of assisted dying are almost two sides of the same coin, with people looking at assisted dying as somehow being an easy way forward on those funding issues.

My concern about the law is that it is simply not the right instrument. It will not give anything like the safeguards we need; indeed, it might make life even more difficult for members of the medical profession and the police, who will be reluctant to do the right thing if the laws that are put in place notionally to provide safeguards simply regulate their lives more stringently in reality.

I speak slightly from my own experience. It is 21 years ago almost to the month that my father died. He was diagnosed with terminal cancer seven or eight months before he died. I was his next of kin, and I must confess that I was very happy that we had a long-standing family doctor. My instructions, and indeed my father’s instructions, to our doctor were that my father did not want to die in pain, and that probably meant that he had more morphine, which might well have accelerated his death by a matter of days or perhaps even weeks. Such decisions should be made by the medical profession, but my worry is that any change we make in the law will make that right decision much more difficult, because it will be a regulated legal decision.

Above all, the problem is that, if we try to introduce such changes in the law, which is natural for us as legislators, we will end up introducing a charter for those who think there are elderly, disabled and other people whose lives have less value than those of the rest of us. That is a very dangerous way forward.

Going forward, we will all have to fight. As my hon. Friend the Member for Montgomeryshire (Glyn Davies) rightly said, there is a vocal group that is keen to change the law. All of us must now get ready for a battle to stand up for the silent majority, who think, very much as we do, that the importance of life should not be underestimated at all.

There is a famous saying that only two things in life are certain: death and taxes. In the short time I have been in this place, it seems we have talked a lot about taxes, but very little about dying. I worked in the hospice movement for more than 12 years, and the hospices have a wonderful saying that they cannot add days to people’s lives, but they can add life to people’s days. That is the fundamental point to make.

I want to talk about children’s hospices. I spent most of my time working for Martin House, which is a children’s hospice in Yorkshire. Children’s hospices are very different from adult hospices. Having also worked in an adult hospice, I have been able to see the differences between the two. Caring for a child with a life-limiting and terminal illness is incredibly difficult. The whole family need support, not just the patient. One father I spoke to said that, if he got up eight times in the night to go to his child, he considered he had had a good night’s sleep.

Many people are frightened of using a hospice, because the view is that that is where we go to die. In my experience, however, things really are much better than that, because hospices are about living and making the best of difficult lives. I want to give two examples, although I will try to be as brief as possible. Two parents came to see me after their six-week-old baby suddenly died. They had spent five weeks in hospital unable to touch the baby, but when they went to Martin House, they were allowed to hold the child. As they put it, they were allowed to be parents, rather than carers. That really shows the wonderful work that the hospice did.

Another thing also made me realise that, for many people suffering from terminal illnesses, the important thing is life and the issues surrounding it. I and other staff from the hospice were interviewing a young man who used it as part of a promotional video, for want of a better term, to help raise funds. The head of care asked him what the most difficult thing was about having a life-limiting illness. In my naivety, I thought he would say it was the fear of dying and the fact that his life would be short, but he said it was falling in love. I could not quite understand that at first, but he said, “Who is going to love me if I have a muscle-wasting disease?” I suddenly realised that the hospice movement was about helping young people who face not only a difficult disease, but the emotional difficulty of not being able to live their life in the way we do. Hospices do so much work to make the very best of difficult lives. The holistic approach they offer—the respite care, the emergency care, the terminal support and the bereavement support we have heard about—is vital to the families that need them.

While I was working at the hospice, it needed to raise £4 million a year. We got only 6% of that from the PCTs, which, frankly, is not good enough. We really should spend a lot more on providing excellent care to ensure that those who are coming to the end of their lives have the very best death possible. When the Minister looks at providing money for hospices, I urge her to recognise that children’s hospices provide very different care from adult hospices.

There is no doubt in my mind that, if we allow assisted dying, it will eventually become encouraged exit. G. K. Chesterton wrote that, when orthodoxy becomes voluntary, it will be prohibited, and we could be on a dangerous, slippery slope. One of the witnesses to the Falconer inquiry said:

“I think we can only go for terminal illness at the moment, so this doesn’t actually apply to the people who are probably about to go into care homes. But, you know, baby steps.”

That is a chilling statement.

There is a lot I could say about this issue, but time is short. We all know that it is virtually impossible to predict how long someone has to live—we know that even from the famous case of the Lockerbie bomber. We also know how people suffer from depression in their last months of life. We know what has gone on in Oregon and in the Netherlands, where 8% of all deaths are the result of euthanasia. We also know about the experience in the Northern Territory, in Australia.

However, I just want to make one simple point, and I apologise, because I suppose it is a moral point. I visited St Andrew’s hospice with my hon. Friend the Member for Cleethorpes (Martin Vickers). To us, this is a moral issue; we believe that the body is simply the mirror of the soul, and however old, crippled or useless someone might seem to society—our society seems to be dominated by the worship of youth and beauty—they are of immense value to society and should be sustained by society to the very end of their lives.

If more hon. Members who support assisted suicide had participated in the debate, one word would have been heard above all others: safeguards. The only hon. Member who seemed to make the case for assisted suicide talked, in a brief intervention, about some people viewing these issues on a religious basis, by which I think he meant that we should judge them on a rational basis. I judge this issue entirely on the basis of rationality, rather than religion, and according to that rationality, it is impossible that the safeguards can be practical or reliable. Safeguards could not be applied to people choosing to end their lives, because the people who would try to apply them could not get into the minds of those people whose future was in question.

The case for assisted dying has been made by a small number of strong-minded and articulate people who have made up their minds that they want to die, but who cannot end their lives without help. If everyone relevant to the question were like that, there would be much less of a problem; but the real reason why safeguards are thought to be necessary is twofold. One is to prevent people from being subjected to subtle pressure, which no outside person could detect. However, as my hon. Friend the Member for South West Bedfordshire (Andrew Selous) said early in the debate, even without outside pressure, there would be a danger that people would feel they had to end their lives in a spirit of self-denial, so as not to be a burden on others. There is no way to erect safeguards to prevent subtle pressure from being applied undetectably; still less is there any way for such safeguards to prevent people from genuinely deciding, although they might want to continue with their lives, that they want still more to end them so that they will not be a burden to others. We cannot apply safeguards to those cases, and that is why the case for assisted dying based on the application of safeguards is fundamentally flawed.

First, I congratulate the hon. Member for Enfield, Southgate (Mr Burrowes) on securing the debate. We have lived through an era when MPs have been seen as irrelevant, not to say venal, and when Parliament has been seen as remote. However, increasingly, in this Parliament, we have found that we are seriously debating issues at the centre of current political debate. The present debate is one of them. I want to touch on policy issues that relate to palliative care and to say a little about assisted dying, but I will begin by saying that in a busy, urban 21st century society people seem increasingly reluctant to talk about death or even to face the possibility of death.

At the risk of generalising, I will mention that, as many hon. Members know, my family come from rural Jamaica. In such rural communities, people make a point of talking about death. People stay up all night with bereaved families, night after night. That may seem strange to some, but it is a way of saying, “Death is a reality, and we will support you through it. Your community is here for you.” In a way, the rather hurried, perfunctory and frightened way that we deal with death in modern urban Britain is not necessarily an advance on the way people deal with it in rural communities around the world.

End-of-life care is of course an important issue, not just because death will come to us all, but because it is a major issue for the NHS. It represents billions of pounds of NHS spending—a fifth of NHS costs and a total of £20 billion altogether. Yet, as hon. Members have said, whereas most people would prefer to die at home, most do not have that privilege. It has been a concern of successive Governments to find out how we can give people the range of choice that they want for end-of-life care and how we can improve the level and type of care that is available.

Among the published reports on the issue, the King’s Fund report identified improving the primary care management of end-of-life care as one of the top 10 priorities for new commissioners. We have heard about the unevenness of funding of hospices and end-of-life care, even within the same part of the country, so I should like to ask the Minister whether it is the Department of Health’s view that end-of-life care should be a national priority and how she proposes to deal with the considerable variation in quality, efficiency and funding. What is the Department doing to ensure that the NHS can support the voluntary sector hospices and other specialist palliative care providers? Can the Minister give the House some reassurance that the Government’s proposed commissioning arrangements in the Health and Social Care Bill, which is being considered in the other place, will ensure that there is planned 24/7 provision of community support, including care co-ordination, nursing and symptom control?

As I have said, we know that most people would prefer to end their life at home, but most cannot. We also know that half of all complaints to the NHS involve criticism of the circumstances in which someone died. Often the time when a relative is dying is one of the rare occasions when a whole family come together and perhaps watch the process minute by minute. Therefore, a focus on and concern with end-of-life care comes to us all, and we will all have a view on it. The Minister will be aware of the Demos report, “Dying for Change”. Demos made a number of recommendations and said:

“Unless we can devise ways to get people to talk about how they want to live while they are dying, our efforts to improve services will be like groping in the dark.”

That is a reminder of the need to talk about and face death and to say, while still well enough to give an unconstrained opinion, how we want things to happen. Demos referred to training in palliative care and the important question of linking hospices to groups of care homes, so that hospice skills and values can migrate to care homes. It said that services need to be commissioned in an integrated way. The Minister will also be aware of Age UK’s public policy proposals on those issues.

The House would expect me to say a word about Labour’s record. Under the previous Labour Government, the NHS end-of-life care strategy was launched in 2008. It covered all adults with advanced progressive illnesses and care in all settings. The 10-year strategy was backed by an extra £268 million. There is no question but that progress was made, as I am sure that the Minister will acknowledge. The number of staff using models of care specifically designed for the end of life rose. Those models are now used by 75% of GP practices and hospices and 85% of acute hospitals.

Is the Minister aware that the King’s Fund has warned of the dangers of losing momentum in the drive to improve end-of-life care? Is she also aware of the report of Dr Rachael Addicott, “Implementing the End of Life Care Strategy: lessons for good practice”? Dr Addicott expresses concern

“that the decision not to hold a review until 2013 risks losing momentum and missing the opportunity to build on the progress already made.”

I have been fortunate, as a Hackney MP, to have a close relationship with St Joseph’s hospice, which was set up in 1900 by five Sisters of Charity and is the place where, in the 1950s, Cicely Saunders developed the principles of modern hospice care. My respect for the men and women who run hospices cannot be bettered by anyone in the Chamber today.

As for assisted suicide, I do not want to take a position one way or another. I have great respect for colleagues who advance the case for it and for people in the media who earnestly want to be able to decide how and where they end their lives. However, I have represented a busy, kaleidoscopic urban constituency for 25 years. In Hackney, the best of life and the worst of life can be seen—and the best and the worst of people. I have seen what fantastic support families can give, even when the state lets people down; but in a tiny fraction of cases, I have seen how venal families can be.

My concern about assisted dying would be for that tiny handful of cases involving elderly people who did not want to be a burden—and how many times have hon. Members sat in advice sessions and heard elderly people say that? I would worry about the cases—tiny in number, but still representing the lives of actual people—in which, if we were to provide a legal framework to make assisted dying possible, such people might feel almost an obligation to move forward. I stress to the House that that is a personal view. It comes, as I have said, from seeing the best of people, but also the worst of people, in more than 20 years of being a Member of Parliament.

End-of-life care is one of those issues that is at the centre of people’s debate and concern, because death comes to us all. Advances have been made in recent times, partly through what has happened in the voluntary sector—in hospices all over the country, such as St Joseph’s, which is a wonderful hospice—and partly through conscious Government policy. I am interested in what the Minister has to say on policy going forward.

Thank you very much, Sir Roger. May I say what a pleasure it is to be able to say “Sir Roger”? I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on securing this debate. It is timely that the House is reminded of the excellent work that goes on, and we have had tributes from all parts of the House this morning for individual hospices and the work of individuals. I also want to congratulate my hon. Friend on his comments on the fears that surround death. Death is an inevitable consequence of life, albeit for some it is tragically premature. We do not find death and dying a comfortable subject. It is thought frightening and mysterious. If nothing else, debates such as this may demystify some of the issues around death.

I also want to mention in particular the hon. Member for Hampstead and Kilburn (Glenda Jackson) and her comments on the privilege it is to be present at a member of one’s family’s death. The hospice movement, as she rightly said, has enabled that to be possible for so many more people today.

Services in some parts of the country are excellent and in some parts of the country they are patchy at best. As my hon. Friend the Member for Portsmouth North (Penny Mordaunt) pointed out, the quality of care does not always live up to what we expect. It also does not live up to what we expect in the treatment of certain conditions and in end-of-life care.

The Department of Health’s end-of-life care strategy was published in 2008 under the previous Government. I want to pay tribute to the progress that they made. It remains the blueprint for improving this area. Last September we published the third annual progress report on implementing the strategy. It is on the Department of Health’s website and I urge hon. Members to have a look at that.

I will not for the moment, because I have so little time.

Our plans for the NHS mean that we want people to have as much choice as possible in treatment in life but also in death. We want commissioners and providers to ensure that the right services, which include 24/7 community-based services, are available to support people at home.

Progress is frustratingly slow, but the examples around the country where it is working well are of note. We will review progress regularly to ensure that this becomes a reality for people. It is much overdue.

One development is the electronic palliative care co-ordination systems. I hate these names, but they can be effective tools. Through those, care providers can instantly share care plans and express preferences for care. We piloted that approach successfully in eight sites across the country and it is now being adopted more widely. We are also working to make sure care planning is a routine part of care for people who are dying. It is dreadful that care planning is not a routine part of care for all people. That has not been the case for some years, but it should be.

In November, NICE published its quality standard for end-of-life care of adults. That is an important contribution to this issue. It covers the whole of the end-of-care pathway, not just the medical bit. The 16 statements include social, practical, emotional and spiritual and religious support. We have also developed a national survey of bereaved relatives to get first-hand experiences of people’s care. The first survey should be completed by March. That will inform a new indicator on end-of-life care in the NHS outcomes framework.

To provide quality services, where and how people want them, hospices and other palliative care providers need support and funding. We will introduce a new per-patient funding system for all providers of palliative care, covering both adults’ and children’s services. We set up the independent palliative care funding review to help take that forward. The final report was published last year. It came up with some significant proposals, which we will consider in detail to ensure that we get that right. It is the first major step in local palliative care funding. We will have pilots to collect data and test the review’s recommendations, which will be established from April this year. The aim is to have the new funding system in place by 2015, which is a year earlier than was anticipated.

I also want to pay tribute to the voluntary sector. Palliative care was first developed in the voluntary sector and it still provides us with those beacons of best practice. Dame Cicely Saunders has already been mentioned and had tributes paid to her. She founded St Christopher’s hospice in 1967 and I want to associate myself with those tributes. I also pay tribute to people such as Dr Colin Murray Parkes, who has done so much in the area of bereavement and grief. That has been mentioned, but it possibly did not get the mention that it should.

The hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Southend West (Mr Amess), for Congleton (Fiona Bruce), for Harlow (Robert Halfon), for Montgomeryshire (Glyn Davies) and for Portsmouth North all paid similar tributes. I would love to mention every contribution in detail, but they all surrounded the same issues: this is about dignity; this is about choice; this is about life. It is also about bereavement and the care of the relatives who live beyond the death.

My hon. Friend the hon. Member for Banbury (Tony Baldry) specifically mentioned assisted suicide, as have other hon. Members. This is a matter for Parliament as a whole to decide, not the Government. He talked about the perception of failure when someone dies. On a personal level, to be present at a good death is a privilege and an opportunity, not a failure. We need to right that balance a bit and see the success in someone dying well. As I have said, it is such an important part of the bereavement process.

We have a comparatively smaller number of people who die in a hospice, but so many more benefit from their services and expertise. We want to see hospices flourish and develop. In particular, we want to see them continuing to expand the care they give to those with illnesses other than cancer, as well as expanding into community-based support for patients, their families and their carers. That is where the work that we are doing on palliative care funding is so important. It will be key to moving us towards a fairer funding system for all providers, including hospices.

It would be remiss of me not to mention the one issue that has not been mentioned. In accepting that death is part of life, we also need to consider those who can be given the chance of life through another’s death. As I have ministerial responsibility for organ transplants, I have to mention that we need to make organ donation a normal part of end-of-life care. We need to recognise that through a sensitive approach to the family, we can, in death, give life to many others.

In conclusion, we come to this place to give our constituents and this country a better life, because we believe that everybody deserves a good life.

I just want to touch on the point that in my constituency, the Donna Louise Children’s Hospice Trust does some fantastic work. There is this difference between it and the work of the Douglas Macmillan hospice just outside the constituency. There is a mishmash and I would be grateful if the Minister looked at that in the future.

We want to end any mishmash. We want a consistently high quality of care for everybody. Everybody deserves a good life and that is why we came to this place. This debate has allowed us to debate, discuss and share the opportunities that exist for Parliament to allow people a good death too, with dignity, without pain, in the company of those we love and at peace in death with the lives that we have led.

Order. Just before we move to the next debate and while I am awaiting the arrival of the Minister, who is not late, may I thank all hon. Members for the tone and the self-restraint that has been exercised this morning? As a result of that, we have managed to accommodate the views of 21 Back Benchers, in addition to those on the Front Bench. I regard that as exceptional. I hope that many people outside the Chamber will have heard the quality of the House of Commons at its absolute best. Thank you.