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Health: End-of-life Care

Volume 693: debated on Tuesday 10 July 2007

asked Her Majesty’s Government:

Whether the health and social care outcomes and accountability framework will have end-of-life care as one of its 40 domains.

My Lords, the new outcomes framework being developed by the Department of Health will strengthen local accountability and decision-making. The framework establishes roughly 40 indicators covering the range of health and social care outcomes. Primary care trusts and local authorities will use it to set priorities against clearly benchmarked performance indicators. It is too early to say whether end-of-life care will be in the final set. We are engaging publicly on these outcomes.

My Lords, I thank the Minister for her reply and for outlining the framework. Does she acknowledge that there was a manifesto commitment both to beginning-of-life and end-of-life care, and that the Government with their end-of-life care strategy—and being on the board, I must declare an interest—are trying to establish measurable outcomes to ensure that patients receive the care that they need? Does she recognise that, if one of these domains does not cover end-of-life care, we will effectively not be preparing for the one thing that comes to us all? Given that death will happen to everyone, it must be a core framework for the delivery of health and social care services.

My Lords, I acknowledge the manifesto commitment and pay tribute to the noble Baroness for her expertise and diligence in following these issues. As I have said, it is too early to say whether it will be in the final set of indicators. However, I readily acknowledge that the framework offers an opportunity to place end-of-life care much higher in the consciousness of PCTs. It is going to affect us all, so we all have a vested interest in it.

My Lords, is the Minister aware that the United Kingdom’s consultant oral and maxillofacial surgeons were surveyed last year? They deal with perhaps the most distressing forms of cancer, which are so disfiguring and cause difficulty in eating. Seventy-two per cent of the 197 experts consulted in this field considered that it was very important to have a much greater stress on and funding of end-of-life care. Will she take that into consideration?

My Lords, I was not aware of the views expressed by that group of people, for whom I have high regard. However, I know that, when asked, the majority of the population express a preference for the location of their death. People are concerned to ensure that there is much better end-of-life care. Therefore, those surveyed are reflecting the views of the population.

My Lords, in considering this framework, does the Minister think that it might be used to ensure that workers receive regular supervision, particularly those working on their own in the community?

My Lords, I am sure that issue will be considered in the review announced last week by the Secretary of State, which is being undertaken by Sir Ara Darzi.

My Lords, does the Minister agree that chaplains continue to play a vital part in end-of-life care by providing appropriate spiritual care and support to patients and their families, not least by acknowledging and sometimes absorbing the distress—and sometimes the despair and the anger—that is experienced by many in those last days and weeks of life, which other healthcare professionals are simply not in a position to be able to do?

My Lords, I certainly acknowledge the terrific role that chaplains play in end-of-life care. I pay great tribute to and thank them greatly for their work in this area.

My Lords, following the noble Baroness's earlier answer, would it be possible for the department to monitor how many people die either at home or in a hospice as opposed to in an acute hospital—which, as the research shows, is what most people wish to avoid?

My Lords, that sounds like a very simple question, and I would like to say that it should be possible to monitor those numbers, but I will have to look into it before giving the noble Baroness a definitive reply.

My Lords, can my noble friend indicate how the Government’s excellent strategy for the support of carers will link into this work, since the more people die at home, the more burden and distress is likely to fall on their families?

My Lords, one of the most important aspects of the new framework is that it is designed to engage with local people, and carers are extremely important within the community. It is also designed to ensure that there is much more joined-up action between local government and local PCTs. As local government actions and health in the community both have a great bearing on the lives of carers, I think that the framework will have greatly beneficial implications for carers.

My Lords, can the Minister explain what issues are making it difficult for the Government to decide that end-of-life care should be one of the 40 domains?

My Lords, it has been decided that there will be only about 40 outcomes and with so few it is not possible to cover every area in which noble Lords are concerned. However, I hear what the whole House is saying—that end-of-life care is extremely important. I am sure that the Government will take that into account when they decide.