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Health: End-of-life Care

Volume 697: debated on Thursday 13 December 2007

asked Her Majesty’s Government:

Whether patients at end of life are receiving the care to which they are entitled under the National Framework for NHS Continuing Healthcare which came into operation on 1 October.

My Lords, as part of the new National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, we have published a fast-track pathway tool to help clinicians make a decision on the need for urgent continuing healthcare for end-of-life patients. The framework was published in June and became mandatory in England on 1 October. We will review the framework in September 2008.

My Lords, I thank the Minister for that Answer. That fast-track tool is really the basis of my Question. Can he confirm that the primary care trusts are using that tool or an equivalent, speedy and effective process, as they have a choice? We were told that a document would be published in December—an end-of-life strategy—and we are now told that it has been delayed. Can he confirm whether it has been delayed and when it will be published?

My Lords, at the moment anyone at the end of life who needs it should receive continuing care under the new framework, as I said earlier. The noble Baroness refers to the end-of-life strategy document. Within the spirit of the NHS Next Stage Review, nine different strategic health authorities across the country have end-of-life clinical pathway groups, currently designing the best models of care based on international exemplars. Those different clinical groups have representation from health and social care and the voluntary sector which makes a tremendous contribution to the pathway. Those will be published in about March or April next year with the belief that a locally driven pathway will be easier to implement than a nationally enforced end-of-life pathway.

My Lords, given the known inequity in access to specialist palliative care services, and despite the much welcomed initiative that the Minister has just outlined in relation to strategic health authorities, can the Minister confirm that the delay in publication of a palliative care strategy will mean that palliative care services will be embedded in the long-term provision of health and social care and that it does not mean that the strategy is being shelved?

My Lords, I am grateful to the noble Baroness for mentioning the end-of-life strategy. This Government are committed to the pathway. In the history of the NHS this is the first time that such a pathway has been put together. We are committed to the pathway; we are committed to the commissioning of the pathway once it is launched; and we are working very closely with the voluntary sector. There are good exemplars of this across the country, such as Marie Curie Cancer Care in Lincolnshire which has implemented the pathway very successfully. We can learn from that exemplar as we implement it on a national basis.

My Lords, can the Minister inform the House whether there has been any advance in the problem of feeding frail and elderly people in hospitals? Has there been any advance in the idea, for instance, of involving families or volunteers more? Can he inform the House of anything that has been done in this regard?

My Lords, in my interim report, I published the principles on which the NHS Next Stage Review should be based, one of which was personalised care—in other words, tailoring care around the needs of patients. In-hospital nutrition is very much part of that. We are identifying pathways and models in which we involve not only nutritionists but also carers and the voluntary sector, which has a tremendous interest in this, in ensuring that the nutritional status of patients, either at the time of their admission, prior to their operation or when they are discharged, meets the needs of patients.

My Lords, are the needs of carers, as set out in the Carers (Equal Opportunities) Act 2004, being fully taken into account when assessments are made under the national framework, and how that will be monitored over time?

My Lords, on Monday we published the concordat with social services, including the involvement of carers, but on the specific point that the noble Baroness has raised I shall be more than happy to respond in writing.

My Lords, the Minister will be aware of a survey produced earlier this year which demonstrated that within one strategic health authority individual PCTs were 15 times more likely than other PCTs to recommend the provision of NHS continuing care. Given the fast-track tool for end-of-life care, what will be done to train staff to ensure that there is greater uniformity of assessment across the country?

My Lords, I am grateful to the noble Baroness, Lady Barker, as I agree that variations exist across the country. Recently—in a previous life—I led a review in London on the end-of-life pathway. I came across one shocking piece of information: 58 per cent of those who approach the end of life are dying within a hospital setting, in contrast to their preferences since about 60 per cent wish to die at home with their family and loved ones.

Interestingly, finances have never been the main enabler in this; mostly, the enabling has been in how we integrate the different providers of that pathway. Those include social care, health services and the voluntary sector. It is in how we provide the training, which was highlighted, to make sure that that pathway is not only integrated but also delivered competently so as to ensure that the patient achieves their preferred place of death.

My Lords, following on from that reply, I am sure that the Minister will be aware of recent research by the King’s Fund showing that the discharge community liaison nurses provide a really invaluable role in end-of-life choice, when people want to die at home. Are those nurses to be deployed across the country and, if so, on what timescale?

My Lords, I could not agree more. We need the integrator between health and social care, and those roles to which the noble Baroness, Lady Hanham, referred will be essential in that integration—and in getting rid of some of the virtual boundaries that we clinicians are good at creating.