Care of elderly terminally ill people
20 May 2009
I am grateful to you, Mr. Cook, for allowing me to say a few words, and I congratulate the hon. Member for Vale of York (Miss McIntosh), both on bringing to the House a subject of growing importance, and on dealing with it in a sensitive and thoughtful way. Care of the elderly is a measure of the civilisation of our society. When people are at the end of their lives, it is a stressful time for them and their families, and they require a lot of dignity and respect. I should like to declare an interest: my son is a consultant neurosurgeon who treats some of the hon. Lady's constituents at the neurosurgical centre in Hull and he often allocates beds for elderly people.
In January this year, Help the Aged, which is merging with Age Concern to make a single charity that will lobby on behalf of elderly people, and the British Geriatrics Society, produced a report in which they highlighted the fact that almost half the doctors who specialise in health care for the elderly think that the NHS is institutionally ageist. That is a worrying statistic, and I will say more about it.
First, we should put this debate in context. In the past decade, the Government have increased by a phenomenal amount the resources going into health care, on which they are to be warmly congratulated and for which they should be thanked. I am sure that whoever forms the next Government will continue that process but, unfortunately, the outcomes in the health service are not perceived to have increased or improved at the same rate, never more so than in relation to this matter, probably because people are living longer, which is a blessing. More seriously, the demands for care are growing consistently and will continue to do so.
The hon. Lady made the valid point that there are insufficient beds, but the really important point is patient choice. It is not so much a matter of how many beds there are in any one part of the system, but of ensuring that there is the right number of beds in each part of the system to meet demand, however many that is. There are different ways of caring for people when they are elderly or terminally ill, and it is important to ensure that there are sufficient beds in each part of the system to care for them, and to enable them to have choice between acute hospitals, community hospitals, the hospice service, nursing homes and family care at home. Different people will make different choices as to how they want to spend their last weeks, months and years.
I will focus on hospices, because the number of hospice beds determines how many beds will be needed in the NHS. I am grateful to the Government for the funding of the adult hospice sector—much more so than for the funding of the children's hospice sector, which is a different matter. The Government are funding the sector generously, but we must ensure that hospices remain essentially voluntary organisations funded by charitable donations, as that is their ethos and character, which is a good thing. However, we must also ensure that any care given by hospices that displaces care that would otherwise have to be given by the national health care service, and would thus involve providing beds, is properly funded. The NHS and the Government must continue to work with hospice centres to develop a proper service agreement under which the care provided by hospices is funded by the NHS, so that hospices can continue to provide service and increase service to meet demand. I know that the Minister is sympathetic.
The right hon. Lady—excuse me, the hon. Lady; she should be a right hon. Lady—made some excellent points on nursing homes, but the problem with nursing homes is the formula for deciding how much a family must pay in top-up fees for the bed provided. I am aware of one particular case involving a lady who had a stroke eight years ago and has not said a word since. She is doubly incontinent and cannot speak, stand, eat or support herself sitting up, yet her family must pay several hundred pounds a month in top-up fees for what is obviously nursing care, which traditionally would have been provided in a long-term hospital bed. Eight years after the stroke, the family is having great difficulty paying the top-up fee. The lady was reassessed recently, but the family must still pay just over £106 a week in top-up fees. That is not good enough.
The Government are not only short-changing families but themselves, as the situation means that people stay in hospitals because they are not happy to move to homes. The Government are missing a trick. If they were a little more generous, and ensured that social services were more generous in assessing the nursing care element, we could get more people into residential homes where they would have society and a better quality of life and would be nearer their families. All in all, that would be a good deal for the individual and for the public purse.
On care at home by the family, there are some wonderful, heroic families who care for loved ones at the end of their life. They can do so only because of the fantastic support that they are given by Macmillan nurses, who take a lot of pressure off the NHS to provide beds in hospitals. We must never lose an opportunity both to congratulate Macmillan nurses on what they do and to promote their activities. I have probably said enough, so I will end by quoting Help the Aged and the British Geriatrics Society, which said that the NHS must
"stop being service-led and become people-centred",
and must do it soon. I know that the Minister is doing all that he can to move in that direction
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