Health Committee

No 28, Session 2003-04                                           21 July 2004


Palliative Care -  Report Published

Chairman David Hinchliffe said:

"The right to a good death should be fundamental. Care and respect of those with terminal illness is a key indicator of society's values.

We hear much of the 'choice' agenda in the NHS at present. But for those who are terminally ill, choices are not being realised. Around 55% of people die in hospital but many of these individuals would prefer to die at home-in fact, fewer than half of those wishing to die at home do so. A number of barriers prevent them. We would like to see more done to support people in their own homes. We call on the Government to consider advances in care currently being achieved in Canada and in particular to introduce a statutory right to a period of paid leave for carers. We have also-as so often-encountered problems in the gap between personal social care, which is means tested, and healthcare, which is free. It is high time this divide was overcome and an integrated structure produced.

We found worrying evidence of inequities in service provision. Some affluent areas have plenty of hospices, for example, while others have few. Those with complex needs, or from black and minority ethnic communities seem less able to access services. We hope that the best practice that exists patchily will be rolled out nationally and that the representation of the National Partnership Group for Palliative Care will be widened. As we have found in previous inquiries, there seems to be a gap in provision between children and young adults. We call for the NSF for Children to acknowledge the difficulties here. Above all, there is a huge mismatch between provision for cancer services and that for other illnesses. Around a quarter of us will die from cancer, but over 95% of hospice places are taken by those suffering from that disease. Those who are terminally ill with, say, motor neurone disease, or heart disease are most unlikely to use specialist services. So we call for the NSF for long-term conditions to incorporate the key principles of the NICE guidance on supportive and palliative care as far as possible to remove the bias against treating other diseases.

The Treasury cross-cutting review in 2006 will entail the state paying for the services which it currently receives with a large subsidy from the voluntary sector. I hope that this will be used as an opportunity to provide more equitable provision, with funding being provided-and if necessary withheld-according to need.

I want to be clear that the Department deserves much praise for recent initiatives in palliative care. The workforce is set to double by 2015, over £50 million has been put into services, and particular funding is targeting black and ethnic community projects and services for children. Protocols for care of the terminally ill are doing much to improve standards of treatment by non-specialist services and we call for them to be introduced as quickly as possible.

Finally, it has to be acknowledged that death has become a taboo subject and that the fact of death is much less visible to young people today than it was in previous generations. So we call for moves by the Department for Education and Skills to examine the place of education about death both within the curriculum and teacher training."

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Amongst its other recommendations the Committee calls for:

  • The Department of Health (the Department) should consider the Marie Curie analysis of the potential cost benefits of more patients dying at home which one Minister (Stephen Ladyman) said could produce "massive savings".

  • The Department should review the place of domestic care within social care services and ensure that people's needs for domestic help are adequately supported and that aids and adaptations are made in people's homes to allow them to stay there during their last days.

  • The Department should develop national criteria for continuing care to remove anomalies between Strategic Health Authorities.

  • The Government should consider whether the exclusion of patients in hospices from the delayed discharges legislation is having a deleterious effect on these patients.

  • The Department should analyse the index of need drawn up by the National Council for Hospice and Specialist Palliative Care Services to assess whether a better match between need and provision can be agreed.

  • The Department should review the regulatory inconsistencies that beset hospice and palliative care service providers and remove these.

The Health Committee will publish its Fourth Report of Session 2003-04 on Palliative Care (HC 454-I) on Thursday 22 July at 10:00 am. A press conference will be held at 10.00 am in Committee Room 8 on Thursday 22 July.

Volume II containing oral and written evidence will be published on Monday 26 July.

Confidential advance copies of the report, which will be embargoed until 10:00 am on Thursday 22 July, will be available for collection on Wednesday 21 July between 11 am and 12 noon from the reception desk at 7 Millbank, London SW1.

Please present this Press Notice; a signature will also be required.

Advance copies of the report will also be made available to the Press from the Press Gallery, House of Commons, at 11 am on Wednesday 21 July. Witnesses' copies will be posted to them.

Following publication, copies of the Report will be on sale from the usual Stationery Office outlets (tel. 0845 702 3473) and the Parliamentary Bookshop (tel. 020 7219 3890). Following publication the Report may also be viewed at:

The Health Committee is a Select Committee of the House of Commons. It is appointed under Standing Order No 152 to examine the expenditure, administration  and policy of the Department of Health and associated public bodies. The Committee has power to send for persons, papers and records.