Stephen O'Brien MP: The end of life care strategy

Stephen O’Brien MP is the Shadow Health Minister and MP for Eddisbury. The Conservative Palliative Care Policy is included in ‘The Patient will see you now, Doctor’.

Politics lends itself to the imagery of death – to topple a minister is to ‘gain a scalp’, to broach certain topics is ‘career-death’, the New Labour version of spin is to “bury” bad news, and, of course, we all are waiting for this Prime Minister to be ‘stabbed in the back’.

Yet I have no doubt that politicians are at one with our constituents in avoiding considering our actual mortality and that of our nearest and dearest, and the Government’s End of Life Care Strategy makes welcome mention of that fact – with fewer people dying at home (one in five of the 500,000 that die each year, as against the two thirds who would like to), our experience of death has been relegated to fictional narratives and inoculating news cycles.

‘Dying isn’t a very sexy subject for news editors’ - Janet Street Porter in the Independent echoes in Alan Johnson’s complaint, but Thursday’s papers rose manfully to the debate with both the Mail and the Times including moving personal accounts of death and dying, alongside broader news and comment articles.
The broad thrust of the Government’s End of Life Care Strategy is to support rapid response palliative care teams to enable people to stay in their own homes as they approach the end of their lives, based the Marie Curie delivering choice pilot, underpinned with £88m in 2009/10 and £198m in 2010/11.

Whilst, as with all policy interventions in emotionally complex areas, it is hard to look the gift-horse in the mouth, the Mail, the Times and, uncharacteristically, the Mirror, identified the holes in the Government’s strategy. Dr Stoppard in the Mirror was ‘sceptical about these proposals being put into practice’, on the grounds that dying at home takes not only a commitment from palliative care providers, but families and carers too. 

Nigel Hawkes in the Times led with the wry headline Promise may fit the manifesto: will it meet the need picking up on the notes to the Government press release which stated:

"In its manifesto in 2005, the government committed to double the investment in palliative care. Given the lack of data on the cost of end of life care services, a decision was taken to interpret the manifesto commitment to mean doubling funding for specialist palliative care services.

It is estimated that when the manifesto commitment was made in 2005, expenditure on specialist palliative care services by the NHS was about £180m. This is, therefore, the amount of additional funding calculated to be needed to meet the manifesto commitment."

What no columnist pointed out was the Government’s broken promise over introducing Payment by Results (PbR) – the pay-per-episode system on which the NHS’s internal market is based – into the palliative care sector. At the moment, palliative care services are outside that system, so they still block contract with the NHS. This means they are paid not the cost of the care they provide, but a sum which falls far short of it: the upshot is that charitable giving subsidises the tax-payer funded NHS. 

The Government promised PbR in its response to the Health Committee Report on Palliative Care. What is more, they said “the national tariff will, in effect, provide the full cost recovery recommended by HM Treasury’s Cross Cutting Review on Voluntary and Community Sector in Public Service Delivery”. In that review, the Treasury, under Gordon Brown, committed all Departments to “ensuring that the price for contracts reflects the full cost of the service... by April 2006”.

The role of hospices in the strategy was summarised thus:

"there will be new opportunities for hospices, working as part of an integrated locality. As independent organisations, voluntary hospices will have the opportunity to take on new roles in agreement with their local PCTs."

Past the GovSpeak, this means, as Nigel Hawkes again pointed out, “if local leaders opt to spend the money on something else, nobody is going to stop them”. It is also a surprising sidelining of residential palliative care, which is after all where Dame Cicely Saunders started.

The strategy rightly identifies caring for the dying as an indicator of how we care for all sick and vulnerable people. In addition to being the right thing to do, effective palliative care is integral to enable death with dignity as people come to the end of their natural lives. But despite moving the debate forward the strategy is a missed opportunity, too much informed by the politics of manifesto commitments and white-washing another of Macavity Brown’s broken promises.