HC Deb 30 June 1999 vol 334 cc402-12

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Dowd.]

7.6 pm

Mrs. Virginia Bottomley (South-West Surrey)

I am privileged to have the opportunity to address the House on an intensely important matter that is rarely discussed on the Floor of the House and is almost as widely ignored among the vast majority of people. The subject is bereavement.

The few speeches and debates about death usually fall into one of two categories: how to stop it and how to make up for the lost wages. We can never prevent death. As Benjamin Franklin, the leading US political philosopher and inventor of the lightning conductor, said 200 years ago, in this world nothing can be said to be certain, except death and taxes. Whereas in Victorian times there was much discussion and debate about death, but sex was taboo, in our generation, there is much debate and discussion about sex, but the question of death has become taboo. Debates about how we can prevent death are numerous. Of the 220 all-party groups in the House of Commons, around one in five concern health or health-related matters. In last week's debate about widows pensions, we talked about making up for lost wages and the upgrades to provide for widows, but no mention was made of the emotional difficulties of bereavement counselling.

For many years, I was vice-chairman and am now vice-patron of what is now the Carers National Association, which came into being to provide support and recognition for carers. For those who have been caring for an elderly relative, the experience of bereavement and being left on their own and isolated after the death of their loved one causes at least as much difficulty.

There have also been debates about the regulation of the funeral industry. There has been a welcome for the expansion of the voluntary funeral ombudsman service. Around 21,000 people are involved in the funeral industry. They require greater recognition, more training and more respect in the community. The National Association of Funeral Directors has introduced excellent initiatives on that, but people still tend to be bashful about saying that they are an undertaker and they are not regarded as being as important to the community as midwives.

Inevitably, death is usually seen as intensely personal, or too frightening to discuss and accept for what it is. When discussing the television film about the man who had his own process of death filmed, Lord Winston—who, appropriately, is a professor of fertility studies at Hammersmith university—recently said: We live in a society which hides death because it is beyond our control and, partly in consequence, we are terrified of it. In hiding death, we make it a taboo. There have been other interesting accounts, such as Virginia Ironside' s book "You'll Get Over It: the Rage of Bereavement", in which she describes how, before her father died, she thought that she knew a little bit about bereavement: In my job as an agony aunt I would blithely send out leaflets to bereaved people full of kindly, sympathetic advice, telling them about stages of grief. Colin Murray Parkes is a president of Cruse, and his academic work and practice have helped us understand more about the process of bereavement, and made an enormously important contribution.

Virginia Ironside said that when her father died nothing made sense. Perhaps he was resting in peace", and that grief was only a minuscule part of the process … with other shameful feelings of rage, greed, loathing, hatred for life; physical feelings of lethargy, shooting pains in my legs, a permanent ache in my neck, and a new, embarrassing interest in religion and the afterlife. And there was relief. He had been a loving but emotionally and intellectually dominating figure. Now he was gone I could breathe. And yet how can anyone breathe when consumed by the fury of loss? That is an open account, but typical of the experiences that people have when, without previous thought, preparation or consideration, they find themselves in the turmoil of bereavement. That contrasts starkly with the process of childbirth, for which there are preparation for parenthood classes, the National Childbirth Trust, support from health visitors and so on. People understand that childbirth is a life stage with implications both for themselves and for their immediate families.

However, there is little to help prepare grieving relatives, work colleagues and associates for death. Fortunately, in 1959, Cruse was founded by Margaret Tome, OBE, who was concerned about the isolation and poverty of young widows and their children. She established the first group, in the Richmond area, and supported many young widows and helped them to find ways of surviving emotionally and financially.

As a result of the publicity, other Cruse groups were formed around the original group, offering support not only for widows, but for others affected by death, including children, and people of all ethnic and religious backgrounds. Today, for example, three out of 10 of those who seek assistance from Cruse are widows, one in eight are widowers, one in three have lost a parent, and one in 10 have lost a child. The picture of bereavement moves on.

I used to support Cruse when I was a Minister at the Department of Health. I was also approached by Cruse in my constituency to speak at a fundraising concert in Guildford cathedral. In the light of my on-going interest in the activities of Cruse, I am pleased to say that it has asked me to be a patron, so I should declare that interest to the House.

Now, under the leadership of its executive director, Dr. Carole Easton, Cruse is still based in the Richmond area and after 40 years, it is busy preparing itself for the challenges of the next generation and the next century. There are now 188 branches throughout the United Kingdom, and I am pleased that it is acknowledged by the Home Office as a lead voluntary organisation for dealing with major disasters in the United Kingdom.

Cruse has certainly gained the respect of many in the medical profession, and 45 per cent. of its clients are now referred by their general practitioners or other health professionals. At this moment, the General Medical Council and others are discussing, with the all-party group on primary care, the nature of GP training. Before I left the meeting early, I said that one of the important steps in the training of GPs, and all medical professionals, should be how to handle death. It is a difficult and sensitive subject for the professionals involved as much as for bereaved families.

The challenge now is to ensure that everyone in the United Kingdom knows about Cruse. People need to know that there is a place where they can get help in dealing with the complex and intense emotions associated with death. They need not only support and comfort, but practical advice. The complexities of death—such as the forms to be filled in and the process of organising a funeral service—do not come routinely, and are not widely understood.

It is not only bereaved people who need to know about Cruse. Employers, health care providers, ministers of religion, educators and family and friends all need to know that the best support that they can give someone struggling with a loss is to lead them to someone else—someone who has been trained to deal with bereavement.

The services that Cruse offers are varied. Each bereavement is different. There is no one way to help someone to cope with a loss. The different branches across the country are flexible. The focus is on counselling, but they also act as a source of practical information and practical assistance. Some clients are seen in their own homes; others attend the centres; some choose to talk on the telephone.

At the latest count, there were 154 social groups, 165 specialised groups, including groups for the recently bereaved, and 60 drop-in centres. Last year, they provided face-to-face counselling for more than 21,000 clients, counselled 5,500 clients over the telephone and received 110,000 requests for information about their services and about surviving a loss.

Each year in this country, about half a million people die, and only a fraction of the bereaved look for specialist support and help. However, investing in caring for those people at the time can often lead to safeguards for the future, better functioning and a less prolonged mourning period.

There has been an increase in the more traumatic forms of death. Anyone who has acted as a Minister with responsibility for roads will have met many parents of young people who have been killed in traffic accidents. Sudden death is often all the more distressing—not only from traumatic causes such as a road accident, a murder or a heart attack; any form of death that has taken the family unawares can leave people feeling confused, angry and needing help.

Perhaps the most worrying aspect of the loss of life for this generation is the growing number of people who take their own lives. More young men now take their lives through suicide than are killed on the roads. When people take their own lives, the effect on parents, grandparents, siblings and friends is all the more distressing and traumatic. There is associated guilt, anger, perplexity and sadness, and people often need expert help and support to talk that through. Cruse has created specialised groups to provide care for those who have lost loved ones from a range of particular causes.

The population is ageing; that is well understood—but it leads to a need to change the services designed to help people who are bereaved. Old people are more likely to have to deal with death alone when a spouse, child or friend dies. They are more often left isolated, with nowhere to turn and no one to turn to. More than 30 per cent. of those who seek assistance from Cruse are over 60.

Cruse has been able to establish itself as a link between the elderly and bereavement care. With the advances in modern medicine, it is crucial that Cruse maintains its connection with elderly people. People who live longer will see more other people die. Elderly women, especially, are at risk, because their life spans continue to exceed those of their spouses—and in many cases, those of their children.

We in this country pioneered the development of hospices: a concept that is now respected around the world. The hospice movement has effectively removed the physical pain of death and dying, but that still leaves a huge gap in emotional and practical support, for which we must provide better services. There are complexities involved if people are bereaved when they are homeless or in prison. The growing number of divorces has led to more complex and ambivalent feelings. When someone dies who was long since divorced, the experience can bring back many old sensitivities and hurt feelings.

Cruse works through a remarkable army of 6,500 volunteers giving from two to 10 hours a week of their time. They certainly deserve our gratitude. Many know how hard it is to offer condolences to a friend or colleague who has experienced a loss. Cruse's commendable volunteers give their time to help those who need a kind word, a shoulder to cry on or an attentive ear.

In this generation, there is a need to refocus on the importance of that gift relationship and the role of volunteering. I hope that more people will feel that becoming a Cruse volunteer is a constructive way of investing back in the emotional and social fabric of their community. In my constituency, Cruse operates the Guildford and Waverley branch, based in Godalming. I want to express my profound appreciation, on behalf of the local community, for the effective and professional support that it offers my constituents.

Cruse's plans for the future will succeed as long as the Government are able to give their support, encouragement and authority and help it to overcome the complex labyrinth of funding mechanisms, grants and available resources. As it moves to the next decade, Cruse is planning improvements to make it even better able to provide help to the bereaved. Its development plan proposes that it further diversifies the services that it offers, giving more support, information and advice.

Branches need back-up and professionalism. Today's public are discriminating consumers of services and demand a professionalism that may not have been so essential in years gone by. Management of the branches will be restructured so that the volunteers can concentrate on delivering the services and receive better support and back-up from headquarters. All the change is being led by the executive director, Dr. Carole Easton. She is undertaking a major consultation exercise with the branches to prepare the organisation for the next century.

The key millennium project that Cruse wants to undertake is to develop a national Cruse helpline: a telephone number that anyone anywhere in the country can ring to get advice, support and encouragement. It wants to establish a centrally answered telephone service that is readily accessible to anyone, including deaf people and non-English speakers.

Inevitably, like almost every not-for-profit organisation, a crucial and central preoccupation for Cruse is how it can secure the funding to maintain its services. To offer increased services, volunteer training and numbers need to be increased. Cruse needs funding to allow it to recruit, train and support effectively volunteers of all ages and ethnic backgrounds.

Last year, Cruse helped 110,000 people at an average cost of only £23. It has done remarkable things with the little money that it has. It can continue to do that, but it needs and deserves increased income. Its current income is simply not sufficient to allow it to expand its services to the extent of its potential.

The question is how we can help Cruse to provide the best possible support. Almost everyone who has had experience of Cruse wishes that more people knew about its services. If it is to raise its profile and expand its services it needs to expand its budget.

I want in fairness to acknowledge the funding that the Government have provided. This year, Cruse was granted £60,000 a year for three years for a quality care-in-bereavement project. Last year, it was granted £40,000 a year for three years as part of the regional support network project. In 1997, it was granted £150,000 over three years as part of that project and in the same year it received £97,000 over three years for an equal opportunities officer project. Time and again, Cruse receives a packet of money for a specific project, which is welcome in itself but does not solve the underlying problem of core funding to support its headquarters and the services that it provides every day.

I am delighted to report, as an echo of days gone by, the number of lottery awards that Cruse has received. There was a phase in my life when every question that I had to answer involved how many lottery awards had been made available for a project. Cruse has received 29 National Lottery Charities Board awards, totalling £837,000, ranging from £120,000 for a training and development programme to £736 towards the start-up costs of a group in east Sunderland.

I hope that the Minister will be able to help Cruse to access more substantial sources of funding. There are several initiatives under way that may offer Cruse an opportunity. "Our Healthier Nation" identified mental health as an area in which the Government want the national health service to make more progress in preventing ill health. Is it possible to consider some of the mental health sources of funding?

In exploring resources locally, Cruse branches have found that they get sent from the primary care group back to the mental health trust and on to the health authority or social services. Are there any guidelines to make it clear which was likely to be the primary source of funding for a project as evidently worthwhile as Cruse?

Savings can be made in long-term mental health services and people will be able to invest in other aspects of education and employment if they can overcome the mourning process more swiftly, so supporting Cruse provides excellent value for money in the true sense of the phrase. In a study published in the European Journal of Palliative Care, Marilyn Relf argues that support from volunteers leads to bereaved people using their GPs and medical services less. Any way of saving the NHS money is welcome.

I hope that the Minister will appreciate that it is of the utmost importance to assist Cruse to meet its funding challenges. Many elderly people have mobility problems, so it needs to expand its capacity for home visits. Above all, there is the national Cruse helpline, which will need core funding and assistance.

There is a difficulty that is becoming progressively more evident. I suspect that the Minister is already aware of it. I spoke this morning to Marjorie Wallace of Saneline who, like the supporters of Childline and the Samaritans, believes that the establishment of NHS Direct has led to a strangulation of funding for the other national helplines.

I appreciate the difficulty of Ministers funding all their pet projects, but if £14 million goes to NHS Direct while all the existing, highly professional and valued helplines wither, it will be seen to be an error of priorities.

NHS Direct will undoubtedly take calls from those for whom bereavement, mental health or children's difficulties are the primary concern. I believe that NHS Direct will need and benefit from the experience and specialised expertise of those professional national helplines. Therefore, I very much hope that the Minister will be able to re-examine that particular difficulty.

The deeply moving funeral of the late Cardinal Hume was held only last Friday. Not very long ago, the nation suffered an enormous outburst of grief at the death of the late Diana, Princess of Wales. The emotion surrounding those two events—perhaps like the effect in "Four Weddings and a Funeral" of the reading of W. H. Auden's poem—are modern examples of occasions on which attention has been focused on death and bereavement. Nevertheless, the subject is all too rarely debated in the House.

I believe that the Minister could raise the subject's profile, and increase not only the acceptability of seeking specialist help, but the availability of help in dealing with a specific crisis in family life. The Government's communication skills exceed all others, and I hope that the Minister will be able to help to identify Cruse as an organisation for which the Government have special regard.

I have some specific questions. First, how can the Minister help Cruse to raise its profile, to ensure that people know about it without having to struggle to discover it? Secondly, has he visited the Cruse branch in his constituency or in any other constituency? Thirdly, what research is being done on bereavement care? Fourthly, what can the Government do to help Cruse to keep functioning for another 40 years? Fifthly, will there be more joined-up funding for Cruse from various Departments? Although I realise that it is not easy to have responsibility for millennium volunteers, lottery awards and health funding, we really should have a map and a navigator on the bereavement issue. Sixthly, how will the Government help Cruse to celebrate its 40 years of service? It is certainly hoped that the Minister will attend the party that Cruse hopes to hold for hon. Members—on 20 October, on the Terrace—not only to celebrate its success, but to discuss its plans for the future.

Above all, in thanking the Minister for being here to reply to the debate and in welcoming the workings of the House, which enable us to continue this debate until 10 o'clock—I do not want to cut short the hon. Gentleman's remarks in any way—I ask him to join me in congratulating Cruse on 40 years of service and in commending its staff and volunteers for all their hard work and dedication to helping others.

7.33 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)

I warmly congratulate the right hon. Member for South-West Surrey (Mrs. Bottomley) on raising the subject of bereavement and drawing the House's attention to the outstanding service that Cruse provides. I should also like to congratulate her on her recent appointment as a patron of Cruse. The House will be very well aware of her long-standing interest in mental health issues.

The right hon. Lady has asked me some specific questions, and I certainly want to answer them in my speech. However, she started her speech by saying that bereavement is a taboo subject, and she was right about that. Nevertheless, bereavement is something that we shall all experience.

Bereavement might be coupled with feelings of guilt—to which the right hon. Lady referred—particularly if an elderly relative has died in residential care, for example. There may be difficulties for working-age adults, when a partner is left behind, not only in coping with their loss, but also perhaps with a young family. There may be trauma for younger children facing the death of a parent, or for parents facing the loss of their child.

Our concern should extend beyond the effects of bereavement on family and friends. The attitudes of staff in the national health service and in various agencies are very important in helping families or loved ones to begin to come to terms with their sense of loss. It is therefore very important that staff working in both the NHS and social services are sensitive to the needs of the families of their patients. However, it is also important that they do not "medicalise" normal grief reactions.

The care offered need not be specialist help: much of it is common sense. Staff need to keep relatives up to date about the condition of a critically ill family member, and support them when told of his or her death. People need practical information, such as guidance on necessary post-mortem procedures, on contacting funeral directors—to which the right hon. Lady referred—or on notifying friends or relatives of the death.

The right hon. Lady rightly mentioned some of the wider issues in death and bereavement, not the least of which is the economic cost to the nation of bereavement, which some estimates place as high as £800 million annually.

The right hon. Lady also rightly spoke extensively about the work of Cruse. I associate myself and all my colleagues in the Government with the very warm words of praise that she expressed about the work of Cruse, which is the major organisation in bereavement counselling. The healing process following a bereavement can take a very long time, and the bereavement counselling done by Cruse can play a big part in that process.

In opening its doors to all bereaved people, Cruse bereavement care offers a free and confidential service to all those who need it. The trauma following bereavement can affect all ages and, without sensitive care, can often lead to other problems. I pay tribute, as the right hon. Lady did, to Cruse's work.

I have already mentioned young people coming face to face with death. Ensuring the mental health of children and adolescents is a matter of key importance for us all and is among the Government's national priorities for both health and social services in the next three years. It is an important issue, as mental health problems in young people not only hinder their own life opportunities but create distress for their families, obstacles for teachers, and tensions in the wider community. We are therefore dedicating new resources—£84 million in the next three years—to supporting the development of effective child and adolescent mental health services.

Cruse is certainly to be congratulated on the introduction, in March 1998, of a new national "Youth Line" service to help bereaved children and young people to come to terms with their loss. The telephone helpline gives young people the opportunity to talk to a trained counsellor about their loss, to explain in confidence the particular difficulties they are facing, and to receive advice on how to cope.

Much can be achieved in promoting the mental health of young people by helping them to cope with major life events and experiences, such as bereavement and parental discord and divorce. The death of a parent is a particularly well-recognised risk factor in the development of emotional and behavioural problems. In such times of distress, young people may welcome the opportunity to talk things over with someone outside the family circle who is knowledgeable, sympathetic and easy to approach. Voluntary groups have traditionally played a very significant role in providing information, advice and counselling in an informal and user-friendly way. Cruse is already providing precisely that type of service.

The Government recognise the vital role that Cruse plays in offering a free nationwide service—to a consistently high standard—of counselling, information and social support to anyone who has been bereaved. It also offers training, support, information and publications to those who work in caring for bereaved people, and increases public awareness of the needs of the bereaved through education and information services. That is why we have supported Cruse with section 64 grants for several years. For example, we gave Cruse core finding for five years, until last year, amounting to over £500,000, and are providing grants for four of its projects, some of which were mentioned by the right hon. Lady.

The first project is development of a regional support network, which aims to develop and maintain Cruse's network of local branches by developing the role of its regional officers. The officers provide support and training for Cruse volunteers and help to maintain quality standards and monitor all aspects of work of local Cruse branches. Funding for the project is £50,000 per annum for three years, which started in 1997.

The second project, on the development of regional support for bereaved people and Cruse volunteers, aims to provide support in training and management for Cruse volunteers in central and northern England, to ensure proper communication between their headquarters and support groups and to develop and maintain a Cruse branch network in those areas. The project also helps develop new branches of Cruse in those areas. We are funding this project for three years from 1998–99 with £40,000 for each year.

In addition to that support, we are helping the equal opportunities officer project, which seeks to promote good and consistent equal opportunities practice among Cruse branches. The project grew out of a recognition that Cruse needed to broaden accessibility to the services that it provides to clients and potential volunteers from all sectors of the community. We gave this project £35,000 in 1997–98, £32,000 in 1998–99 and £35,000 in this financial year.

Finally, the quality care in bereavement project is designed to ensure that all clients of Cruse receive the best possible care, support and information. The project defines what is essential for quality care and ensures that the mechanisms to deliver it are in place. The Department began funding this project this year and will continue to do so until 2001–02, with £60,000 for each year.

In answer to a question from the right hon. Lady, let me say that the Department is not funding any specific research into bereavement care at present. However, I should be happy to discuss with Cruse representatives any ideas that they might have in that regard.

In total, our financial help for Cruse this year amounts to nearly £200,000. That is an indication of how well we regard the organisation and how strongly we support its aims. As the right hon. Member for South-West Surrey knows, I have already arranged to meet Cruse's director, Dr. Carole Easton, next week. I look forward to that meeting so that she can tell me at first hand of the work of her organisation. We will also discuss how the Government might be able to help with plans to develop a national telephone helpline as part of Cruse's millennium project. The right hon. Lady asked specifically about that, and I can confirm that we shall be happy to discuss any detailed proposals that Cruse might want to put to us.

My Department has been a supporter of a number of voluntary organisations that run helplines. They include Sane, the Samaritans and the National Schizophrenia Fellowship. We have been doing some work with the organisations to see how they can best be linked to the NHS Direct helpline. That helpline may be best placed to offer general advice about local service provision, with the voluntary organisations able to offer specialist advice on mental health issues, as appropriate.

Again, the right hon. Lady drew my attention to the work of the Saneline service, and I want to place on record my appreciation of, and admiration for, what that service provides. We certainly do not want that service to wither on the vine. In the near future, I hope to be able to discuss with Sane its concerns in more detail.

Indeed, this Government recognise fully the vital role that voluntary organisations such as Cruse play in helping people cope with their grieving and the loss of a loved one. Apart from Cruse, we are also funding three other organisations that deal with bereavement to the tune of some £90,000 in the current financial year. People suffering a loss often turn to the voluntary sector first, because it is seen as user friendly and perhaps more understanding of the difficulties that they face, and because it is regarded as having a sympathetic ear.

It is important for us all to remember and recognise the important role played by the wider voluntary organisations in promoting mental health and meeting the needs of the mentally ill. Much of the innovation takes place in that sector and we must make sure that we learn from their experiences. We are supporting some 64 voluntary organisations working in mental health with some £4.2 million of funding this year. That is a record sum.

We should also keep in mind that mental health problems are as common as asthma. Mental health is not, therefore, a marginal issue for the NHS or for social services. Improving the mental health of our country is one of the new national priorities for health and social services.

In recognition of that, we have launched the biggest investment and reform programme for mental health since the inception of the NHS 50 years ago. An extra £700 million will be invested in improving mental health services over the next three years. To underpin that investment, last December, we published our strategy document on modernising mental health services, which sets out the direction of travel for the national service framework for mental health.

That strategy will address unacceptable variations in services across England. It will set national standards for both health and social care, and establish performance indicators to measure the progress made by services, ensuring that they all meet basic criteria. It will address the whole range of mental health service provision, from primary care—where the majority of mental health problems can be managed—to specialist mental health services

Many, indeed most, of those who have suffered a recent bereavement will be in contact with their general practitioner or with other primary care health professionals. Older people may make that contact for their own health needs, and a general practice or district nurse may be in a prime position to identify their grief and the effects of bereavement. For others, the GP and others in the primary care team will have cared for their dying relative: either way, primary care staff have a unique role.

I am very conscious of the need for a primary care work force able to deliver consistent, good-quality, primary mental health care to people who have been bereaved and who, as a result, are often depressed and vulnerable in both their physical and mental health. Many primary care teams do just that, but we know that depression may often be missed, especially when concurrent with other physical health problems.

I and my colleagues in the Department want the national health service to ensure that people who are bereaved and who present to their GP are properly assessed for their mental health needs and offered effective help and treatment, with referral to specialist services where appropriate. Primary care teams, along with specialist mental health services and social care agencies, should agree and implement protocols to that end.

We also want to make sure that grieving patients receive adequate information about the process of grief, their depression, and its management. Finally, we want to make available adequate information about the local voluntary agencies and self-help groups, such as Cruse, that can offer people expertise and services complementary to those of the NHS.

I therefore reassure the right hon. Member for South-West Surrey that we are continuing to support Cruse and that we value highly the service that it provides to our fellow citizens. I join with her in congratulating Cruse and all its staff and volunteers on their excellent work in this difficult but very important area. I also join with her in hoping and expecting that Cruse will continue that tradition for another 40 years.

Question put and agreed to.

Adjourned accordingly at twelve minutes to Eight o'clock.