HL Deb 31 October 1994 vol 558 cc692-5

2.48 p.m.

Lord Ashley of Stoke asked Her Majesty's Government:

Whether there has been any change in the responsibility of the National Health Service for providing care for terminally ill people.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

No, my Lords. The National Health Service continues to be responsible for purchasing services to meet the health needs of terminally ill people.

Lord Ashley of Stoke

My Lords, I am grateful for that reply. However, is the noble Baroness aware that directors of social services have protested that terminally ill patients who are about to die have been thrust on them, after being forced out of hospital, for assessments and means testing? Can she tell the House whether the Government believe that terminally ill people who need continual nursing treatments are entitled to that free under the health service, or do the Government believe that they should depend upon social care provided by local authorities?

Baroness Cumberlege

My Lords, I should be very surprised to learn of any cases where dying people were thrust onto social services without sufficient nursing and medical support. If there are individual cases, I shall of course take them up personally. The NHS has responsibility for people who are sick or who need health care; social services have responsibility for social care for those people. If medical care is needed, it is the duty of the National Health Service to provide it.

Lord Hailsham of Saint Marylebone

My Lords, in view of the religious needs of the terminally ill, will my noble friend pay tribute to the private hospices, provided by the Church and others, for their special care?

Baroness Cumberlege

My Lords, I am grateful to my noble and learned friend for this opportunity. Hospital chaplains are some of the unsung heroes of the National Health Service. They work extremely hard. The voluntary sector has led the world in the way in which we provide care for the terminally ill. Perhaps I can take this opportunity to pay tribute to the Duchess of Norfolk who, in her work for Help the Hospices, leads that movement: with inspiration and dedication.

Baroness Cox

My Lords, does my noble friend agree with all of us who have been associated with those who work in palliative care and hospices, and indeed in the home, that they deserve our profound admiration for their dedication to that work? Can my noble friend give an indication of the increase in provision made by the Government over recent years for that kind of care?

Baroness Cumberlege

My Lords, my noble friend is right in that, as stated by the World Health Organisation, the voluntary sector has led the world in this field. The growth has been outstanding. In the past 10 years the number of hospice beds has increased by almost two-thirds; and day care has increased four-fold. There has also been a substantial increase in home care, which my noble friend mentioned, which has increased three-fold in terms of the number of home teams—300 today compared with just 100 10 years ago.

Lord Cledwyn of Penrhos

My Lords, is the Minister aware that during the Recess I had the great privilege of opening a day care hospice in Anglesey? I was immensely impressed by the dedication of those who worked there, most of whom were voluntary workers. In the circumstances, can the noble Baroness say what help her department gives to the erection and maintenance of those splendid organisations?

Baroness Cumberlege

My Lords, it is interesting to see how palliative care—that is, care for dying people— is increasingly taking place in the home and also with the support of day hospices. They are crucial. We value highly the work done by volunteers, and we do so not only in terms of tribute through what we say, but also in the financial support that we give. In 1990 resources from central government amounted to £8 million; today it is £48 million. The increase therefore has been substantial over a four-year period.

Baroness Platt of Writtle

My Lords, is my noble friend aware how grateful the hospice movement is for the financial support, which is considerable, from the National Health Service for terminal and palliative care? I am sure that the Minister will agree that that is only fair in terms of freeing beds in the National Health Service. Is she also aware how important it is for hospices to feel secure in future years as regards National Health Service financial support if they are to continue, in a largely voluntary financial situation, to provide this important and much needed care?

Baroness Cumberlege

My Lords, I am aware that many people in your Lordships' House today are closely involved with the hospice movement, not least my noble friend. I thank her for the work that she does. She is right; we must give some security for the future. Indeed, the way in which we are now commissioning services through the new reformed National Health Service ensures that hospices know in advance the amount of money that they will receive. They therefore have some security in terms of future financing.

Baroness Jay of Paddington

My Lords, I am sure that we are all agreed in our congratulations and thanks to the voluntary hospice movement. However, will the Minister accept that there is still some anxiety in relation to the nature of National Health Service funding for continuing care, particularly after her department issued new guidelines on this subject earlier in the summer? Can the noble Baroness give us an assurance that no one who is in need of continuing medical care will be means tested because he has been transferred to the social services department? Will the Government take an active role in ensuring that the health service provision for continuing care, and particularly for those who are terminally ill, will be maintained?

Baroness Cumberlege

My Lords, a circular for consultation was issued earlier in the year. The closing date for responses was 10th October. We are now looking to see what the response has been from the various organisations which were consulted. But the circular is only to clarify the position. Social services have never given a free service. When I was the chairman of a social services committee aeons ago I remember that even then we were means testing for social care. The distinction is quite clear. Medical care is for the National Health Service to provide; but social care is for the social services.

Lord Ashley of Stoke

My Lords, as always, the Minister is extremely helpful. However, to clarify this final important point, can she assure the House that nobody who is terminally ill will be forced out of hospital and denied nursing care but will be pushed onto the social care of local authorities? Can she give us a categoric commitment on behalf of the Government in that regard? Can she also assure the House that she will discuss these issues with the directors of social services?

Baroness Cumberlege

My Lords, we have a continuing dialogue with the directors of social services. Since the community care Act came into being their responsibilities for social care have grown. In my experience the National Health Service is very compassionate. The last thing one would expect to see is people being turned out of hospital who needed medical or nursing care. Indeed, I tried to illustrate this afternoon that through day care, the home care teams and day hospices, people who require medical care receive it through the hospice movement, not only in hospices but also in the community.