Last orders

Norman Warner on the rationale behind his Bill on the right to die at home

Today, I will introduce a Private Members Bill into the House of Lords to give people the right to choose to die at home. I want people to have as good and dignified a death as possible, with their friends and family around them. That is more likely to be achieved if they have a right to register their preference for dying at home or their place of normal residence – rather than in the hectic and impersonal environment of an acute hospital ward.

Around half a million people die each year in England, about two-thirds of them over the age of 75. A century ago, most of us would have died in our own homes. Today most of us will die in hospital. In 2012, around 42 % of people were dying at home or in a care home – an improvement from 38% four years previously. But on present trends it will be the end of the decade, at least, before half the deaths occur in the place of usual residence. And this improvement in the national figures conceals considerable regional variations. If you live in the south-west, with 48% of deaths occurring in the place of usual residence, you have more choice than those of us living in London where the percentage drops to 35%. There is an even wider variation between local authority areas.  

The great majority of us want to die at home or the place we normally live. Perversely, we end up not only dying in the place we least want to be but in the most expensive place. 

Marie Curie research has shown that a week of palliative care in the community costs about £1,000, whereas hospital in-patient specialist palliative care for the same period costs virtually £3000. The National End of Life Care Programme shows an estimated potential net saving of £958 per person if you die in the community rather than hospital. Macmillan polling has shown that 8 out of 10 health and social care professionals agree that community-based end-of-life care would save money. On top of this, 9 out of 10 MPs think their constituents should have the choice to die at home. 

Let me be clear. I am not trying to dragoon people into dying outside hospital to save money. But it would mean fewer people dying in hospital and would reduce pressure on A&E departments and acute hospital beds – a not inconsiderable benefit given current NHS clinical and financial pressures. There is every prospect that the cost-savings involved would pay for exempting terminally-ill patients from local authority social care charges – another way of improving people’s end of life experience.

What’s not to like about my Bill? It is very straightforward in that it enables people to ask their GP to register in their medical records that they wish to die at home or the place they regard as home. The Bill gives the Health Secretary the power to produce regulations to achieve this, and to require health and care staff to honour the wishes of patients in accordance with statutory guidance.

All political parties are in favour of greater patient choice at the end of life. I hope that a cross-party consensus can be achieved to provide the parliamentary time for legislation to be scrutinised and passed to achieve the main objective of my Bill: that our last orders are followed.

Lord Norman Warner is a backbench Labour Peer and a former Health Minister

Published 28th July 2014