'Rights' of passage - revisited

Warnernorman4x3.jpgNorman Warner on giving terminally ill people the choice to die at home 

Today, I am moving an amendment to the Care Bill that would give NHS patients a right to choose to die at the place they regard as home. It also enables terminally ill patients, with 6 months or less to live, to be exempt from adult social care charges and to have their needs for care and support to be assessed urgently.

Around half a million people die each year in England, about two-thirds of them over 75. A century ago most of us would have died in our own homes. Today, we mostly die in hospital. The latest figures show that in April 2012 about 42 % of people were dying at home or in a care home – up from 38% four years previously. On present trends it will be at least the end of the decade before half the deaths occur in the place of usual residence. The 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 living in London where the percentage drops to 35%. And there’s an even wider variation between local authority areas. 

The great majority of us want to die at home or the place we normally live rather than the impersonal environment of a hospital ward. Perversely, we end up not only dying in the place we least want to be but also the most expensive. Marie Curie research has shown that a week of palliative care in the community costs about £1000 a week, whereas a week of hospital in-patient specialist palliative care costs virtually £3000 a week. 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.

I am not trying to dragoon people into dying outside hospital to save money. They should 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 statutory right to choose. It would mean fewer people dying in hospital thereby saving the money to pay for terminally-ill patients (within six-months of death) to be exempt from council social care charges; and to have their needs for support given priority.  

Voluntary organisations like Marie Curie, Macmillan and Help the Hospices support such changes. The government is piloting the idea but that seems unlikely to produce speedy change. Accepting my amendment would lay down a clear marker that Parliament wants government to move in the direction that most people want; and would give Ministers plenty of time to consult on the detailed arrangements. They should not miss the chance to put this change on the statute book.

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

Published 29th July 2013

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