Assisted Dying Bill- MPs reject right to die law

MPs have rejected plans for a right to die in England and Wales in their first vote on the issue in almost 20 years.

Assisted Dying Bill- MPs reject right to die law
In a free vote in the Commons, 118 MPs were in favour and 330 against plans to allow some terminally ill adults to end their lives with medical supervision.

In a passionate debate, some argued the plans allowed a “dignified and peaceful death” while others said they were “totally unacceptable”.

Pro-assisted dying campaigners said the result showed MPs were out of touch.

Under the proposals, people with fewer than six months to live could have been prescribed a lethal dose of drugs, which they had to be able to take themselves. Two doctors and a High Court judge would have needed to approve each case.

But Sarah Wootton, the chief executive of Dignity in Dying, said it was an “outrage” that MPs had gone against the views of the majority of the public who supported the bill.

A series of high profile and emotionally charged right to die cases have appeared in the courts.

But the response from judges has been clear. As Lord Justice Toulson ruled in the case of Tony Nicklinson: “These are matters for Parliament to decide.”

Now the message from politicians has been an overwhelming rejection of the right to die.

And opinion is not shifting – 74% of MPs voted against this bill compared with 72% back in 1997. The emphatic nature of the result would suggest politicians are unlikely to discuss this again soon.

Campaigners will regroup and point to their own polls showing 82% of the public back assisted dying and calls for change may yet intensify with an ageing population.

The latest proposals were brought before the Commons by Rob Marris, the Labour MP for Wolverhampton South West.

Opening the debate, Mr Marris said the current law did not meet the needs of the terminally ill, families or the medical profession.

He said there were too many “amateur suicides, and people going to Dignitas” and it was time for Parliament to debate the issue because “social attitudes have changed”.

Mr Marris added: “This bill would provide more protection for the living and more choice for the dying.”

Mr Marris said he did not know what choice he would make if he was terminally ill, but said it would be comforting to know that the choice was available.

Euthanasia, which is considered as manslaughter or murder, is illegal under English law.

The Suicide Act 1961 makes it an offence to encourage or assist a suicide or a suicide attempt in England and Wales. Anyone doing so could face up to 14 years in prison. The law is almost identical in Northern Ireland.

There is no specific law on assisted suicide in Scotland, creating some uncertainty, although in theory someone could be prosecuted under homicide legislation.

In a lengthy speech, Labour MP Sir Keir Starmer told MPs about prosecution guidelines he developed in his role as director of public prosecutions, when he had to deal with a number of “right to die” cases, including those of Debbie Purdy and Tony Nicklinson.

But he warned that his guidelines had shortcomings without a change in the law.

He said: “We have arrived at a position where compassionate amateur assistance from nearest and dearest is accepted, but professional medical assistance is not unless you have the means of physical assistance to get to Dignitas.

The British Medical Association, the doctor’s union, opposes all forms of assisted dying whilst the Royal College of Nursing takes a neutral stance.

Dying need free social care cancer campaigners say

Free end of life social care is needed to save the NHS money and improve patient care claim cancer campaigners.

Dying need free social care cancer campaigners sayMacmillan Cancer Support says it could save the NHS in England £69 million a year on the care of cancer patients alone. Its analysis is based on a review of patient surveys, official NHS spending data and interviews with senior decision-makers.

Social care is currently means tested, but ministers are considering providing it to everyone at the end of life.  About half of people end up dying in hospital despite eight in 10 saying they would prefer to die at home.

Macmillan’s analysis said this equated to about 180,000 people spending their last days in hospital against their wishes.

The cost to the NHS of this was estimated to be £685 million a year, Macmillan said.

If those patients were cared for in the community via a combination of community NHS services and social care the cost would be £340 million – a saving of £34 5million.

Of those 180,000 patients, about 36,000 are cancer patients. This would equate to a saving of £69 million if they were able to die at home, Macmillan said.

Earlier this week the Association of Directors of Adult Social Services warned the current system of social care was “unsustainable” because of a lack of funding and rising demands.

Macmillan chief executive Ciaran Devane said: “We urgently need to reform end-of-life services in England. Every day around 100 cancer patients die in expensive hospital beds when they wanted to die at home.

“This is both morally wrong and a scandalous waste of precious NHS resources.”

A Department of Health representative said: “We want to make sure that people nearing the end of their lives can choose where to spend their last days and have more of a say on how they are cared for.  We are currently reviewing how to improve the quality and experience of care at the end of life and the system for funding it.”

Carers at breaking point Commissioner warns

More needs to be done to support carers who are at breaking point the Older People’s Commissioner for Wales warns.
Carers at breaking point Commissioner warns

Sarah Rochira who is the Older People’s Commissioner is concerned that too many carers across Wales are missing out on much needed help and their work is often undervalued.

She said it can often lead to a deterioration of their mental and physical health.

Ministers said much had been achieved in policy to support unpaid carers since devolution.

Speaking on Carers Rights Day, Ms Rochira is worried at the pace of progress in a strategy to help carers and said she wants to ensure Wales gets it right for its 370,000 carers.

“Without the care provided by unpaid carers in Wales, estimated to be nearly £6 billion a year, many of our statutory services would, quite simply, be unable to cope,” she said.

“Carers should therefore be seen and treated as one of our greatest assets. Many of the carers I have met as part of my Engagement Roadshow are at breaking point – they feel that no-one listens to them, despite asking for so little.”

“In so many cases they just want a little bit of help before a crisis occurs, such as information, advice, help to make decisions, practical help and training, and advocacy – someone to speak up on their behalf.”

Ms Rochira said the Welsh government’s Carers Strategies Measure, which was launched in 2010, was a “welcome step forward”.

It is a requirement on the NHS and local authorities in Wales to work in partnership to prepare, publish and implement a joint strategy to help carers.

But while she said improvements were starting to be seen, she added she had “real concerns” over the pace of the progress and that she intends to review the impact the measure is making with carers being at the heart of the review.

She also wants service providers to work together more effectively and focus on what carers want, not what they think the carers need.

The Welsh government said: “We should be grateful that so many people in Wales are prepared to care in this way.

The spokesperson said a refreshed carers strategy was published in June and “much has been achieved in terms of policy, legislation and service development” for unpaid carers since the first version in 2000.

This includes the Carers Strategies (Wales) Measure in 2010 which requires health and social services to engage with carers.

Social care in England has bleak future after £800 million cuts

Social care in England is facing a bleak future despite planned changes as services have been forced into budget cuts.Social care in England has bleak future after £800 million cutsResearch by the Association of Directors of Adult Social Services showed £800 million was likely to be taken from the £16 billion budget this year.

The group warned it meant “the bleak outlook becomes even bleaker”.

It comes as the government looks set to signal later in the Queen’s Speech its determination to reform the system.

The draft social care and support bill, which is expected to be included in the speech, will be used to clarify the law on social care and pave the way for the introduction of a cap on the costs people face for elderly care.

Currently anyone with assets of more than £23,250 faces unlimited costs, but ministers have said they want to see lifetime costs capped at £72,000 from 2016.

The result of the move would be that many more people would be brought into the state system. Estimates have suggested an extra 450,000.

Health Secretary Jeremy Hunt said the changes to the social care system needed to be made quickly, as the UK faced a “very big challenge” because of its ageing society.
Resorting to rationing

But the ADASS figures, compiled from a survey of directors at 145 of the 152 councils, illustrate the problem councils are facing trying to provide services to the elderly and disabled.

The projected £800 million reduction in spending comes after nearly £2bn has been trimmed from budgets in the past two years.

While social care directors said they were trying to make savings through measures such as more efficient working and better procurement, nearly a fifth thought the quality of life that could be provided would worsen in the coming years.

Half said the numbers able to access services would reduce too as councils resorted to rationing.

ADASS president Sandie Keene said: “Gazing into the next two years, without additional investment from that already planned, an already bleak outlook becomes even bleaker.”

Handling of care home closures disastrous says health minister

The way the potential closure of NHS residential homes in Northern Ireland has been handled has been “disastrous”, Health Minister Edwin Poots has said.Handling of care home closures disastrous says health ministerHe was speaking as the western trust became the latest NI trust to confirm it plans to close all its NHS homes.

The western trust defended its actions, saying it had tried to be “honest” with people during its discussions.

Deputy First Minister Martin McGuinness criticised the anxiety the plans had caused to elderly care home residents.

Mr McGuinness and Northern Ireland’s first minister, Peter Robinson, re-stated their backing for the policy of caring for older people in their own homes but they hit out at the health trusts.

“Unfortunately, we have seen fear and anxiety on our television screens over the last few days and that is unacceptable,” said Mr McGuinness.

The Southern trust’s decision will affect 80 residents, in the Northern trust the number is 154, and in the South Eastern trust area 128.

In the Western trust there are 128 places available. A spokesperson said 73 of these beds are currently occupied.

Belfast, the largest trust area, began the process in 1990 and has since closed 10 homes.

The remaining three, Pine Lodge, Chestnut Grove and Grovetree House, will close in five years, under natural circumstances according to a spokesperson.

The three have a total of 20 residents.

Over the past decade, a majority of older people who required care in Belfast have moved to places in the private sector/independent sector.

“I think it is incumbent on the department to get a grip on what is happening within the trust and make it clear that this is going to be dealt with in a very sensitive way to ensure that we meet the needs of our older generation.”

Mr Robinson said moving around was “not the kind of thing you want to be doing at any stage of your life least of all when you are in your 80s or your 90s.  That has to be handled very carefully and very sensibly.”

“I think the policy, which was to approximately reduce by half the number of care homes over the next five years, was a sensible enough policy. I’m not quite sure how any trust can justify the closure of their homes and I think they need to seriously look at that again.”

Care home companies face harder financial checks

Large providers of care homes in England are to have their financial records regularly checked in future to spot potential business problems.Care home companies face harder financial checksUnder the government’s plans, the Care Quality Commission and local authorities will also ensure care continues if a company does go bust.

It comes after provider Southern Cross collapsed, causing distress and anxiety to its residents and their families.

Care minister Norman Lamb said the move would give reassurance to people.

The Care Quality Commission (CQC) will start to make checks on between 50 and 60 of the largest care companies in England, including those that provide care in a person’s home.

CQC chief executive David Behan said the measures – to be set out in new legislation – would provide early warning of potential company failures in the care industry.

The CQC will have the power to:

  • Require regular financial and relevant performance information
  • Make the provider submit a “sustainability plan” to manage any risk to the organisation’s operation
  • Commission an independent business review to help the provider to return to financial stability
  • Get information from the provider to help manage a company collapse

The Department of Health said the powers would bring care in to line with other services such as hospitals and holiday operators, which have procedures to check on the “financial health” of organisations.

In the case of the collapse of a national provider the effects would be felt in many parts of the country, so it would be unfair for local councils to have to deal with the problem, the department said.

Mr Lamb said: “Everyone who receives care and support wants to know they will be protected if the company in charge of their care goes bust.

“The fear and upset that the Southern Cross collapse caused to care home residents and families was unacceptable.

“This early warning system will bring reassurance to people in care and will allow action to be taken to ensure care continues if a provider fails.”

Southern Cross, the country’s biggest care provider, had thousands of elderly residents at more than 750 care homes across the UK when it collapsed in 2011.

The firm was brought down by having to pay a £250m rent bill as local authorities made cuts.

After its collapse, other operators had to step in to take over the care of more than 30,000 people.

Dementia care patchy- quango finds

The standard of care provided for people with dementia is “patchy”, the National Institute for Curbing Expenditure (NICE) has said. Dementia care patchy- quango findsSome people with the condition were not getting even basic levels of care, it added.

The warning came as NICE unveiled new standards for dementia care in England, covering issues such as housing and access to leisure services.

Care services were playing “catch-up” on dementia, it said.

The guidance is the first to be produced by NICE under its new extended remit.

To date, the organisation has focused on issuing recommendations about NHS treatments and encouraging healthy lifestyles.

But under the shake-up of the NHS, it now has responsibility for providing guidance on care and support provided by the likes of councils and care homes.

NICE’s dementia guidance includes 10 standards it wants the care sector to follow.

One calls for people with dementia to live in housing that meets their needs, while another says they should be given the support they need to access leisure activities.

Others focus on keeping patients involved in community life and ensuring they get access to services such as dentists and opticians.

NICE deputy chief executive Prof Gillian Leng said: “The general picture is that care is patchy.  We know that it is really good in places but it’s not consistent.  My personal view is that we are all playing catch-up because the number of people with dementia has been increasing so dramatically.”

Currently about 670,000 people in England are living with dementia but one in three over the age of 65 are expected to develop the condition.

George McNamara, of the Alzheimer’s Society, said people with the condition were being denied the quality of life they deserved.

“These standards will be a useful tool for the care sector and show what people with dementia and carers should be able to expect,” he said.  “But, as they are not mandatory, it’s a case of ‘wait and see’ as to whether this guidance will drive real change or just sit on the shelf.”

NHS satisfaction ratings stabilising after record fall

Public satisfaction ratings with the NHS appears to have stabilised following a record fall- according to the British Social Attitudes Survey.NHS satisfaction ratings stabilising after record fallThe poll of more than 1,100 people in England, Wales and Scotland last year found satisfaction with the way the NHS was run stood at 61%.

This followed a record fall from 70%, in 2010, to 58% in 2011.

The drop coincided with the first year of the spending squeeze and controversy over reforms in England.

The 2012 survey, conducted by NatCen Social Research, found that 74% were satisfied with GPs while just 30% were satisfied with social care.  A total of 59% said they were satisfied with A&E units and 56% were satisfied with dentists, it found.

Prof John Appleby, of the King’s Fund think tank, said the poll was an “important barometer”.

“With no real change in satisfaction with the NHS in 2012, this suggests the fall in 2011 was not a blip and that the ground lost may take some time to recover,” he said.

Patients Association chief executive Katherine Murphy said it was important to “look beyond statistics and properly assess patient experience”.

“People are still contacting our helpline every day to tell us that they or a loved one is receiving the most appalling care in hospital.

“These serious issues need to be tackled and the government needs to monitor closely the impact of its reforms.”

A spokesman for NHS England, the new national board which oversees the health service, said: “The changes which have been implemented put patients at the centre of everything the NHS does.

“We are committed to providing the best services possible for patients in England.”

Social care cost caps brought forward

The government will bring forward its overhaul of social care funding by a year the chancellor has announced.
Social care cost cap brought forwardA cap on the amount the elderly pay for social care in England – which was to be £75,000 but will now be £72,000 – would start in the same year.

Mr Osborne promised in his budget to “help people who are young and people who are old”, while sticking with the government’s deficit reduction programme.

The cap on social care costs, originally planned to be set at £75,000 and introduced in 2017, will now be introduced in 2016 at a level of £72,000.

This would only cover the cost of social care and people would still have to pay for accommodation and food – although some support will be provided.

Mr Osborne said the cap would protect people from “getting a disease in later life and having to sell their house” to pay bills.

For Labour, shadow minister for care and older people Liz Kendall said: “George Osborne is still failing older people and their families. Today’s minor adjustments to the government’s plan will still leave far too many selling their homes to pay for care.”

She added that any cap above £50,000 would not “provide adequate protection” for people on low incomes.

Ms Kendall said: “We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people stay healthy and living independently in their own homes for as long as possible.”

Mr Osborne said: “I agree that we need to spend more on capital, which is why I had taken the decision in December to increase the spending on capital – but paid for.

“In the end this country has got to pay its way. We can’t just keep on thinking the answer to our problem is more borrowing. You can’t get out of a debt crisis by borrowing more and more.”

But the chancellor defended the ring-fenced budgets for the National Health Service and international aid.

He said the 0.7% of national income earmarked for overseas aid was a “moral commitment” and “sound foreign policy for Britain”.

Paying for social care- Jeremy Hunt aims to bring clarity and affordability

Plans for a £75,000 cap on the amount the elderly will have to pay for social care in England will give people “greater peace of mind”, Health Secretary Jeremy Hunt has said.Paying for social care- Jeremy Hunt aims to bring clarity and affordabilityMr Hunt told MPs the current social care system was unfair and left many families facing “ruinous” costs.

He also announced a rise from £23,250 to £123,000 in the amount of assets people have before having to contribute to the costs of basic nursing care.

At present, up to 40,000 people every year are forced into selling their homes because they face unlimited care bills.

The health secretary said many families currently faced “often ruinous costs…with little or no assistance from the state” and the proposed new framework, due to come into force in 2017, would bring “greater certainty, fairness and peace of mind”.

Ministers may be giving themselves a big pat on the back for their changes to the social care system- but for many involved in the sector this is just the start of the process.

Firstly, the £75,000 cap is more than double the figure recommended by Andrew Dilnot, the independent expert asked to look at the issue by government two years ago.

While publicly it is being welcomed – campaigners have been promised reform ever since Tony Bliar came to power – there is a nagging fear that it is too high to really get people engaged with planning for their old age.

And, secondly, this reform does nothing to improve the quality of services currently on offer- it is purely aimed at preventing people having to sell their own homes to pay for care.

Local government has long argued the system is dramatically under-funded and services are suffering as a result.

Of all that some say needs to be done, the introduction of a cap may well turn out to be just the tip of the iceberg.

While costs vary hugely, it is estimated that half of all people turning 65 in future will have to pay up to £20,000 towards their basic nursing care – such as help to get washed and dressed – while, for one in ten, the figure will be above £100,000.

This figure would only cover the cost of nursing care and people would still have to pay for accommodation and food – although some support will be provided.

If the changes are approved, people are only expected to start receiving support above the £75,000 cap by 2019 at the earliest.

But the hope is that, by establishing the principle that the state will cover the really high costs, people will start planning for their future care needs in the way their do for their pensions in retirement.

The government is also proposing increasing the means-tested threshold – there to ensure the less well-off get state help towards their care costs.

Currently anyone with assets of more than £23,250 has to pay for their care. Under the plans, the threshold will rise to £123,000, reflecting the fact that rising property prices over the years have effectively meant any home-owner falls outside the state system.

Mr Hunt also confirmed that the plans, expected to cost about £1bn a year, will be part-funded by freezing the inheritance tax threshold – at £325,000 for individuals and £650,000 for couples – for three years from 2015.

That is despite Chancellor George Osborne’s Autumn Statement pledge, in December, to raise the threshold by 1% – to £329,000 for individuals and £658,000 for couples – in 2015/2016. And breaks another election pledge to raise the inheritance tax threshold to £1,000,000.