Assisted Dying Debate

Fiona Bruce (Congleton) (Con): Thank you, Mr Deputy Speaker, for calling me to speak to my amendment. I understand that although I am not able to move it yet, other Members may speak to it throughout the afternoon.
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I support the motion in the name of my hon. Friend the Member for Croydon South (Richard Ottaway) and I oppose the amendment in the name of the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock).
Britain has been ranked first in the world for quality end-of-life care in a survey by T he Economist intelligence unit of 40 OECD and non-OECD countries, including the USA, the Netherlands, Germany and France. We should be proud of and support services that are providing care to enable patients to live as well as possible, while accepting natural death and doing everything to keep patients comfortable during dying.
Mr Robert Buckland (South Swindon) (Con): Will my hon. Friend join me in paying tribute to organisations such as the Prospect hospice in my constituency, which offers world-class palliative care, not only in-house but within the community that it serves?
Fiona Bruce: I will, and I pay tribute to the entire hospice movement in this country. The care and treatment of patients provided by such services embodies the culture that we have in this nation of prioritising care at the end of life, and does not prioritise foreshortening life by months or years at the end-of-life stage.
The DPP has said that the guidelines that he operates are working well; indeed they are. Prosecutorial discretion is part of our criminal law and applies across a wide range of crimes. We cannot fetter it in law because each case is different. The law gives a clear message that one person should not encourage or assist another’s suicide.
Robert Halfon (Harlow) (Con): I am proud to be supporting my hon. Friend’s amendment today. Does she agree that this is not about choice, but is about people being forced to make choices? Does she also agree that rather than having debates about assisted dying it would be much better if we had more debates and discussions about how we could improve palliative care?
Fiona Bruce: I do, and that is entirely the intent of my amendment.
Mrs Eleanor Laing (Epping Forest) (Con): Will my hon. Friend give way?
Fiona Bruce: I will continue now, if I may, to allow for the many other speakers who want to speak this afternoon.
If encouragement or assistance is given for others to commit suicide, individuals are answerable for their actions, but when appropriate, the law takes a compassionate approach. Patients at the end of life are very vulnerable to influence, particularly from those providing care. Just yesterday a specialist consultant in palliative care told me of his concerns about any change in the law in this area. He told me of an incident which, he said, was not isolated, but typical. He said: “I had a single male patient who was dying of cancer. Life was difficult for him; he had an estranged daughter who confided in me that her father had asked to be taken to Switzerland because his life was not worth living. His daughter had left home quite early in life and they had lost all contact. I talked with him and he told me how proud he
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was that she had become a head teacher, he himself having been a teacher earlier on in his life. I encouraged him to get to know his daughter again, to tell her he loved her, and that he was proud of her. They did so and they spent the last two weeks of his life together in the hospice having these conversations, which meant so much to both of them.” Is not that the approach that we should take towards those at the end of their life?
The consultant continued, “We”—that is, doctors—“have real concerns that it would place us in a very difficult position if the law is changed, since at the heart of what we do is the tenet that we should do no harm to our patients. So for someone to have their life terminated would place our relationship on a very different footing.” Doctors do not want the relationship of trust between doctor and patients fractured. That surely is why the DPP guidelines tend towards prosecution if assistance with suicide is given by a doctor or nurse as part of their clinical relationship with the patient.
Several disability groups have told me that they would be extremely concerned should there be any change in the law—that is, in this relationship—a change which could well occur should doctors, such as the consultant I mentioned, have the “option to kill”—as he put it—their patients as one of their choices.
Unlike Oregon, where assisted suicide was made legal in 1997, we have specialist palliative care in the UK, with a full four-year training programme. Oregon has had a four and a half-fold rise in assisted suicides since it legalised the practice in 1997, a practice that would result in over 1,100 assisted suicides in this country on a population basis. And Oregon’s safeguards are paper-thin. The Royal College of Physicians has stated that physician assisted suicide

“would fundamentally alter the role of the doctor and their relationship with their patient. Medical attendants should be present to preserve and improve life—if they are also involved in the taking of life, this creates a conflict that is potentially very damaging.”

Help the Hospices says:

“It is right that actions by a care professional are treated differently from actions by a friend or family member”.

Baroness Campbell of Surbiton, speaking on behalf of disabled groups, has said that a change in the law

“wouldn’t just apply to the terminally ill, no matter what the campaigners may say. It would affect disabled people too, not to mention the elderly. A change in the law. . . would alter the mindset of the medical and social care professions, persuading more and more people that actually the prospect of an ‘easy’ way out is what people such as me really want. Well, the vast majority of us do not.”

The motion should keep the DPP guidelines as they are, and support improved care at the end of life.

Fairtrade Speech 2012 - in the Constituency

Fiona’s Speech to the Congleton Fair Trade Event

Saturday 10^th March 2012

It is lovely to be asked to speak at today’s event. I will speak, briefly, on the importance of supporting Fairtrade.

As many of you know the Fairtrade movement is about ensuring better prices and working conditions for farmers and workers in the developing world. Launching Fairtrade Fortnight, the foundation said that every day in the UK people consume 9.3 million cups of Fairtrade tea, 6.4 million cups of Fairtrade coffee, 2.3 million Fairtrade chocolate bars, 530,000 cups of Fairtrade drinking chocolate and 3.1 million Fairtrade bananas.

Sales have risen by 40% recently meaning that, last year, more than £1billion worth of Fairtrade sales were made. Britain is now the world’s biggest consumer of the Fairtrade range.

In my constituency Alsager, Congleton and Sandbach all have Fairtrade Town status as well as a number of churches with Fairtrade status and the council is looking to achieve this also. Even schools can apply for Fairtrade status. I congratulate everyone on working hard to achieve this and to raise the profile of Fairtrade.

We do, however, need more businesses and groups who are willing to agree to use only Fairtrade products such as tea, coffee and sugar. To do so would be to follow in the footsteps of large PLCs like Marks and Spencer and coffee house Starbucks. This helps both the Fairtrade movement and your customers who wish to ensure that what they buy is fairly traded.

The Fair-Trade Resource Network gives the top 10 reasons why you should support Fair Trade. Firstly, supporting fair trade means helping farmers and producers get fair pay and better working conditions.

Secondly, Fair Trade is better for the environment as it supports sustainable practices that minimise their environmental footprint.

Thirdly, Fairtrade products are often hand-made and thus a greater attention to detail is made creating a high quality product, which leads nicely into point 4 (perhaps a matter of opinion!) that Fairtrade means better tasting food! Crops are grown and harvested in smaller quantities with the farmers involved at every stage meaning fair-trade food is fresher.

5. Fair trade helps to preserve valuable eco-systems and limits the use of harmful agrochemicals.

6. By working through co-operative structures Fairtrade supports not just individuals but communities as the money earned can help provide housing, healthcare and schools.

7. Fairtrade encourages direct relationships between buyers and producers meaning that the relationships and therefore the trade can be counted on so farmers have a sustainable and reliable income.

8. Since fair-trade products are often artisan they are unique to the people and places that they come from thus they offer a piece of another culture.

9. Fairtrade encourages farmers in the developing world to build their own businesses rather than working for a middle man, so their profits stay with them, their business and their community.

Finally, point number ten, by choosing fair-trade you are making a difference to the lives of people in countries where life can be a daily struggle, with fair-trade what you buy matters.

Results of a recent global study showed that Fairtrade is the most widely recognised ethical label. Six out of ten consumers in the UK (59%) believe their own shopping choices can make a real difference to the lives of farmers and workers in poorer countries and four out of five (83%) say that they look to companies they deal with to help in reducing poverty through the way they do business. These figures show the importance of Fairtrade to the consumer and for that reason I encourage cafes, restaurants and other businesses to become registered users of Fairtrade.

This Fairtrade Fortnight, as I’m sure you know, the Fairtrade Foundation has launched the ‘Take a Step’ campaign and is asking the public to think about what they can do every day, every week or every month throughout 2012 to make a difference to the lives of farmers in the developing world who produce the products they buy – whether that be choosing to buy Fairtrade coffee at a cafe, or adding one or two more Fairtrade products to the weekly shopping, or encouraging others to switch to Fairtrade.   I encourage supporters, businesses, community organisations, faith groups, and schools in my constituency to ‘Take a Step’ and to tell others about Fairtrade and what it does.

The Fairtrade Foundation is asking everyone who “takes a step” to register it on their website at www.fairtrade.org.uk/step where steps will be displayed on an interactive 'step-o-meter'. I hope many Congleton residents have their steps displayed on this.  

The Fairtrade movement is growing bigger and bigger every year and its growth is due to the hard work of volunteers like you who raise the awareness of the movement with the public.  The fact that we now live in the world’s biggest supporter of Fairtrade is testament to the importance local people put on ethical and fair trading with others. I encourage all volunteers to continue their work, encourage those using Fairtrade products to continue to do so and to introduce others to them.

I would like to offer my thanks to all the volunteers here today for their hard work in promoting Fairtrade and to all of you who buy and use Fairtrade products.

Adult Social Care

4.55 pm

Fiona Bruce (Congleton) (Con): I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on the sensitive and caring way in which she
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brought this debate to the House. I also pay tribute to the 6 million unpaid carers in the UK. Unsung and often unseen, they are heroes and heroines who daily and sacrificially dedicate their lives to caring for others, often for 24 hours a day, seven days a week, 52 weeks a year. They deserve our utmost respect and appreciation, and I wish to record mine here.
I therefore wish to focus on the need to support carers in this era of an increasingly elderly population and greater longevity and with the exponential Treasury challenges that it will undoubtedly bring. Two million people currently move in and out of a caring role each year, but an ageing population and people living longer with chronic conditions mean that this figure is likely to rise significantly, so we must give serious consideration to how such carers, caring charities and community organisations can be better supported.
It is essential that we encourage a major cultural shift to consider how more support can be provided to carers, especially those who care for their families, and to charitable organisations that support carers. Caring charities, such as Crossroads Care Cheshire East, of which I am privileged to be patron, and the Prince’s Royal Trust for Carers, provide disproportionately greater value for money in the support they give than purely publicly funded social care services would ordinarily provide. As one former employee of the Prince’s Royal Trust for Carers told me, they supplement that work with volunteer support and the ability to act flexibly and go the extra mile, while all the time operating to high professional standards.
A significant caring role can affect a carer’s emotional, physical and financial health, but by supporting carers more positively, we can not only help them and those they care for but save the public purse considerable expense, which, as my hon. Friend the Member for Banbury (Tony Baldry) so eloquently said, will be increasingly important in the coming decades—to a degree that we have only just begun to glimpse. Crossroads Care Cheshire East writes:

“A clear agenda to support carers is an essential component of adult social care strategic planning.”

Caroline Hebblethwaite, who has been a volunteer worker with a caring charity in Cheshire, then an employee and now a full-time carer, speaks with unchallengeable authority and has told me of the many ways in which she believes we could support charities that in turn support carers more effectively. She says that longer-term funding commitments would help—beyond, say, two years—because shorter-term commitments make it difficult for organisations to plan and result in unhelpful churning, loss of experienced staff and disruption to well-established, cost-effective services. As Crossroads Care Cheshire East writes:

“Constantly having to reinvent well developed and user led services simply to fit another funding criteria is not a good use of time and money. Innovation is essential but experience should not be ignored.”

Both Caroline Hebblethwaite and Crossroads Care refer to the essential need for carer breaks. Crossroads says that carer breaks

“should not be paid for out of any benefits received by the person with care needs but should be a carer’s service for the benefit and health and wellbeing of the carer. It is not appropriate to assume that service users will use their own personal budgets to allow their carer a break—we know that often this does not happen. Without practical support carers and families will break down—this can be avoided by low level investment at an earlier stage.”

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I will give examples of some of the many ways in which relatively low-level investment can be made.
Local authority funding could make a huge difference if a little more was channelled through carers charities, to be paid out at the discretion of the charities’ trustees. Caroline Hebblethwaite tells me that when she worked for the Princess Royal Trust, small grants paid directly to carers—not means-tested—made a disproportionate difference. She tells me, for example, of an elderly man caring full time for his wife for whom that small grant paid for a shed, in which he could pursue his hobby. It gave him that little bit of extra space and helped him to keep going. For another carer, there was a one-off spring clean, while yet another received computer literacy training, and another the occasional massage.
Provision to enable carers who work so that they can remain in work—by having someone call in, just two or three times a day, to check that their loved one is all right—can make such a difference. A sitting service is also helpful, so that carers can go out. One way that local authorities can offer support—at a very modest cost, but making a real difference for those who care—is by funding befriending groups. Such groups enable carers to share experiences, but they need to be local, because carers do not have the time to travel far. Those that have helped in Cheshire include befriending groups that have provided talks on such matters as how to redecorate on a budget or how to make a hanging basket, and have even given advice on healthy eating. That might seem mundane, but it can make a real difference to carers, who often feel run down or a little bit depressed. Such small amounts of support can have a disproportionate benefit, and we need more of this.
Carers, often low on energy and self-esteem, find it hard to get information, advice and support, and I am advised that social workers often do not have much time to signpost them. However, local charities for carers can perform an important function in offering a great source of advice. Another function that they perform is by acting as a counselling service, providing counselling time—again, something that social workers cannot provide. There is a real need to recognise and support carers—for example, by giving them help in adapting to change, or to loss, or grief for a life once lived, or a life that might have been.
Caroline Hebblethwaite also told me about how much carers days have meant to those whom she has supported. Carers days in Cheshire have been held at local hotels, or even at a golf club. Carers are invited to come for special “feel good” days, where they are affirmed and told how much they are valued, and where high-level speakers talk to them, acknowledging the vital role that carers play. More of this is what we need as we move forward.
Local authorities could also ask professional advisers in carers charities to carry out more assessments of carers. This would not only be a valuable source of additional funding for carers’ charities, but also a likely cost-saver for local authorities. Incidentally, I am informed that assessments of carers’ needs are not made as frequently as they should be in many circumstances.
I would like now to deal with one or two other points. First, my constituent Barry Smith has written to me about higher attendance allowance:
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“My parents-in-law are both 89, my father in law has advanced Alzheimer’s and my mother in law, in poor health herself, and lacking easy mobility after having broke both hips, is his primary care…We have spent the last few days trying to fill out the forms for…Higher Attendance Allowance and have come to the conclusion that the application itself constitutes a form of discrimination against the elderly. We had been warned…that the form is extremely difficult to fill in…and that the rate of success is only 60%,”

but it seems that

“for most elderly people it is simply impossible to complete…It is as though it has been carefully designed to ensure that the minimum number of applicants receive their entitlement”.

Hopefully that is something the Minister will look at.
I commend the proactive work of Cheshire East council, the local authority area in which my constituency lies, to support older people, as illustrated in its innovative “Ageing Well in Cheshire East” programme, 2012-17, which has just been launched. It focuses on how to support people from as early as 50 upwards—a little depressing for some of us at that age!—on the basis that the earlier we plan, the better those plans will be for later life, given that we all want to live well for as long as possible.
The aim of the programme is to ensure that older people live well and have access to the right levels of different services and support, including crisis support, at appropriate times in their lives. The programme aims to ensure also that they have a strong voice in influencing local policy and services; remain healthy, active and independent; receive help to plan their finances long-term; live in a safe environment, with appropriate housing; access appropriately constructed public transport; benefit from and contribute through employment, volunteering and learning; keep their links with family and friends; are actively involved in their communities; and maintain their roles as partners, carers and grandparents.
I commend in particular the wide-ranging network of relevant public, private and voluntary sector bodies which the Ageing Well programme has fostered, garnering a commitment to the programme that will be essential if we are to maximise our support and provide the effectively integrated care that has been talked about today. The programme has secured a commitment from agencies as wide-ranging as Cheshire fire and rescue, the police, clinical commissioning groups, local councils, the faith sector, housing providers, care charities and even the chambers of commerce.
The programme is already tackling older people’s concerns, such as those about disjointed services, the variable quality of care and social and economic isolation, and it is also improving volunteering opportunities. Such forward-thinking work is an essential component of our successfully rising to the challenge of caring for the elderly in the years ahead, and it is particularly important in an area such as Cheshire East, which has a rapidly ageing population and, in fact, the largest elderly population of any area, per head of population, in the north-west of England. The number of over-65s in the area will grow by 50%, and the number of over-85s is set to double, by 2025.
Cheshire East has funding challenges, however. The Government funding for the area is among the lowest of any in the country, despite the challenges that we are going to face and, indeed, already face in caring for such a large elderly population. We are given £191.62 per head, while Tower Hamlets, by way of comparison, is given £968.18, meaning that we can afford to spend per head £753.42, while Tower Hamlets has almost double, £1,428.16.
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The funding context of each local authority area is an important influence on the services that can be provided, and in an area such as Cheshire East, with low funding but an increasingly elderly population, that is going to be a challenge, so I ask the Minister to consider it as we move forward.
I commend the Minister’s commitment to build on community capacity as the way forward, helping people to stay independent, healthy and well for as long as possible. Indeed, perhaps a better term for independent living would be inter-dependent living, recognising the importance of, and the need for, all of us to give and receive care at various stages of our lives. The more we can encourage caring within families, by friends and in communities, the healthier our society will be. We need to do all that we can to foster support and to encourage the sharing of caring, and we need to treat with gratitude and respect those who do care.
The words of the chief executive of Carers UK are apt:

“Our health and social care services could not function without the contribution of the unpaid care provided by families—which we estimate to be the equivalent of £119 billion a year.”

The basic building blocks of a healthy society are found in relationships—the networks of reciprocal responsibility that are found in the family, in friendships, in church, in community life, in work, and in schools. Through these basic building blocks, individuals meet the needs of their community. It is as much, if not more, the role of Government to help society to meet its needs through those relationships rather than seeking to take control and trying to meet those needs itself. As human beings, one of the ways we grow is through the challenge of meeting the needs of others in our relationships within our communities. Our national mindset needs to be increasingly directed towards that goal. Looking to the selfless example of our country’s 6 million carers would be a very good place to start.