Using housing wealth to fund social care: why the Care Act 2014 is unfair

Posted: 04 Feb 2015 06:30 AM PST

Nicholas HopkinsEmma Laurie

The Care Act 2014 reinforces the expectation of leaving housing wealth as an inheritance, which perpetuates inequalities across generations, argue Nicholas Hopkins and Emma Laurie. Intergenerational fairness requires homeowners to use a greater proportion of their housing wealth to fund social care rather than relying on the state.

The issue of funding social care costs is one that provokes strong feelings. Many homeowners resent the idea of having to sell the family home to pay for residential care costs. But with an ageing population, a real concern is raised over who should pay. The Commission on Funding of Care and Support (the Dilnot Commission) was an independent body tasked by government with reviewing the funding system for care and support in England. Its report, Fairer Care Funding, provided advice and recommendations to government and was subsequently enacted in the Care Act 2014.

The Dilnot Commission’s overriding objective was to make the system of funding adult social care fairer as well as sustainable. The Commission took the view that it was fair to limit the extent to which an individual is required to draw on their own wealth, including housing wealth, to pay for the costs of their care. It also recommended that the home should not have to be sold during the owner’s lifetime in order to pay for social care costs.

To achieve these two objectives, the Care Act 2014 places a cap on individual liability for care costs and provides a scheme of Universal Deferred Payment (UDP). UDP is intended to prevent ‘forced sales’ of the home. Despite its name, it is not intended to be available to everyone. We consider that the measure is justified and that its operation could be confined to those who would otherwise have to sell their home. This could be achieved by making UDP available only to those who could not pay the capped sum from non-housing assets.

Our concerns with the Care Act 2014

Our principal concern lies with the Act’s treatment of housing wealth through the cap. Its effect is to preserve individual wealth and, in practice housing wealth, at the expense of the public purse. Ultimately, it will benefit those who will inherit that wealth. The use of public funds to preserve an inheritance lies at the heart of our criticism.

By passing a greater proportion of the costs of social care to the state, the Act will inevitably have undesirable – and unfair – consequence for the younger generation of taxpayers. We therefore advocate a phased scheme which would aim to change the expectation of leaving housing wealth as inheritance and, instead, inculcate an expectation of using housing wealth to fund social care costs.

This will be a controversial argument for many people. We understand the sense of unfairness felt by current homeowners at having to use housing wealth to pay for their social care costs and the desire to leave housing wealth as an inheritance. The ability to provide an inheritance is one of the bases on which homeownership has been promoted. Equally, there is understandable confusion about the different funding models for health and social care. While health care is provided free at the point of delivery, social care is means-tested and incorporates an assessment of a person’s assets to determine eligibility for financial support from the state.

The need for intergenerational fairness

Nevertheless, the wider concern of intergenerational fairness requires homeowners to use a greater proportion of their housing wealth. There is a growing recognition that issues of intergenerational fairness must form part of the ‘social contract’ between individuals and the state. In the UK, life expectancy has been growing while the birth rate has been falling. The consequence is popularly referred to as a ‘demographic time-bomb’, and the phenomenon of an ageing population is a policy concern that has been taken up at international, European and national levels.

But government policy on the need for intergenerational fairness is inconsistent. On one hand, the government has taken steps to increase the age of eligibility for the old-age pension and further increases are planned. On the other hand, it has passed the Care Act 2014 which entails a greater proportion of the costs falling on the state and, inevitably, the younger generation.

Changing expectations

Inculcating an expectation of drawing on housing wealth to fund older age care can address our concerns of intergenerational fairness. Such a policy reflects the principle of asset-based welfare, which entails expanding asset holdings among low-income households as a means of reducing wealth inequalities and promoting wealth-creating behaviour among citizens.

Successive governments since the 1950s have consistently encouraged homeownership and, as a result, housing wealth now exceeds other forms of investment to become by far the largest element in personal disposable assets. Homeownership has spread wealth more widely than any other form of asset or investment. Despite doing so, housing wealth is unequally distributed. Many older property owners have seen large, tax-free capital gains over the past few decades due to the rising value of property. The proportion of housing wealth held by older people is forecast to grow, while the term ‘generation rent’ has been coined to refer to those younger people who have no realistic prospect of buying their home. Inculcating an expectation that people will look to their housing asset, rather than to the state, to fund their welfare can reduce those intergenerational disadvantages by requiring homeowners to use the wealth in their lifetime.

Homeownership has not been explicitly promoted with the idea that the wealth will be drawn upon to fund the owner’s older age. Combined with the lack of understanding of the difference between health and social care, it is perhaps unsurprising that a strong sense of unfairness is felt at the prospect of housing wealth accumulated over a lifetime being dissipated by the requirement to fund a few years of social care. However, rather than attempting to change expectations, the Dilnot Commission’s proposals, as implemented by the Care Act 2014, appear uncritically to accept the perception of unfairness. The Act reinforces the expectation of leaving housing wealth as an inheritance, which perpetuates inequalities across generations. As a result, the funding model provided by the Act is neither fair nor sustainable.

The Coalition’s Record on Health: Policy, Spending and Outcomes 2010-2015

David Cameron promised in 2010 to “cut the deficit, not the NHS”. But how have the Coalition’s policies – including health reforms which are widely viewed as going beyond election commitments – impacted on health?

– While the Coalition has ‘protected’ health relative to other expenditure areas, growth in real health spending has been exceptionally low by the standards of previous governments. Average annual growth rates have lagged behind the rates that are deemed necessary to maintain and extend NHS care in response to increasing need and demand.
– Forecasts warn of an NHS ‘funding gap’ as wide as £30bn by 2020/21 unless the growing pressures on services are offset by productivity gains and funding increases during the next Parliament.
– Major health reforms emphasising decentralization, competition and outcomes have been implemented. These have transformed the policy landscape for the commissioning, management and provision of health services in England. The overall framework for political responsibility and accountability for health services in England has also changed.
– Minimum care standards, inspection and quality regulation have been revised and strengthened following the Mid-Staffordshire NHS Foundation Trust Public Inquiry.
– Key indicators point to increasing pressure on healthcare access and quality. These include indicators on patient access to GPs, accident and emergency services and cancer care. Public satisfaction with the NHS is considerably lower than a peak reached in 2010.
– The UK’s ranking on OECD “international league tables” remained disappointing for some health outcomes including female life expectancy and infant mortality.
– Suicide and mental health problems remained more prevalent following the 2007 economic crisis.
– Health inequalities remained deeply entrenched. The difference in average life expectancy between men living in the poorest and most prosperous areas of England is nine years, and six years for women.

http://sticerd.lse.ac.uk/case/_new/news/year.asp?yyyy=2015#772

Tony Blair: Labour must search for answers and not merely aspire to be a repository for people’s anger

The centre has not shifted to the left, says Tony Blair. Labour must resist the easy option of tying itself to those forces whose anti-Tory shouts are loudest. 

The paradox of the financial crisis is that, despite being widely held to have been caused by under-regulated markets, it has not brought a decisive shift to the left. But what might happen is that the left believes such a shift has occurred and behaves accordingly. The risk, which is highly visible here in Britain, is that the country returns to a familiar left/right battle. The familiarity is because such a contest dominated the 20th century. The risk is because in the 21st century such a contest debilitates rather than advances the nation.

This is at present crystallising around debates over austerity, welfare, immigration and Europe. Suddenly, parts of the political landscape that had been cast in shadow for some years, at least under New Labour and the first years of coalition government, are illuminated in sharp relief. The Conser­vative Party is back clothing itself in the mantle of fiscal responsibility, buttressed by moves against “benefit scroungers”, immigrants squeezing out British workers and – of course – Labour profligacy.

The Labour Party is back as the party opposing “Tory cuts”, highlighting the cruel consequences of the Conservative policies on welfare and representing the disadvantaged and vulnerable (the Lib Dems are in a bit of a fix, frankly).

For the Conservatives, this scenario is less menacing than it seems. They are now going to inspire loathing on the left. But they’re used to that. They’re back on the old territory of harsh reality, tough decisions, piercing the supposed veil of idealistic fantasy that prevents the left from governing sensibly. Compassionate Conservatism mat­tered when compassion was in vogue. But it isn’t now. Getting the house in order is.

For Labour, the opposite is true. This scenario is more menacing than it seems. The ease with which it can settle back into its old territory of defending the status quo, allying itself, even anchoring itself, to the interests that will passionately and often justly oppose what the government is doing, is so apparently rewarding, that the exercise of political will lies not in going there, but in resisting the temptation to go there.

So where should progressive politics position itself, not just in Britain but in Europe as a whole? How do we oppose smartly and govern sensibly?

The guiding principle should be that we are the seekers after answers, not the repository for people’s anger. In the first case, we have to be dispassionate even when the issues arouse great passion. In the second case, we are simple fellow-travellers in sympathy; we are not leaders. And in these times, above all, people want leadership.

So, for Britain, start with an analysis of where we stand as a country. The financial crisis has not created the need for change; it has merely exposed it. Demographics – the age profile of our population – technology and globalisation all mean that the systems we created post-1945 have to change radically. This is so, irrespective of the financial catastrophe of 2008 and its aftermath.

Labour should be very robust in knocking down the notion that it “created” the crisis. In 2007/2008 the cyclically adjusted current Budget balance was under 1 per cent of GDP. Public debt was significantly below 1997. Over the whole 13 years, the debt-to-GDP ratio was better than the Conservative record from 1979-97. Of course there is a case for saying a tightening around 2005 would have been more prudent. But the effect of this pales into insignificance compared to the financial tsunami that occurred globally, starting with the sub-prime mortgage debacle in the US.

However, the crisis has occurred and no one can get permission to govern unless they deal with its reality. The more profound point is: even if it hadn’t happened, the case for fundamental reform of the postwar state is clear. For example:

What is driving the rise in housing benefit spending, and if it is the absence of housing, how do we build more?

 How do we improve the skillset of those who are unemployed when the shortage of skills is the clearest barrier to employment?

 How do we take the health and education reforms of the last Labour government to a new level, given the huge improvement in results they brought about?

 What is the right balance between universal and means-tested help for pensioners?

How do we use technology to cut costs and drive change in our education, health, crime and immigration systems?

 How do we focus on the really hard core of socially excluded families, separating them from those who are just temporarily down on their luck?

 What could the developments around DNA do to cut crime?

There are another 20 such questions, but they all involve this approach: a root-and-branch inquiry, from first principles, into where we spend money, and why.

On the economy, we should have one simple test: what produces growth and jobs? There is roughly $1trn (£650bn) of UK corporate reserves. What would give companies the confidence to invest it? What does a modern industrial strategy look like? How do we rebuild the financial sector? There is no need to provide every bit of detail. People don’t expect it. But they want to know where we’re coming from because that is a clue as to where we would go, if elected.

Sketch out the answers to these questions and you have a vision of the future. For progressives, that is of the absolute essence. The issue isn’t, and hasn’t been for at least 50 years, whether we believe in social justice. The issue is how progressive politics fulfils that mission as times, conditions and objective realities change around us. Having such a modern vision elevates the debate. It helps avoid the danger of tactical victories that lead to strategic defeats.

It means, for example, that we don’t tack right on immigration and Europe, and tack left on tax and spending. It keeps us out of our comfort zone but on a centre ground that is ultimately both more satisfying and more productive for party and country.

You are invited to read this free preview of the upcoming centenary issue of the New Statesman, out on 11 April. 

http://newstatesman100.tumblr.com/post/47687650241/tony-blair-labour-must-search-for-answers-and-not

The Spirit of ’45 – first look review | Film | guardian.co.uk

Ken Loach’s account of the Labour postwar programme of nationalisation favours reminiscence at the expense of detail, but it certainly packs an emotional punch

Andrew Pulver

guardian.co.uk, Monday 11 February 2013 11.25 GMT

Labour of love … a still from Ken Loach’s The Spirit of ’45

No one can accuse Ken Loach of sitting on the fence. This account of Labour’s postwar general election victory and the subsequent programme of nationalisation is about as partial as they come. In Loach’s eyes this was a glorious time, when the experiences of the second world war were put to era-changing use on a home front still crippled as much by the depression of the 1930s as by military expenditure. The rush of socialist enthusiasm ended dangerously exploitative conditions in heavy industry, rebuilt lousy housing and established a free-to-all medical service.

The Spirit of ’45

Production year: 2013

Country: UK

Directors: Ken Loach

More on this film

Well, Loach’s film certainly packs an emotional punch. He calls on a string of retirees – former mineworkers, nurses and the like – to tell their stories. It’s clear that a big part of Loach’s purpose is to confront the decades of media propaganda that have characterised unionised workers as overpaid shirkers, brakes on growth and “the enemy within”, as Loach’s principal bete noire, Margaret Thatcher, would have it. Indeed, as Loach presents it, this was a time when the union man (and woman) was a heroic figure, straddling the age and hewing the future with bare hands. It’s stirring stuff.

But I do have to confess to feeling a tiny bit disappointed. Although Loach’s film is certainly engaging – largely down to his spirited interviewees – there’s something a little sketchy about it. We know that this was an epoch-making period, that the 1945 election was great national drama, that Attlee was a great leader – but the film rushes through it all with little attempt at in-depth contextualisation. Loach’s aim is to favour memories and reminiscences (as the title indicates); I’d have liked the exhortatory tone leavened with more detail. Rather bafflingly, for example, he completely blanks that other great project of the 1945 Labour government, the disengagement from empire – the global impact of which has arguably been greater.

But it would be churlish to pick too many holes. This is clearly a subject Loach has great feeling for, even if he keeps himself scrupulously off camera. There’s a very contemporary purpose at work here too: to remind people, if nothing else, why the NHS is worth fighting for at the very moment it’s being dismantled. Films are rarely this committed or, indeed, persuasive.

via The Spirit of ’45 – first look review | Film | guardian.co.uk.

Accountability and transparency demand that Freedom of Information requirements should be an essential corollary of receiving public funding, throughout the whole of the NHS

Posted: 30 Jan 2013 05:15 AM PST

Changing patterns of provision for public services can have serious implications for existing standards of public accountability, converting large swathes of previously open and published information into ‘commercially confidential’ material kept secret by for-profit companies. Grahame Morris MP argues that the solution to this creeping decrease in accountability is to require that FOI rules on public disclosure apply even-handedly to all service providers within the NHS, whether they are in the public or private sectors.

In late January 2013 the Department of Health announced the formation of an expert panel within the Department advising the government on ‘Strengthening the NHS Constitution’. Replacing the older NHS Future Forum working group, this panel would “oversee the consultation on strengthening the NHS Constitution” and “develop a set of proposals to give the NHS Constitution greater traction so that patients, staff and the public are clear what to do, and who to turn to, when their expectations under the Constitution are not”. The Department also disclosed the Commercial Director of Virgin Care (that Dr Vivienne McVey), has become a member of an expert panel within the Department advising the government on ‘Strengthening the NHS Constitution’. Now Virgin Care is actively involved in bidding for lucrative NHS contracts up and down the country, and is now controversially running some NHS services in Southern England. So Dr McVey’s company is just one of a number of private companies, from home and abroad, now bidding for an estimated £7 billion of NHS contracts that have in recent months been put out to tender. In common with other private healthcare companies, Virgin Care stated in an interview to the Financial Times that it intends to make an 8 per cent profit from NHS contracts, which are financed by us, the taxpayer.

The question any reasonable observer might ask is what possible interest could Virgin Care have in ‘strengthening’ the NHS constitution, when their business model would seem to be premised on public provision performing poorly? So taxpayers and patients may justifiably ask if Virgin Care’s Commercial Director is the best person to take up this important advisory position. Most people accept that transparency is a key tenet of a strong NHS. So what might Dr McKay have to say about the current bidding practices for NHS contracts that allow commercial organisations such as Virgin Care to withhold details of those bids under the cloak of ‘commercial confidentiality’, while NHS Trusts have to reveal all and are subject to the Freedom of Information Act? Does Dr McKay and Virgin Care support the extension of the FOI Act to follow the public pound to include private medical firms running parts of our NHS?

These considerations, together with substantial support from community activists campaigning against the fragmentation and privatisation of our NHS, lead me to table a Parliamentary Early Day Motion calling for private health care companies also to be subject to the Freedom of Information Act. It has attracted the signatures of 85 MPs from 7 different parties and it has received plenty of supportive comment in the media, including in The Guardian. If you, like me believe that our NHS should not be put up for sale through secretive bidding processes, please ask your MP to sign as well. Details of the motion (known as EDM 773) are as follows:

‘That this House notes that

the most significant development that has followed from the Government’s healthcare reforms has been the 7 billion worth of new contracts being made available to the private health sector;

further notes that at least five former advisers to the Prime Minister and the Chancellor of the Exchequer are now working for lobbying firms with private healthcare clients;

recalls the Prime Minister’s own reported remarks prior to the general election when he described lobbying as `the next big scandal waiting to happen’;

recognises the growing scandal of the procurement model that favours the private health sector over the NHS, by allowing private companies to hide behind commercial confidentiality and which compromises the best practice aspirations of the public sector;

condemns the practice of revolving doors, whereby Government health advisers move to lucrative contracts in the private healthcare sector, especially at a time when the privatisation of the NHS is proceeding by stealth;

is deeply concerned at the unfair advantages being handed to private healthcare companies; and

demands that in future all private healthcare companies be subject to freedom of information requests under the terms of the Freedom of Information Act 2000 in the same way as existing NHS public sector organisations’ .

Over the years there have been many campaigns launched to save our NHS, but never has there been a more important time as now, to do just that. Achieving a level playing field in bids for NHS contracts is only a start. In my own view, the next Labour Government needs to move to take the ‘for profit’ sector out of public health and our NHS, once and for all.

Note: This article gives the views of the author, and not the position of the British Politics and Policy blog, nor of the London School of Economics. Please read our comments policy before posting.

About the author

Grahame Morris MP is the Labour Member of Parliament for Easington.

NHS cancer figures contradict David Cameron and Andrew Lansley’s claims

The prime minister and health secretary have criticised the NHS on cancer, but new figures suggest the service is a world leader

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Comments (134)
Denis Campbell, health correspondent
guardian.co.uk, Monday 7 November 2011 18.48 GMT
Article history

Andrew Lansley and David Cameron, who have used criticisms of the NHS record on cancer to justify a planned shakeup. Photograph: Dan Kitwood/PA
David Cameron and Andrew Lansley’s repeated criticisms of the NHS’s record on cancer have been contradicted by new research that shows the health service to be an international leader in tackling the disease.

The findings challenge the government’s claims that NHS failings on cancer contribute to 5,000-10,000 unnecessary cancer deaths a year, which ministers have used as a key reason for pushing through their radical shakeup of the service.

In fact, the NHS in England and Wales has helped achieve the biggest drop in cancer deaths and displayed the most efficient use of resources among 10 leading countries worldwide, according to the study published in the British Journal of Cancer.

“These results challenge the feeble justification of the government’s changes, which appear to be based upon overhyped media representation, rather than hard comparable evidence. This paper should be a real boost to cancer patients and their families because the NHS’s performance on cancer is much better than the media presents. It challenges the government’s assertion that the NHS is inefficient and ineffective at treating cancer – an argument for reforming the NHS,” said Prof Colin Pritchard, a health academic at Bournemouth University.

He co-wrote the research with Dr Tamas Hickish, a consultant medical oncologist at Poole and Royal Bournemouth and Christchurch hospitals in Dorset.

The research shows that ministers have misrepresented the NHS’s record on cancer in order to gain support for their unpopular shakeup, said Pritchard.

The prime minister and the health secretary have said that both survival and death rates from the disease in Britain are low by international standards. Cameron, for example, claimed during last year’s general election campaign that Britain had a higher rate of cancer deaths than Bulgaria.

The authors studied cancer mortality and the amount of GDP spent on healthcare between 1979 and 2006 in England and Wales and nine other countries, including Germany, the US, Spain, Japan and France.

While cancer deaths fell everywhere, England and Wales saw the biggest drop in mortality among males aged 15-74 – down 31%. While six countries saw falls of at least 20%, England and Wales – which in 1979-81 had the third highest rate with 4,156 deaths per million men – improved the most, achieving the fifth lowest rate among the 10 countries by 2004-06 with 2,869 deaths per million. Among men aged 55-64 and 65-74, who are more likely to get cancer, mortality dropped by 35% and 28%.

While mortality among women the same age declined by less, at 19%, that was the third biggest improvement after Japan (23%) and Germany (20%).

And the NHS was the most efficient of the 10 countries at reducing cancer mortality ratios once the proportions of GDP spent on healthcare were compared, the study found. While England and Wales spent less on health than most others, they achieved the biggest overall annual fall in cancer mortality over the 27-year period, of 900 deaths per million. Once average GDP spending on healthcare was compared, the NHS saw the biggest fall in male and female cancer deaths of an extra 119 lives a year per 1% of GDP spent, ahead of the Netherlands (74) and almost double that in Germany (68), France (67) and Japan (60).

“That shows how good England and Wales are on cancer care, relative to spend. We do significantly more with proportionately less. It means that 34,484 people are alive today that wouldn’t have been if things had not improved since 1980,” said Pritchard.

Two authoritative studies have concluded that cancer survival rates in the UK have lagged behind those in comparable major developed countries, though experts dispute which indicators give the most accurate picture of Britain’s cancer performance. For example, Prof John Appleby, chief economist at the King’s Fund health thinktank, published research in the British Medical Journal earlier this year which disputed the portrayal of Britain as “the sick man of Europe” and argued that cancer survival rates had been improving, significantly in the case of breast cancer.

Duleep Allirajah, policy manager at Macmillan Cancer Support, said: “In the past 10 years cancer services in the UK have improved dramatically. Waiting times have decreased and services have been modernised.” But, with cancer survival improving, the NHS now has to address new challenges, notably improving care for patients who have undergone treatment.

“Far too many people in the UK still experience sometimes serious problems related to their cancer treatment. For many these can persist up to 10 years after treatment. The focus now must be for the government and the NHS to address the issues of aftercare and making sure cancer is treated as a long term condition,” said Allirajah.

Pritchard said: “David Cameron and Andrew Lansley are happier with NHS ‘bad news’ stories rather than, as our research shows, that we should celebrate the NHS which, in monetary terms, is vastly superior to the private healthcare system of the USA.

“Of course we should always be looking to improve. But the only way to judge the NHS is to compare it with other countries, which shows that we are still getting the NHS on the comparative cheap.”

The Department of Health declined to respond directly to Pritchard and Hickish’s findings. “There is a difference between achieving efficiency and the results patients receive. While it is good that NHS cancer treatment is relatively efficient, we know that the results patients actually get lag behind many other countries,” said a spokesman.

“Our cancer strategy is clear – we aim to save 5,000 lives extra every year by 2015 which will bring us up to the level achieved in many other comparable countries. We owe it to patients to deliver standards which are up there with the best in the world,” he added.

http://www.guardian.co.uk/society/2011/nov/07/nhs-cancer-figures-cameron-lansley

I’ll always be grateful to the GP who eased Mum’s pain – even if it hastened her death

By Nick Maes

Nick Maes's mum Wil lived with a diagnosis of dementia for three yearsNick Maes’s mum Wil lived with a diagnosis of dementia for three years

Earlier this month, Dr William Lloyd Bassett, a Shropshire GP, was hauled in front of a disciplinary panel at the General Medical Council.

It was alleged that he’d deliberately hastened the death of a terminally-ill man by giving him a huge dose of morphine.

The case made headlines across the country, and prompted debate about the fine and treacherous line between aiding a patient in distress and hastening death.

But for me, this case was especially shocking. For I had witnessed Dr Bassett in action: he gave my mother morphine as she was about to die.

The recent General Medical Council hearing centred on an incident in May 2009 when Dr Bassett went to the home of a man dying from lung cancer and treated him with a high dose of diamorphine.

This led to him being questioned over his fitness to practise; a serious charge that could have ended his career.

Crucially, though, the family of the man who died would have nothing to do with the charges against him, and supported Dr Bassett 100 per cent in his actions.

The patient had become deeply distressed in his final hours. Although Dr Bassett accepted that the 100mg dose of morphine was too high and a mistake, it led, in all likelihood, to a more peaceful death

Last week, the hearing decided that Dr Bassett should continue to practise, but issued a warning of serious misconduct against his name.

Such cases mean many GPs are now nervous about administering pain relief to people in the final hours of life, in case they find themselves in a situation similar to Dr Bassett’s.

Dr Clare Gerada, chair of the Royal College of GPs, agrees that doctors are frightened to administer powerful opiate drugs.

‘It’s very difficult for doctors to offer palliative care because of the threat of manslaughter charges should the patient die soon afterwards. When one hears of a patient dying after a dose of morphine, there’s a sense of relief that you’re not the one who has administered it.’

Dr William Bassett gave Wil morphine as she was about to dieDr William Bassett gave Wil morphine as she was about to die

But after witnessing Dr Bassett at work in a similar situation as he attended my dying mother three years ago, I can only thank him for his caring, professional intervention.

At 83, my mother Wil — the name she was known by to all her family and friends — had been living with a diagnosis of dementia for three years.

Yet she managed to remain at home because of the stalwart support of her family, and carers who came in a couple of times each day.

Mum was determined to stay put. That was her resilient, forthright character — some would call it bloody mindedness, but it made her who she was.

When a social worker pushed for her to enter a home, the idea was swiftly rejected — by Mum and by us as a family. She’d cling to her staunch independence, a trait compounded by losing her husband Arthur nearly 40 years earlier.

But Wil’s general health was suddenly complicated as her vital organs began to fail: heart failure, water retention, high blood pressure and immobility intensified the problems.

Our family GP had no sure way of telling how long she might live, although it was suggested she might survive for another two weeks.

Mum’s condition rapidly deteriorated. Within 24 hours, she looked intensely frail and was hallucinating.

But that evening she seemed to rally. She sat up in bed and enjoyed an impromptu party, drinking brandy, laughing and chatting with all those closest to her.

Mum loved a good party and I think secretly enjoyed being the centre of this particular one. Our spirits were raised, even though we sensed, deep down, this would be the final stage of her illness.

At midnight, as my three sisters and I prepared Mum for bed, she had a seizure. Her eyes rolled into the back of her head, her body became a dead-weight and any colour that might have been there drained from her complexion. It was as if she’d imploded.

We eased Mum back into bed, tacitly understanding the end was close. Yet none of us really quite knew what to do. We’re not a foolish or mawkish family by nature, yet confronted by our mother’s inexorable slide towards death we found ourselves helpless.

It was eventually decided to call Shropdoc, the local out-of-hours doctor’s service. Dr Bassett isn’t our family doctor; it was sheer luck that he happened to be on call that night. His response was quick, and after examining Mum he suggested sending for an ambulance.

Nick Maes, aged four, with his mum WilNick Maes, aged four, with his mum Wil

We didn’t want Wil to go to hospital; there was no logical reason to send her. Dr Bassett respected our wishes and left, urging us to call again if there were any change.

We took it in turns to sit with Mum. But as the night drew on, Wil became restless, pointing into space, trying to shift her tiny frame off the bed. Mum’s agitation and distress became more marked and then she was sick.

At 4am we called Shropdoc again and Dr Bassett returned. It was obvious that neither I nor my sisters knew what we were doing. Dr Bassett’s presence was a huge reassurance to us, and more importantly to Mum, towards whom he was compassionate. He was with us for an hour all told and his manner was exemplary.

He spoke with Mum as she drifted in and out of semi-consciousness, asking her how he could help. Eventually he suggested that she might like morphine as a drip and as an oral dosage to ease her pain and relax her. (Wil hadn’t had any other medication until that point.)

Mum was unequivocal and nodded agreement. Wil was a woman who’d always said she wasn’t afraid of death, and now her old resilience flashed back. I felt an innate sense of relief, as did my sisters, that a decision had been made and a course of action taken.

Dr Bassett didn’t shy away from explaining what would happen, not to Mum nor to us, her children. The morphine would calm her and relax her; as the drug worked she’d probably slip away with less fight, drifting inescapably into a deep sleep.

He attached a line to Wil’s leg and placed the morphine drip-feed device on the dressing table — an incongruous addition to the knick-knackery of mirrors, perfume and jewellery usually found there.

Ensuring Mum was comfortable, Dr Bassett slipped quietly out of the house, leaving us to sit and gently talk with her.

The morphine quickly took effect, and she drifted off into a calm and deep sleep. We sat around her bed, holding her hands, stroking her hair, reminiscing about the marvellous times we’d had together and telling her how much we loved her.

Just after 9am the next day — a little over five hours later — Mum stopped breathing; she’d died with dignity and in peace.

The nature of her death was due to Dr Bassett’s seemly and humane intervention.

Her suffering had been minimal and she’d had the great good fortune to die in her own bed surrounded by all of her children.

Because of this experience, I’m under no illusion that assistance for those in the final stages of dying should, if requested, be given by doctors without fear of reprisal.

I’m not advocating wholesale euthanasia, or ending life along the lines practised at centres such as Dignitas in Switzerland. But when life is undeniably ebbing away, it is surely our responsibility, as a kind and caring society, to alleviate unnecessary suffering.

Doctors are rightly governed by a strict code of conduct. Key to the principles of medical ethics is that the doctor acts in the best interest of the patient. This would include giving pain relief to ease the suffering of the dying patient.

But this action can conflict with another key principle: do no harm. Even small doses of morphine suppress breathing, and there is a point where adequate doses may, inevitably, stop the breathing.

Dr Clare Gerada explains: ‘There’s no guidance regarding the amounts of diamorphine to be used on patients. This is because some cancers require hundreds of milligrams and others maybe just 10 or 20. It makes it very difficult for doctors because it’s difficult to predict.

‘Morphine is a very good drug, not because it kills people, but because it calms people down; and in the case of lung cancer makes it easier to breathe.’

Yet I would argue that if someone was on the verge of death, then what difference would alleviating the pain and hastening the inevitable make?

It’s a pragmatic approach, due in no small way to the practical influence of my mother.

‘We all have to go at some time,’ my mother would say. ‘No exceptions. There’s nothing to be scared of.’

Of course, the real fear is of dying in anguish. But the use of morphine to ease this fear still conjures up — almost unavoidably — awful memories of Dr Harold Shipman.

However, we shouldn’t make these nervous connections and demonise the drug. It’s vital that we have open and honest dialogues with GPs, patients and families in order to make informed decisions.

Until recently, it was common knowledge that the family GP, when tending the dying at home, might help shorten the suffering with morphine.

Maybe this was more an implicit arrangement — an unofficial, yet profoundly caring intervention that was acknowledged but not openly talked about.

Perhaps in previous generations there was a greater level of interaction between doctor and patient than we have today.

Each year, approximately half a million people die in Britain. A recent report from the think-tank Demos shows two-thirds of us would like to die in the peaceful and familiar surroundings of our own homes.

This is an infinitely preferable option to the noisy and frightening environments found in over-stretched and busy hospitals.

Yet, in reality, barely 18 per cent actually manage to achieve this last wish — which equates to more than 190,000 dying in hospital each year when they would rather die at home.

The Dying for Change report suggests that by 2030, just one in ten will have the opportunity to die at home.

Charles Leadbeater, the report’s co-author, said: ‘It’s not just that we’re living longer; part of this means that people are dying over a longer period, losing first their memory and then their physical capacities in stages.

‘If we put in the right kind of supports for people to cope at home, many tens of thousands of people could have a chance of achieving what they want at the end of life; to be close to their family and friends, to find a sense of meaning in death.’

From sitting in those final moments with my mother, I know nothing is as intimate or as personal as being with someone as they die. It is a great and intensely private honour.

And when my time comes, I can only fervently hope that someone as caring and as compassionate as Dr Bassett will be at my bedside.