Palliative Care Bill [HL]

My Lords, I share the strong feelings of support expressed by the noble Lord, Lord MacKenzie of Culkein, for the excellent Bill of the noble Baroness, Lady Finlay. I wish it a fair wind in this House. I have no interests of any sort to declare. I have never known anyone who has experienced hospice or palliative care, and I have no medical expertise of any sort, no medical legal expertise and certainly no medical ethical expertise to offer your Lordships’ House, so I suppose that I speak as the average Peer in the street in support of the noble Baroness’s Bill. The first thing that occurs to me is that there are gross inequalities in the provision of palliative care in England and Wales. One has only to look at the geography. It is reflected in the geography because the distribution of such services often seems randomly related to need. Secondly, there is also a considerable element of randomness in access to such services, for those with terminal illnesses, other than cancer, are grossly disadvantaged in their search for help—so much so that I think, to most people in England and Wales, the mention of ““hospice”” or ““palliative care”” equals ““cancer care”” for those who are dying of cancer. The fact is that only about one in 10 of those who get palliative care in a hospice or hospital is not suffering from cancer. So there is a geographical disequilibrium and there is also, I believe, a gross disequilibrium between different classes of patient suffering from different terminal diseases. The noble Baroness’s Bill gives a clear road map for how this and other inequalities can be put right, and I congratulate her on that. It is very straightforward and easy to understand. I expect that the Minister will say in his wind-up speech—I must not try to pre-empt that of course—that to pick on palliative care is to pick out one bit of the National Health Service and that that is very unfair because there are lots of other important bits of the NHS, and it is wrong to pick out one bit of partly publicly funded provision for special treatment, which is, in itself, inequitable. That argument simply does not run and I hope that he will not use it, for, in fact, more than half the funding for palliative and hospice care comes from voluntary and charitable endeavour and not from state provision. I believe that, in that sense, palliative care is unique within the National Health Service; it is different, and it is certainly different in the very high level of satisfaction that all patient satisfaction surveys have shown, with the great majority being very satisfied with the care that they get. So we are dealing with something very unusual within the National Health Service, and it is important that we stress that. These duties need to be laid on Minister and commissioner alike to ensure greater equality of access and greater geographical fairness and also to make it clear that a disproportionate amount of what I think should be provided by the National Health Service is not dumped on charities and the voluntary sector in perpetuity. Perhaps I may give one example of how this is being played out now in London, not far from your Lordships’ House. I refer to the Pembridge unit, which was set up not by a charity but by the NHS more than 15 years ago within St Mary’s Hospital, Paddington. This unit has been threatened with closure. It used to have 17 beds; it now has 13—this in a densely populated area known for its problems of social exclusion with, I am told by one authoritative source, no less than 215 different languages and different dialects spoken by those who use the services of that hospital. That figure may not be right, but halve it and it is still a formidable number of different languages and dialects. This year, the Pembridge unit has to raise £400,000 sterling or shut. It has to raise £400,000 sterling next year or shut. That could be the end of palliative care in St Mary’s unless help is forthcoming. So I hope that the Minister and your Lordships do not feel that I am making wild generalisations from the Back Benches about the problems that NHS-founded units have within hospitals. This sort of thing flies in the face of what I always thought was a politically bipartisan policy agreed by successive Governments over the past 20 years, as the noble Lord, Lord MacKenzie of Culkein, has just said in his excellent speech. Yet I think that now palliative care is too often marginalised; too often it has been sub-let to the voluntary sector and charitable bodies. After some recent debates in this place during the Committee stage of the Mental Health Bill, which are ongoing and in which, with his characteristic courtesy and care, the Minister also took part, the General Medical Council wrote to me out of the blue, which was kind of it, and sent me a booklet called Good Medical Practice. It may startle your Lordships to know that I read it. Out of the page at paragraph 3(d) leapt the following instruction to doctors by the GMC. It said that all doctors must, "““take steps to alleviate pain and distress whether or not a cure may be possible””." I simply do not think that doctors in the NHS can do that because of the lack of proper provision for palliative care. That point also highlights the need for good quality of life right to the end and for vigilance at both ends of the National Health Service spectrum of care. What do I mean by that? This is probably more a matter for other Bills and other discussions in your Lordships’ House, but I mean that there is a paradox in that, at one end of the NHS spectrum, units, hospices and community carers are devotedly trying to help those in need who are facing a terminal illness and death. That is sometimes going on in the very same NHS hospitals or other facilities where, at least some would assert, there is increasing evidence that other people are not getting that help and that, indeed, their ends are being hastened by a covert nil-by-mouth strategy adopted by some clinicians and others to withdraw food and water. I do not know whether those allegations and assertions are true; I know only that it has been gone into in very great detail by a number of authoritative persons. One of our noble colleagues in your Lordships’ House tells me that a dossier has been compiled with about 200 examples of such assertions and allegations concerning people who should be getting palliative care, not, in the end, death-inducing neglect. This is a very important issue and it will not go away. I ask noble Lords to imagine the public outrage if, as a matter of public policy, we decided to put down unwanted dogs and cats by shutting them away in a room and taking all the water and food away from them. That would not be seen as acceptable. This is business for another day but it is a marker that I wish to put down for the Minister, because it is business that will be pursued in your Lordships’ House. Lastly, this Bill, when enacted, as I hope it will be, should help, not, as the noble Lord, Lord MacKenzie of Culkein, said, hinder the Government in ensuring that their new end-of-life care strategy is a success. I end my brief words with a request to the Minister. I know that he will be very busy in replying to the debate and that he will not be able to respond to many questions, but I should be extremely grateful if he could answer one question that I pose him in conclusion. I understand that, according to government announcements, the strategy is to be published in autumn 2007. Most of us know that timescales such as spring, summer, autumn and winter are very flexible in government parlance. Indeed, I fear that a form of administrative or governmental global warming might move the autumn season of 2007 inexorably deep into 2008. I should like to press the Minister to give a clear undertaking today that, by the end of the calendar year 2007—I am prepared to let autumn stretch that far—this strategy will be published.