Palliative Care Bill [HL]

My Lords, I am sure that the whole House would wish to join me in expressing our deepest sympathy to the noble Baroness at her sad and recent loss. I am sure also that the House would agree that she spoke with great fortitude in the circumstances. That she was able to make so cogent a speech in those circumstances is no surprise to those of us who have heard her speak on many occasions; nevertheless, it was a remarkable occasion. I join in congratulating the noble Baroness, Lady Finlay, on introducing this Bill, which I support very strongly. When thinking about the Bill I was struck by the contrast we make in the way we speak respectively about birth and death. I am obviously a child; I am also a parent and a grandparent. I have known the sadness of death in the family and the joys of many births, including those of five grandchildren, and I hope more to come. We talk about birth always in terms of joy—a good birth, a happy birth; we talk about the contrast between the pain of childbirth and the joy of the child arriving. In my view there are equal points of good practice, of even joy, to be made about death, but somehow we do not speak about these things as often as we should. The noble Baroness’s Bill helps us to address these issues head on. When my father died at a great age, we enjoyed—I use that term deliberately—as good a death-bed scene as one could imagine. He was dying of a painful cancer, but through the intervention of palliative care specialists, in which I include his general practitioner, we were able to face that death with a degree of pleasure. Indeed, I recall the last words he said to me. He was always of the view that I was very scruffy, and he and I being exactly the same size, his last words to me were, ““Wear my black suit at the funeral””. I wore his black suit when I read the reading at his funeral. One should be able to remember death in terms of joy like that whenever possible. I want to make a point in a few moments about the doctor/patient relationship, which is important in dealing with the purpose and the structure behind the noble Baroness’s Bill. The doctor/patient relationship is very different from the days when my father was a general practitioner in Burnley, Lancashire, where we lived in the surgery in which I was brought up. Of course I recognise that medicine is much more technological than it was in those days, and it is neither possible nor desirable to have the same doctor/patient relationship as there was then, because so much more can be done for patients than simply enabling them to talk to a sympathetic general practitioner. Nevertheless, there are issues about that relationship that are relevant to this Bill, to which I will turn in a few moments. Specialists such as the noble Baroness, Lady Finlay, who is most distinguished in this field, have done a great deal to bring the United Kingdom to the forefront of the possibilities, if not always the practice, of best palliative care. I applaud the Government’s manifesto commitment to double the investment in palliative care. Help the Hospices says in its briefing for this debate, however, that, "““the gap between what hospices spend on NHS services and what the NHS contributes is estimated at £150-£200 million and is widening. Most hospices are suffering a real terms cut in their funding, leaving many hospices reliant on local fundraising””" to provide what we should regard as essential services. There are pressures from elsewhere. My noble friend Lord Roberts of Llandudno—a Methodist minister with some expertise, he tells me, in matters relating to gambling—has drawn to my attention this morning a real issue arising from the Gambling Act. Many hospices that run lotteries and take contributions by telephone and on the internet now have to stump up substantial licensing fees, which bring the very viability of those lotteries into question. Sometimes we know not quite what we do when we introduce yet more regulation. I invite the Government to look at that issue facing hospices and similar organisations to see whether four-figure licensing fees are really necessary. I am concerned about inconsistent commissioning practices. Primary care trusts can decide with little or no warning to reduce commissioning levels or funding. That results in unexpected and unpredictable pressure on charitable income and causes considerable difficulties for the trustees of hospices. I shall now make my doctor/patient relationship point. A few years ago the Welsh Assembly Government granted me the privilege of writing a report on the safety of children in the National Health Service in Wales, Too Serious a Thing, in which I was assisted by many medical experts. The preparation of that report gave me the opportunity to look at the NHS in every aspect as it affected children—the optician, the school nurse, the general practice, the accident and emergency unit, the hospice, child and adolescent mental health services, and every other part of the NHS operating in Wales. The basic observation I made as I sat down to write that report was that there were patients and there were providers of services—the NHS, for the most part—but there was not much relationship between the two. I am one of those old-fashioned Liberal Democrats who believes in the principle of duty: that the state has duties and that equally citizens have duties. We cannot expect the state to work on our behalf if we do not do our bit as partners in the state in which we live. That seems to me the essence of a liberal democracy. As it happens I went to my general practitioner this morning with a minor ailment. I was able to be seen very quickly; I was prescribed; I went to a chemist; I collected the drugs; and, as it happens, I applied them in the gentlemen’s lavatory on the first floor West Front when I arrived here to speak in the noble Baroness’s debate—that is perhaps more detail than your Lordships need. It stuck me as I was going through this process, which is very real to me today, that although my general practitioner could not have been more helpful, I was not really a stakeholder in any contractual sense in my relationship over that minor ailment with the National Health Service. I return to something I mentioned earlier; it is what I called the principle of duty—that is not my phrase, it is used very skilfully in a seminal work by David Selbourne. If I have a compact with the National Health Service and the National Health Service has a compact with me, if there is a quasi-contractual relationship between the citizen and the state, it all becomes much more meaningful. In my view, the framework of the Bill could well be replicated elsewhere. It makes the patient and the state stakeholders; it makes them contracting parties. It means that there are rights—this will trouble the Government—that can be enforced. Surely, when we pay our taxes for the huge National Health Service, we should be able to enforce those rights in roughly the same way as when we go for private medical treatment. The Bill contains a useful framework that could be replicated in many parts of the health and other public services. It is right that such relationships should exist and should be fostered by legislation.