Palliative Care Bill [HL]

My Lords, when I had four very young children, I had a close friend and neighbour who was about the same age as me, in her late 20s or early 30s, who had a second child and then contracted the sort of fast-advancing cancer that can attack young women soon after they have babies. I was deeply shocked. I was very fond of her and we were close friends. She spent the last few weeks of her life in a hospice and we spoke on the phone most days. She told me repeatedly that her last weeks—the time in the hospice—were a very beautiful experience for her and for her young doctor husband. I never forgot that, as I shall not forget the speech that the noble Baroness, Lady Gardner, just made. You do not forget things like that and we are deeply moved. I thank her very much for talking to us in that way. Perhaps I may say how much I support the Bill and its aims. I have a total commitment to and belief in the value of good palliative care, as exemplified by the work of my noble friend Lady Finlay, whom I hold in the highest regard. As a result of many years of work with older people, I became extremely concerned at the lack of good care that so many people experience at the end of their lives—those who are denied palliative care at its best. I pay tribute to the many people, professionals and others, who provide such care to dying people, sometimes in very difficult circumstances and I congratulate the Government on increasing the level of funding available for palliative care. Having said that, I am sure that we all agree that there remains much work to be done and a great need for additional resources if we are to get the provision right. We must ensure that there is greater availability of palliative care to a much broader range of people, often with complex conditions that require specialist attention. It has been heartening to see palliative care start to engage with the challenges of neurological conditions, in particular. I make a special plea for the Government to help to improve the care given to people suffering from dementia. By the time that someone suffering from dementia is admitted to continuing care, they are likely to be within the last two years of their life. Their needs are physical, emotional, psychological and spiritual. Like all Members of the House, I was moved by the speech made by the right reverend Prelate, on which I congratulate him. Much of what has been said today is unforgettable. Much more needs to be done to ensure that the care given to people with dementia meets all those needs. I know that my noble friend Lady Murphy, who is unfortunately unable to attend today's Second Reading, feels strongly about that and shares my view of the priority that must be given to people suffering from dementia. I turn my attention to patient choice. My noble friend Lady Finlay emphasised that that is an important concern, especially as the person reaches the very last stages of life. There is now a more general acceptance of the holistic approach that is needed to the subject of dying, which recognises the process of dying as a life stage for which, like any other, we need to prepare if we can and over which we should be able to exercise as much choice and autonomy as possible. The Government have recognised the importance of choice, dignity and other factors both in their Dignity in Care campaign and in their emerging end-of-life care strategy. The key to helping every individual to achieve the kind of death they long for is to recognise him or her as an individual with individual requirements and needs. Two people may be dying from the same condition but may well experience it in different ways, both physically and mentally. Consequently, they will make different choices about how they want to live their final months, weeks, days or hours. One person may want to die at home; another would find it reassuring to be in hospital. One may want to try every last treatment option available; the other may tire of medical interventions. One person may suffer greatly because she is unusually sensitive to the medication that her symptoms require; the other may experience less pain but find it distressing to receive care from a young person of the opposite sex. Two people may wish to spend the time they have remaining in very different ways and consequently want very different things from palliative care. If we do not achieve as much choice as possible in the process, we will fail the dying. Palliative care should therefore be rooted in the wishes of the patient. For that reason it is important that the principle of patient choice is built into my noble friend’s Bill to ensure that the Bill and palliative care take the individual patient’s needs and wishes as their starting point and protect the discipline against any charge of paternalism. We all recognise that palliative care is not provided exclusively in a hospice setting. Figures from the ONS tell us that most people do not die there, but in hospitals or at home, including in care homes. The majority of our population wish to die at home, the next preference being in a hospice. Much more needs to be done to extend excellent palliative care into all settings and across the NHS, as stated in the Bill. Even in the most up-to-date and best equipped hospital, staff may not be able to devote the time, space and attention that a dying person deserves. I should like the best features of hospice provision included somewhere in all hospital premises, so that the terminally ill patient can have the best of both worlds: an appropriate setting with privacy, time for family and friends to be together in comfort; and first-rate medical support close at hand. Although only a small number of people die from a recognised terminal illness in care homes, they may face inadequate treatment due to the lack of appropriately trained staff or they may be transferred to a hospital for the final stage of their lives, perhaps against their wishes. Neither is acceptable. Ultimately, palliative care is about good care and the relief of suffering, but we know that there are circumstances in which some dying patients still experience considerable suffering, which even excellent palliative care does not relieve. I know that that is true of only a small minority. The noble Lord, Lord Lester, spoke eloquently about the need to respect the autonomy and choice of people at the end of life and the need for clarification of the law to ensure that people have, and know that they will have, adequate care and pain relief wherever they are. Doctors need to know that they are not at risk of being prosecuted for employing what we believe to be good practice. The noble Lord, Lord McColl, whom I admire enormously for his work, noted in last month’s debate that there is a problem here because doctors are wary of giving analgesics, especially when there is respiratory distress. We want to clarify what doctors can and cannot do. Perhaps that could usefully be explored in Committee. Palliative care is the last opportunity we have to treat and care for a person at a stage when their dignity must be maintained and cherished to the end. This Bill will go a long way to ensure that that happens. It deserves our wholehearted support and that of Her Majesty’s Government.