Palliative Care Bill [HL]

My Lords, I thank my noble friend Lady Finlay of Llandaff for this humane and necessary Bill. Why do I think it is necessary? The services of palliative care throughout the country seem to be very patchy. I know that from personal experience. My husband died 11 months ago, having lived for many years with several different medical conditions, which were the result of strokes, diabetes and Parkinson’s disease. He had a bleed in his head from too much Warfarin. A thrombosis developed in hospital: he was discharged with it and then had to be admitted to another hospital as an emergency. He got cellulitis. Later on he also developed a cancerous tumour that resulted in an open wound which had to be dressed twice a day. I am pleased to say that treatment with Warfarin has thankfully improved from the early days and is now monitored regularly, I hope, for everyone who needs it. Over the years, we had many dramas, some excellent medical treatment and some which could have been better. But in the last few months of my husband’s life, I was extremely grateful for good advice from my noble friend about palliative care. As a professor of palliative care, the noble Baroness, Lady Finlay of Llandaff, is the ideal person to introduce such a Bill to your Lordships’ House. Already this Bill has engendered a great amount of interest from the GMC to many voluntary bodies, which is excellent. Perhaps everyone speaking in this debate should declare an interest. One never knows when any of your Lordships or I may find ourselves at the receiving end of palliative care. The weekend my husband died I had to rely on the out-of-hours doctor services. As my husband’s condition deteriorated and he was running a temperature, on that Sunday I had to wait three hours for the doctor to telephone back. When she did, she offered no help; only to say that she was unable to find a physiotherapist to help with his breathing. As she was 24 miles away, she did not bother to come out. Because of the risk of hospital infection, the GPs thought that it was better for my husband to be at home, but the community could not offer the assistance that he needed on that last Sunday. The next doctor to whom I spoke sent an ambulance and we took my husband to hospital, with all the drama that that involved. He died of pneumonia while still in the accident and emergency department, without doctors being able to access his notes because they were in the GP surgery and the other local hospital—and it was a Sunday. As it was classified as a ““sudden death””, the police were involved. This is why I find the Bill so important. I am told that there is a voluntary gold-standard scheme for GPs which includes a quality framework for palliative care, planning for the patient’s end of life, in which the patient and his or her family are involved, and the out-of-hours doctor service being informed of people in a palliative care state in their area. Will my noble friend encourage this service throughout the country? I believe that such a scheme exists in Cambridge. Perhaps one day it will reach North Yorkshire. I am pleased that the Bill has already brought items of good practice to the notice of some of us. I am glad that the General Medical Council has stated that it supports the aim of ensuring that adult patients nearing the end of their lives should have access to high quality palliative care, both in hospital and community settings, regardless of their diagnosis. It also agrees that it is important that access to such services should be provided to all groups in society. I hope that these services will include out-of-hours doctors because so many things happen at week-ends and during the night. I am also pleased that the GMC welcomes the opportunity provided by the Bill for further consultation on how palliative care services should be provided. The debate is timely because it plans to review over the coming months the standards expected of medical graduates in order to gain entry to the medical profession. It can ensure that the themes of this debate are included in this review. I hope it will also include the specialist needs of patients with swallowing problems, such as those with Parkinson’s disease and motor neurone disease, and patients who are vulnerable to pressure sores, such as those with spinal injuries. However basic the needs, they should be included in high standards of medical education. Cases such as the 86 year-old diabetic lady who died in Doncaster Royal Infirmary when she developed leg ulcers after a gall bladder operation last July should be avoided at all costs. It was discovered that ulcer wounds on her legs had become infested with maggots when she was being treated on a ward. Her hospital post-mortem examination reported that she had died of old age, but her family were so unhappy with the findings that they made a formal complaint of criminal negligence to the coroner. The police were called and, in a second examination by the Home Office pathologist, it was found that blood poisoning primarily contributed to her death. The lady’s daughter is a nurse and she condemned the appalling standards of care. Vulnerable patients need particularly good care and there should be no cover-up when things go wrong. People in the last stages of their lives receiving palliative care may be immuno-compromised for many different reasons. Transplant patients and patients receiving drugs for cancer, HIV or liver disease, as well as people with long-term disabilities, are very much at risk—and many have died—from the dangerous infection Clostridium difficile, now rife in many hospitals and care homes. It causes debilitating liquid diarrhoea. This week I was shown by the company ConvaTec an interesting faecal management system—Flexi-Seal FMS—which collects liquid faecal matter from unfortunate patients should they contract C. difficile. If any of your Lordships are interested in seeing this device, I have one in my office. It is hopeful that companies are trying to help patients and staff in these difficult and unpleasant circumstances. The device will save changing a bed many times a day. I would like to ask the Minister this question: what guidelines or protocols are there for the NHS in the treatment of infection-related faecal incontinence—for example, C. difficile? I stress how important it is for patients receiving palliative care in their own homes to have their wound, stoma care, urology and incontinence products delivered. Thousands of patients depend on this service and the companies provide support to patients, carers and clinical nurse specialists in stoma care, urology and continence. I hope this service will continue. It is under consultation at the moment, having been extended until 2 April. The Bill seeks to facilitate the spread of best practice and to drive up standards. It would seem incredible if anyone disagreed with these aims. It is an appropriate time to discuss the Bill, just two days after Ash Wednesday. Good palliative care should also include spiritual support when it is wanted. Very often people who have lapsed want to come back to it at the last stage of life. Good care is not expensive but bad care can be very expensive as there can be all kinds of breakdowns in many directions. I wish the Bill a speedy, successful journey through your Lordships’ House. It has been a privilege to take part and share in the debate today.