Palliative Care Bill [HL]

My Lords, it is a privilege to follow my noble friend Lady Masham of Ilton and to take part in this remarkable and moving debate on the Bill of my noble friend Lady Finlay of Llandaff. I pay tribute to the many memorable speeches we have heard today, in particular that of the noble Baroness, Lady Gardner of Parkes. My noble friend Lady Finlay of Llandaff has achieved a huge amount already in promoting palliative care. Her introduction of the Bill is an important—indeed, essential—step in ensuring that the topic is very firmly placed at the top of the nation’s healthcare agenda. It is a most welcome reinforcement of the Government’s recent thinking on the end-of-life care strategy. No one, of course, is surprised that this service, like so many other philanthropic good causes, began with voluntary charitable work. Palliative care and the hospice movement generally have remained largely dependent on the voluntary and charitable sectors for fund-raising and for mobilising the human resources, skills and training needed to tackle the task. One wonders why so much started by the voluntary and charitable sectors has become the responsibility of the state. I believe that there are two explanations. The first, which is undoubtedly true, is that the expertise developed by organisations such as Marie Curie and Macmillan Cancer Support have so qualified them that, with quite modest backing from the public purse, they are uniquely well qualified to deliver this increasingly community-valued end-of life-service. The second explanation is of a rather different kind, and follows in a way the comments made by the noble Lord, Lord Carlile: it is the impact of what I believe is a developing change in the balance of public perception. We have long celebrated, both in families and as a nation, the birth of every baby—his or her start of life. Medical investment in that has been enormous. So, too, have we applauded every improvement in infant mortality rates. But until recently, at least, the circumstances of that same baby’s end of life has not been seen by successive Governments—nor, to be fair, by the rest of us—as having anything like the same importance. We fail to value or celebrate his or her contribution to family, the community or indeed the economy. Bluntly, those facing end of life have not been a priority for government spending. People carry the scars from bad care they have witnessed for the rest of their life. We have heard some appalling examples of that this morning. It is unsurprising that there has been a reluctance to think, let alone talk, about when—still less, how—one’s death will happen. The most, perhaps, that we have all hoped for until recently has been for a quick, sudden death. Now, however, more and more people are seeing, many of us within our own circle of family and friends, that with palliative care expertise the end of life, though inevitably sad, can be positively reassuring for all involved. I mentioned one such family’s experience when last I spoke on this issue. That same family today is still talking about the comfort and enrichment that that whole experience gave them. That is why this Bill is such an important pointer to a future that is better balanced between birth and death, for there are still far too many circumstances in which palliative care is just not available, and too many communities, towns and even districts where it is barely available at all. We should prefer to die in our own home; we have heard that reinforced. Marie Curie’s 64 per cent is a striking percentage. The crucial requirement, I argue, as your Lordships have done before me, is for all those who are involved in the provision of end-of-life healthcare to have access to resources that will allow them to establish partnership or other arrangements that will secure the best provision of the best possible palliative care. The Bill addresses just that need. Unless the state provides the necessary funding, the palliative care postcode lottery will continue. That means, as usual, that the most deprived areas are the least likely to have the excellent arrangements that we, for example, enjoy in south Warwickshire. Quite apart from the availability of at least three local hospices, we have a well spread, widely supported voluntary organisation, Shipston Home Nursing. Two key features of that are that the chairman is a senior partner in the local GP medical centre, and that there remains open nearby a small local National Health Service hospital from which the combined half-voluntary, half-public seven-day service is organised. That is the kind of standard we should be seeking to achieve elsewhere—everywhere—not just because patients are getting a more appropriate, personal and choice-based service; Shipston Home Nursing is also making a substantial saving for the National Health Service. One patient being cared for at home last Christmas saved the cost of one month in a hospital bed—about £15,000. The follow-up document, published in October 2006, to the Government’s White Paper illustrates some of the other encouraging pilots and partnerships already under way, which will spread knowledge of, and training for and in, palliative methods. It is especially encouraging to read of Marie Curie’s Delivering Choice programmes in Lincolnshire, Tayside and Leeds. All those are steps in the right direction, arising from a growing conviction that the palliative care approach is the right one for all older people at the end of a long life. Arrangements of this kind are already demonstrating that, by providing a rapid-response range of services for those at home, a considerable saving in hospital admissions is achieved. There is a long way to go on that, however, and there are many circumstances in which people will call an ambulance because they are so concerned and unsettled by what they see in a loved one, as my noble friend Lady Masham pointed out. The saving as far as hospital beds are concerned is a claim that all palliative care enthusiasts have made for some time. The research by Professor David Taylor and Sarah Carter suggests that for every £1 extra invested in community palliative care, £2 is released to the acute hospital sector. Even against that background, the Government’s commitment to provide £50 million towards refurbishment of hospices, although of course welcome, will not be remotely enough to ensure that adequate resources, facilities and training for palliative care staff are available throughout England and Wales. That is exactly why my noble friend’s Bill is essential, if anything like the Government’s own plans for palliative care are to be achieved. I join others in hoping that your Lordships will be hearing from the Minister today that the Government will indeed support the Bill.