Palliative Care Bill [HL]

My Lords, it is with real pleasure that I support the Bill, introduced with such eloquence and authority by the noble Baroness, Lady Finlay of Llandaff. It would be hard to exaggerate the contribution that she has made in this field. She combines the hard-headed approach of a distinguished scientist with the humanity that comes of a penetrating understanding of human suffering. It is a combination that I welcome, especially as there appears to some of us to exist in recent months a trend for the end-of-life debate to pit the scientific approach against the humanitarian one, when I think that most reasonable people believe that it should draw on both. As on previous occasions, I need to declare my personal interest in the Bill. I was one of the founders of St Mary’s Hospice in Ulverston, south-west Cumbria, in the late 1980s; I have been continuously involved with the organisation ever since and am currently chairman. I have regaled your Lordships on the problems we have faced at St Mary’s through our gross underfunding and through the failure on the part of the then PCT to understand what the hospice was about or to deal fairly with us. Although there remains very little improvement on the very low 10 per cent funding we have historically received from the Government, I have grounds for mild optimism, and that optimism grows stronger with the introduction of the Bill. Echoing my noble friend Lord Bridgeman, I say that at 10 per cent funding in an area such as mine, it has been a very painful operation to keep going, and it is completely unsustainable. I cannot ask local people to contribute 90 per cent for this sort of operation. This measure seeks to enshrine in law what has in effect been the policy of successive Governments for the past 20 years or more. Apart from providing a statutory framework to ensure that palliative care becomes a mainstream service, it provides for its effective delivery for all who need it. In addition, and very significantly from the point of view of those who run a hospice, it requires commissioners to identify need in their area, demonstrate transparency in publishing their plans of action and account for the progress they are making towards improving core palliative care services. I do not know whether the noble Baroness had any choice over the timing of the Bill’s introduction. For me, the timing is perfect, coinciding as it does with the Government working up their end-of-life care strategy, on which they will report later in the year. On that activity, I have this to say: for a long time now, I have been struck by the public sector’s selectivity when it comes to consulting people. It is as though it avoids having to listen to anyone who might challenge current orthodoxy or whose superior experience and knowledge might be seen as a threat. I share the view of the right reverend Prelate the Bishop of St Albans that it seems odd that the advisory board for the end-of-life strategy includes no one from the hospice movement. I suggest that, at the very least, a senior person from Help the Hospices is invited to join, even at this late stage. After all, between 80 per cent and 85 per cent of palliative care beds are provided by charitable hospices. At St Mary’s Hospice, through the provision of in-patient services alone we save the NHS £1 million a year, calculated on the basis of the tariffs it employs. That does not include the round-the-clock, seven-days-a-week telephone advice that we provide. It does not include the daycare. It does not include the numerous add-ons such as complementary therapy. On the subject of end-of-life care strategy, might the Minister be able to help me when he comes to speak on behalf of the Government? According to information that I have, there are across the United Kingdom nearly 100 vacancies in palliative care medicine. On the understanding that the new strategy will extend, quite rightly, far beyond cancer, the workload will inevitably increase significantly. I have heard it suggested that it may even double. Will the Minister tell me, or perhaps inform me in writing, what steps he has in mind to address this problem? Reading the debate introduced by the noble Baroness, Lady Jay, not long ago—I was very sorry to miss it—I experienced some unease at a number of noble Lords challenging the notion of palliative care going beyond the relief of physical symptoms. There are certainly some add-ons and therapies that we offer in St Mary’s which I would be very hard pressed to measure. I do not think that I can improve on the observation made by right reverend Prelate the Bishop of Winchester in that debate, who said: "““I am not arguing that the effectiveness of palliative care services should not be rigorously assessed and evaluated, but I suggest that in this field, as in many others, there is much that is real, true, describable and important, but not, in the end, measurable””.—[Official Report, 31/1/07; col. 311.]" Albert Einstein put it even more simply: "““Not everything that matters can be measured and not everything that can be measured matters””." There is another major stakeholder whose voice is seldom heard—the general public. Of this I feel certain. The general public, certainly in Cumbria, most certainly want the unmeasurables that we provide. In support of that opinion, I ask why else they give such unstinting and loyal financial support. In our case, it is nearly 90 per cent of our total costs. I shall highlight just one of these unmeasurables—the bereavement service. This is quite often dismissed as unimportant and low on the scale of priorities. Perhaps there was a time when even I was a sceptic. I now know through our experience that it is hugely important. Put at its most prosaic, it is quite often the only path along which a devastated individual family is able to function and resume normal life. Put another way, at the heart of what we in the hospice movement believe is that not only dying people, but also their families and loved ones, must know that they will not be abandoned to their suffering just when they are most in need. Not infrequently, it is the dying person who needs to know that the family will be looked after in this way. At a 30 per cent level of public support for hospices, I venture to suggest that a happy synergy kicks in. Ministers who are faced with an imperative to account for public money can sleep easily in the knowledge that they are getting a bargain deal on core costs of palliative care, and the public get the extras through their local contribution. However, if this is to work, as it can and should, it will entail close co-operation between the public and voluntary sectors. Such co-operation has so far been elusive. Differing cultures present real problems which cannot be wished away. Here I come to my second area of optimism. We in Cumbria have a new PCT under new leadership. We are in discussion with this almost brand-new organisation, with a view to establishing what has become known as social enterprise, which would provide the best possible end-of-life care through proper partnership between the hospice movement, the NHS, social services, the voluntary sector and private nursing homes. The PCT has made it clear to us that it believes that our hospice can play a leading role in developing and spreading best practice around individualised patient care. I pay warm tribute to it for this brave and welcome initiative. I believe that it would be the first such enterprise of its kind in the UK and could herald a new era for hospices. It will be a triumph for all participating parties if we can make this work. We are in the very early days of building our partnership, but I have high hopes for it. There appears to be the will among all concerned and on all sides for it to work. I would welcome the Minister’s comments on rurality—I have touched on it previously. There was a time when, as I remember, financial formulae were in place which were designed to even out the inequities of public service provision which arose out of rurality or remoteness. They have largely been removed with two results: first, providers in rural areas are put under terrible pressure to maintain services and balance their books. The second inevitable consequence is growing rural deprivation. I know that this is a complex subject, and I acknowledge also that common sense dictates that there are trade-offs as a consequence of living in a remote area. However, there should be areas in which there should be no trade-offs and no compromises, and palliative care is one of them. I hope that the Minister will look at this again. If he does not, I fear that he will add in significant degree to the growing problem of rural deprivation and the worsening provision of palliative care in areas such as Cumbria. It has been pointed out to me that Eric Cassell, professor of public health at Cornell University, is regarded as one of the greats in contemporary medicine. He has said: "““The test of a system of medicine should be its adequacy in the face of suffering””." This short but important Bill seems to echo Cassell’s dictum. I support it and wish it safe passage.