Palliative Care Bill [HL]

My Lords, the noble Lord seeks in supporting the Bill to establish a statutory entitlement to services for individuals that, in my judgment, it would not be possible for the statutory services to guarantee to provide. He must recognise that that is a major problem. If we go down the route of legislating for all the things that we would love to be provided by local statutory services without any regard to the practical consequences, all we will do is raise people’s expectations, which the statutory services are almost bound to fail to follow. I was not going to let myself be distracted, but I did. I have no doubt that we will repeat those arguments on Monday. However, these are important discussions and debates. Getting the balance right between a general duty to provide services and explicit provision is clearly very important. However much I may disagree with the noble Baroness’s approach, the need for us to improve the provision of palliative care in this country is not in doubt. Noble Lords have graphically described why we need to do that. My noble friend Lord MacKenzie talked about variations in care in relation to two people whom he knew. The noble Lords, Lord Patten and Lord Alton, and the noble Baronesses, Lady Greengross and Lady Howe, all talked about variation in provision and quality of service. There are variations in geography and pathways of care. There is the fact that if you have cancer and are at the end of your life, you are much more likely to receive high-quality palliative care than are people suffering from Alzheimer’s disease. There are many other examples where we clearly have a major problem of variation in services. I also recognise the funding pressure on hospices. Several noble Lords talked about that; the noble Baronesses, Lady Finlay and Lady Neuberger, in particular, talked about some aspects of it. There is no question about the contribution of the voluntary sector to the funding of palliative care. I understand that the current contribution of the voluntary sector to end-of-life care and existing specialist palliative care services is about 60 per cent, which is an absolutely magnificent contribution. I also accept that the deficits in the health service in England in the current financial year have led primary care trusts to make some difficult decisions about the funding of local palliative care services. I do not seek to deny that that has happened and I understand that it has brought difficulties; indeed, we have heard examples of the difficulties that it has brought to hospices. I just say that that must be considered alongside a 40 per cent increase in NHS funding for adult voluntary specialist palliative care services since 2000. The NHS Cancer Plan 2000 recognised the need for increased NHS support for specialist palliative care, and that has followed. I agree with the noble Baroness, Lady Neuberger, about certainty of funding. I well understand that if a hospice does not know from the beginning of the financial year or, indeed, within the financial year what its allocation from the health service will be, that is a pretty poor position to be in. I also agree with her that it is very desirable that hospices have long-term certainty of funding. That is not in my gift. As the noble Baroness rightly said, these are matters for primary care trusts. However, every time I can, I take the opportunity to make it clear to PCTs that, when they deal with voluntary organisations, they must recognise issues about the raising of money and the fact that those organisations cannot depend on funding in the way that statutory agencies can. I will talk about the end-of-life care strategy in a moment, but I hope that it will address some of those points. The noble Lord, Lord Alton, referred to the challenges for those providing children’s palliative care. The end-of-life care strategy does not cover provision of palliative care services for children, but an independent review of the long-term sustainability of children’s palliative care is being undertaken by Professor Sir Alan Craft and Miss Sue Killen. My understanding is that the review findings will be reported to Ministers shortly. I say to the noble Baroness, Lady Masham, that I and other noble Lords were very moved by what she said about her experience and that of her late husband. I was very sorry to hear of the shortcomings in the service and I shall refer her comments to officials working in this area, as well as to the primary care trust covering North Yorkshire. She is right to mention the Quality and Outcomes Framework for general practitioners, which I assure her contains some points relating to palliative care. The framework certainly recognises the need for GPs to provide their support in palliative care. Obviously, we will look at that to see whether more needs to be done. On C. difficile, of course we have mandatory guidance, but we look to update it from time to time. There is a rapid revaluation panel which looks at ideas and products for dealing with C. difficile and MRSA. I am happy to refer the product that the noble Baroness mentioned to the panel. The noble Baroness, Lady Emerton, and the noble Lord, Lord McColl, made important and heartening contributions on the potential of pain relief. However, we heard from the noble Baroness, Lady O’Neill, in another very moving account, about the experience of her brother and the problem of pain relief in nursing homes, particularly at a holiday time. The availability of drugs within the community will be considered as part of the end-of-life care strategy. I am also aware of the problem that professionals post-Shipman have concerns and may be deterred from using effective painkillers. Of course, that is the last thing that we would wish to see happen. I understand that the department is working closely with healthcare professions on this issue in order to get the right messages across. The noble Lord, Lord Cavendish, talked about rurality. Perhaps I may write to him with details of the NHS approach to that. On the end-of-life care strategy, perhaps I may say to the noble Lords, Lord Colwyn and Lord Alton, and the noble Baroness, Lady Emerton, that I was particularly struck by the demographics. They are quite right that the strategy will need to reflect the demographic challenge that we all face. This strategy is the way in which the Government will address many of the issues raised by noble Lords. The noble Lord, Lord Patten, said that the report is expected to be made to Ministers in the autumn of 2007 and asked me to define the Department of Health’s definition of autumn. I am tempted to say that it has its ordinary and regular meaning; I am afraid that I cannot go further than that. However, of course we treat this with great importance. I am sure that my ministerial colleagues who are concerned with this area of policy will wish to study it with the greatest of care and be able to report to Parliament and the public on the outcome of that work. Several working groups have been set up, which will cover primary care, as referred to by the noble Baroness, Lady Neuberger, and the care home sector. They will also cover the very important issue of the training of staff—not just specialist staff, but general staff in particular. I understand the importance of the questions raised about the membership of Professor Richards’s group and the working groups. The advisory board has representation from the chief executive officer of the National Council for Palliative Care, which is the umbrella body for the NHS and hospices. I understand that Marie Curie is also represented on the board. I would like to take back the issue of spiritual care to consider whether we can strengthen the ways in which the churches, religions and faiths in general can make a contribution to the group. There are a number of working groups on which, I understand, both spiritual care providers and hospices are strongly represented, as are, I should say to the noble Baroness, Lady Emerton, nurse consultants. The working groups have a broad representation, which is very important because we want the ownership of this work to be from as wide a spectrum of stakeholders as possible. As I have said, I will consider the position of the churches, particularly in relation to the advisory group, to see whether we can at least establish some kind of liaison between the churches and the faiths and the work of the group. I understand the importance of that. The noble Lord, Lord Cavendish, is right about the recruitment of consultants, doctors and other staff in general. We believe that the recruitment of consultants in palliative care will increase significantly in the next few years. One of the working groups that have been established is looking into that issue. I very much appreciate the quality of the debate. It has been very helpful and will inform the end-of-life care strategy. I again congratulate the noble Baroness on her Bill and I look forward to debating it in Committee in due course.