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Palliative Care

My Lords, I, too, congratulate the noble Baroness, Lady Finlay, on securing the debate on this important subject. In Swindon, where I live, I first chaired a private hospital, then the Swindon Health Authority, and then the Swindon Acute Care Trust. Never once in all the countless meetings that I attended over 13 years did I ever hear palliative care mentioned, let alone discussed. It was generally known that there was hospice provision in Swindon, but it was assumed that that was the responsibility of the voluntary sector.   Admittedly that was some years ago, but it demonstrates how neglected by the NHS this critical area of service provision was, at least in our area, and I suspect in other areas as well. Even today, palliative care often tends to be a relatively neglected area in the NHS. Curiously, I owe my present knowledge of the outstanding work of the palliative care profession, in which I include the hospice movement, to my involvement with the Assisted Dying for the Terminally Ill Bill. In that regard, I should add that I am firmly in the camp of Professor Sir Graeme Catto, the chair of the General Medical Council. When he gave evidence to the Select Committee on that Bill, he saw no conflict between palliative care and physician-assisted dying. It also became clear from the evidence given to the Select Committee that palliative care is the solution for the overwhelming majority of terminally ill patients, although there are a relatively small but significant number of terminally ill patients who have strong personalities and a history of being in control of their lives, for whom palliative care is not the answer. As has been stated many times, the United Kingdom rightly has the reputation of being a world leader in palliative care. There can be no doubt that in the centres of excellence, the skills and experience of our palliative care practitioners are outstanding. However, as has already been mentioned, to jump to the conclusion that because of that all is well in palliative care would be inaccurate. Provision of palliative care throughout England is uneven, and research has shown that of the 535,000 people who died in England in 2003 the majority had no access to specialist palliative care and little choice over their place of death. Ninety-five per cent of admissions to hospice and specialist care in-patient units are for patients suffering from cancer, yet each year about 300,000 patients with life-threatening conditions other than cancer would benefit from palliative care but unfortunately are excluded from it, principally by reason of their diagnosis. As a result, many die a painful and undignified death, and some a terrible death. The key issue leading to the current unsatisfactory situation is surely one of resource, both for provision of palliative care services and training and development. Bearing in mind that the NHS annual budget is in the order of £69 billion, it is surely unacceptable that, according to an estimate by Marie Curie Cancer Care, to which I am indebted for its briefing, of the £450 million spent annually on hospice and specialist care services in England, only 35 per cent is contributed by the NHS. The question that arises is: why is there this lack of resource? After all, Sir Nigel Crisp, the chief executive of the NHS in 2003, stated that,"““better care for the dying should become a touchstone for success in the modern NHS””," and Labour’s recent election manifesto included a commitment to double its investment into palliative care services. It is clear, therefore, that the Government recognise the importance of palliative care, but the question arises as to what they are doing about it. They have announced the introduction of a £12 million investment over three years, and a further £50 million for three years ring-fenced for developing palliative care services. However, in the context of the total expenditure by the NHS and the need for universal high quality palliative care for the 550,000 people who die each year, these additional amounts, adding up to £162 million over three years, are derisory. In the Select Committee on the Assisted Dying for the   Terminally Ill Bill, Professor Richards, the highly regarded national cancer director at the Department of Health, was asked by the noble Baroness, Lady Finlay, how long it was going to take to have equity and access to specialist palliative care for all terminally ill patients. His response was:"““Although I think it is extremely welcome that the speciality is going to be growing over the next 10 years, and probably doubling in size, even then . . . I do not think that is possible. So I cannot give you a figure for when that will be the case””." Professor Richards was saying that he was unable to predict when quality palliative care services would be   universally available throughout England. He appeared to be suggesting that 10 years may not be sufficient time, and that it might even be a lot longer. I suggest that this is unacceptable. It follows that unless the Government take urgent and determined action, fully resourced, we will have to resign ourselves to a situation where, for the next 10   years at least, and probably for a great deal longer, many terminally ill patients will continue to have unacceptable deaths because appropriate palliative care is not available. From the inquiries I have made, the NHS does not even seem to have completed an assessment of need for universal quality palliative care services, so it is unable to quantify what the need is and what resources are required. This is clearly the essential first step that needs to be taken with a sense of urgency, which is not evident at the moment. The statistics that are available seem to relate largely to hospice care, and it is important to recognise that such care is only a part of palliative care. A needs assessment should include all the services required by the 535,000 who die each year. Bearing in mind the current vast deficit in palliative care services, there needs to be a large and urgent injection of additional resources into the palliative care sector to increase its availability to all—and, in some cases, its quality. Large sums are also necessary for training and development of doctors, nurses and other palliative care professionals. Consideration should be given to making such training mandatory for all practitioners, and should possibly be taken into account when developing the accreditation requirements of doctors and nurses. In conclusion, I ask the Minister what the Government’s current plans are to address the unmet need and by when they aim for the NHS to provide universal, quality palliative care services?