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Palliative Care

My Lords, the House will have observed that my noble and learned friend Lord   Lyell of Markyate is now here, but he has indicated to me that before addressing the House he wishes to pause and recover from his fortitude in getting here. I welcome him, and congratulate him on that fortitude, and, indeed, the noble Baroness, Lady Finlay of Llandaff, who I suspect also had some difficulty in getting here. At one point, when I got here, I was informed that the noble Countess, Lady Mar, was going to speak in the noble Baroness’s place. I congratulate her both on her fortitude and on getting this very important debate. I have a couple of interests to declare, most obviously as chair of Help the Hospices, to which I shall refer on one or two occasions during the course of this speech. I am also the former chair of East Anglia’s Children’s Hospices, something upon which this debate has not focused so far. There are particular points about children’s hospices, which I do not intend to rehearse today, but I hope that we will not forget their importance in the course of our discussions. My interest in this matter goes back quite a long way, long before I was chair of either of these bodies, to when I was a junior social security Minister in the early 1980s. My path crossed—probably the tactful way to put it—those of both Anne, Duchess of Norfolk, the founder of Help the Hospices, and Dame Cicely Saunders, who could almost be seen as the modern founder of the movement. As a result of the experiences I had and, frankly, the lobbying I experienced, I spent some time manoeuvring within a particular part of the social security system to direct more money to the support of hospice care. My track record is therefore a bit longer than I might have indicated. Help the Hospices has funded and supported hospice education for a long while. In the past five years, however, it has greatly expanded the support it offers to information services, in grant aid, in raising funds for local hospices, and in giving voice to the views of the more than 180 local charities which provide the majority of hospice care in the UK, as has been made clear in some of the earlier speeches. Our ability to grow in this dynamic way has been greatly facilitated over the past few years by the active fundraising support of Lloyds TSB, Halifax Bank of Scotland, Tesco and the Flora London Marathon. I say this to the Minister because I think it is a good indication, both direct and indirect, of the level of public interest and support in this area. Organisations of those kinds give their support largely on the basis of what they think their staff would like them to do, and the interests that their staff have. That has not only been a help to us, but is a clear sign of the public support for the movement and the aims of palliative care. I do not have any difficultly in expressing support for the Government’s agendas on extending the availability of palliative care to people with illnesses other than cancer—I warmly endorse the speech of the noble Lord, Lord MacKenzie, in that particular respect—and in enabling people to die at home if that is their choice. Some of the research, however, suggests that something like a quarter of people would actually prefer to die in a hospice. I hope we shall bear that in mind, too. The Government’s focus on those matters is very welcome but the role of hospices in progressing those agendas should be considered more than sometimes seems to have been done. For example, if we are not to   discriminate on grounds of disease, we must understand not only the general palliative care needs of people with other illnesses but also how far they could benefit from hospice care, whether in its current form or a modified form. Help the Hospices is currently supporting a number of pilot projects in local hospices aiming to extend services beyond cancer. Those will be evaluated, and we will be keen to share the results with the department. There is perhaps a failure to appreciate that beyond the traditional image of hospices as ““in-patient units””, to use a not entirely appropriate phrase, a much greater range of services is now provided, some of which now enable people to die at home if that is their preference. That care is provided through services such as hospice at home programmes, advisory home care and respite care provided in day centres and in-patient units. We all wish to see those services continue to grow. Further to some noble Lords’ earlier remarks, I should like to test the Minister on the following point. Given the role of hospices in taking forward the Government’s agendas, it seems important that government should work closely with the hospice movement in its various forms in taking forward work on end-of-life care. As I sense the noble Baroness, Lady Finlay, felt in referring to partnerships, I believe that there would be merit in the Minister or his colleagues being willing to meet representatives of the hospice movement specifically to discuss how hospices can help to further the end-of- life-care agenda. We at Help the Hospices are certainly very keen to do that. I can hardly end without making some reference to funding, which inevitably has been a recurrent theme today. Many figures have been given, including those showing the decline that appears to have taken place in the proportion of NHS contribution to adult hospices run by local charities between 1996–97 and 2001–02, and also those on what must be acknowledged was a fairly significant recovery following the extra money made available through the NHS Cancer Plan. There has also been much reference to the promise made in the last Labour manifesto, which we all welcome. However, we have a little difficulty with it because, as the noble Lord, Lord MacKenzie, said, none of us is sure precisely how much is being spent on palliative care at the moment—there appears not to be an official estimate—so it is difficult to know what is meant by doubling the expenditure. It might help if the Minister could shed light on that. Crucially, in the light of the Government’s undoubted commitment to increased expenditure, we need some assurances that the funding will get through. Local hospices are certainly concerned about whether it will be the priority that it must be for primary care trusts if the money is to find its way to what we would regard as the right places. I hope that   the Minister can confirm that the costs of implementing payment by results for specialist palliative care will be a first call on the additional funds promised in the recent Labour manifesto. I conclude by saying that the concern about funding is familiar to anyone who has done a ministerial job of the kind that I have done and the Minister is doing. But there is a danger that, if we cannot translate warm words into cash reaching the ground, we shall not make the progress that will be universally supported in the House and there is a risk at least that we shall find ourselves going backwards. I hope that the Minister can be both positive and—dare I say?—pretty specific.