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Palliative Care

My Lords, I, too, congratulate my noble friend Lady Finlay of Llandaff for securing this debate. I am pleased that she made it to the Chamber despite the difficulties. I am also grateful to the many organisations and individuals who have provided me with information. Much of my speech draws on their briefs. I start with what I think are the key challenges for delivering high quality palliative care. I hope that the noble Lord will agree with me that they are important challenges. However, he will be relieved to hear that not all of them focus on more money as being the only solution. First among the many challenges is that of delivering palliative care not only to mostly elderly patients suffering from cancer but also to those with chronic and progressive illnesses, to which I shall return. Secondly, there is the challenge of delivering palliative care in multiple care settings. More resource will be necessary, but there also needs to be more effective inter-agency working and better co-ordinated palliative care education, with national quality control, to ensure more effective workforce plans. Another challenge is that of not only recognising the differing needs for the palliative care of children, young people and ethnic minorities, as has already been mentioned, but the need to develop the kind of service structure that delivers it. There is also a need for raising public awareness and expectations of what palliative care can deliver. Often the expectations are not high enough. Let me expand on some of those challenges. People with chronic disease and progressive illness have the same needs as those suffering from cancer. They have a much diminished quality of life and a shorter lifespan. Such people have an equal right to palliative care, but their needs are not met, as dramatically demonstrated in a television documentary last year, which some of your Lordships may remember. The noble Lord, Lord MacKenzie of Culkein, has already referred to some people with motor neurone disease being unable to get palliative care. I believe that only 39 per cent of those with the disease are able to get satisfactory care. Why do I say that palliative care has to be delivered in a multiplicity of settings? The role of acute hospitals is changing and this will lead to a reduction in acute care and the number of beds. Modern approaches to diagnosis, pre-admission and discharge planning will change the way in which care is delivered. The role of care homes and community hospitals will also change. More palliative care in future will have to be delivered in a multiplicity of settings, with clear implications for the training of all health professionals who provide palliative care. Workforce planning has already been referred to by many noble Lords. I will not expand on it further except to say that just providing additional money will not solve the problem. It requires a little more long-term planning. There is a need also for more effective inter-agency working. Many impediments to effective palliative care lie at the boundaries between social work, local authorities, hospices et cetera, as well as around partnerships, care philosophy and organisational ethos. There is also the challenge of the better co-ordination of education in palliative care for all health professionals, with a national overview. My noble friend Lady Finlay and others have already spoken about the differing needs of children and young people in respect of palliative care. I shall speak briefly about the needs of the ethnic minorities. To die with dignity is one of the most fundamental of all human rights, but notions of what is a good death vary between cultures. In ethnically and religiously diverse Britain, I hope that the need for high-quality care at the end of life for all will be recognised. But before that happens, some fundamental changes will be required, both in the provision of palliative care and the rate of progress in introducing education in trans-cultural medicine to medical and nursing curricula. Currently, only a tiny percentage of people from ethnic minorities has access to services for the terminally ill. For a variety of reasons, patients from ethnic minorities are often dying at a young age from diseases not related to cancers. There is a false belief among some people that hospices, with their Christian roots, cater only for people from that faith. There is a lack of understanding on the part of health professionals of the death rites of different cultures. For instance, why is it that a middle-aged Muslim daughter insists on maintaining a day-and-night vigil of her dying mother? Or why is it that the Hindu parents of a dying child wish the child to be as close to the floor as possible? The development of palliative care services that cater for all cultures and the training of professionals to understand them are key issues. More than 65 medical schools in the United States of America now offer modules in spirituality and health. These and other good practices in the education of health professionals need to be introduced in the United Kingdom. These are some of the challenges that need to be addressed. If we accept that palliative care services are not as well developed as they should be, and that they should be developed to deliver care to all who need it to a standard that they deserve, we have an opportunity to shape and develop these services. I hope that the Minister will agree that the starting point could be the palliative care needs assessment report by the research and development department of the Department of Health—a report that is all-encompassing and addresses all of these issues, including the resources required.