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Palliative Care

My Lords, I start with a sincere apology to your Lordships for not being in my place at the beginning of the debate; I was walking across London. I was very sorry to miss the speeches of the noble Baroness, Lady Finlay of Llandaff, whom I congratulate most warmly on introducing the debate, and the noble Lord, Lord MacKenzie. None the less, it is a great honour to be a Member of your Lordships’ House and I am delighted to have the opportunity to make my maiden speech on the very important subject of palliative care. Like many Members of your Lordships’ House, I have been a strong supporter of the hospice movement ever since I came into Parliament—and, indeed, shortly before. I have been a supporter of St Frances Hospice in Berkhamsted, then for many years of St   John’s Hospice in Moggerhanger and currently of the Grove House Hospice in St Albans. Any insights that I may have are not my own but are due to the fact that I was lucky enough to marry into a medical family. Under the inspiration of my father-in-law, the late Professor Charles Fletcher—a great expert on emphysema, which so injures old people—both our elder children are doctors in the NHS. Our elder daughter is a registrar in care of the elderly in Southmead Hospital in Bristol and our son and his wife are both general practitioners in south-east London. So if there is any merit in this speech, it comes not from me. The hospice movement is one of the shining constellations in the firmament of the voluntary and charitable sectors. All governments are wise to cherish it and to work with it closely. As many noble Lords have said, it has developed a great deal over the past 30 years. The first important development, which I strongly encourage, is that in addition to the wonderful work that it does in relation to cancer—both for in-patient residents in the hospices themselves and out in the community—it now treats other conditions that so often afflict those in the later stages of their lives. I refer particularly to heart failure, which can affect people for many years, angina, chronic emphysema and other conditions which obstruct patients’ airways. In both these areas the medical profession is rightly seeking to work out how best to give palliative care to those who may never get better but who can none the less, with proper help, enjoy a valuable quality of life—largely at home—for whatever period is left to them. As I understand it, it tends to be the very frail and the very old who are let down by our system, and those who are fading often find themselves forced to fade in hospital for lack of an adequate structure to give help at home. Nursing care at home is immensely valuable. Families can be very good at caring for their loved ones. Indeed, old and frail people can be very good at caring for themselves at home if they can have, in particular, the advantage of three-times-a-day help, but they often have to wait many weeks, and perhaps months, before such help can be provided—if, indeed, it can be provided at all. Great efforts are rightly made to tie in the work of the National Health Service with local authority social services and, when available, the work of the hospices, both residential and out in the community. This is hugely to be encouraged. An extra problem to be overcome is the fact that general practitioners, who are wonderful and often find the greatest satisfaction in helping their long-term patients in the last years of their lives, cannot necessarily be present out of hours—the out of hours service has to cope—and the systems of the hospice service and the NHS have to meet that particular problem. St Christopher’s Hospice in south-east London was one of the earliest hospices, started by Dame Cicely Saunders herself. It is once again showing the way by providing an excellent palliative care system for elderly patients in their own homes. They are looked after by the hospice team during the day and those hospices work closely with district nurses. In doing so, importantly, they are also able to provide cover by night. However, the work is expensive. It is not, as I understand it—the Minister will correct me if I am wrong—at present supported by any extra funding from the NHS and the continuation of that service is under great pressure. For all their wonderful work, once the need for medical intervention to a patient has ceased and the patient is stable but eventually dying, the hospital is not the ideal place to be. The nurses are inevitably busy. When the family are around the bed, it is all too likely that the patient in the next bed may need to use the commode or another confused patient may be wandering in the ward. Side rooms are at a premium and may be needed for a patient with an infection, so as an elderly patient one is lucky to get a side room. I turn to costs. The costs of nursing care at home at its most intense are probably close to hospital costs, but that usually takes place for only a short period and a hospital bed is freed up. On a cost-benefit analysis, the benefits to a patient and the family are huge compared with the misery that can be suffered when one has to die in hospital, wonderful though the hospital services are. The overall costs of hospice and specialist palliative care services are estimated to total some £450 million, of which 35 per cent is contributed by the NHS. One hundred and seventy million pounds is a modest figure compared to the total NHS spending today of around £60 billion. Professor David Taylor of the School of Pharmacy at the University of London estimates that every pound invested in hospice and home care can release some £2 worth of hospital services. So may the message go forth from this debate that this work by hospices of caring for the very old and the very frail in their own homes deserves the Government’s strongest support. It is not only excellent value for the NHS, above all, at a critical point in our lives; it is of enormous benefit to all our fellow citizens.