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Palliative Care

My Lords, it is a great privilege for me to congratulate the noble and learned Lord, Lord Lyell of Markyate, on his splendid maiden speech. I expected him, with his background as a former Solicitor-General and Attorney-General to speak with immense clarity and confidence, but I did not know that he was also going to speak in such a moving way. It was particularly moving for me because he emphasised so much the plight of very old and frail people. The noble and learned Lord will make an important contribution to this House. We will all be aware of the huge experience and the contribution he will make to all our deliberations. I wish him well and congratulate him again. I also thank the noble Baroness, Lady Finlay, for   having secured this debate, which is critically important. I congratulate the other speakers, because it is obvious that all of us are proud of the UK’s record. We have a superb record of palliative care and world leadership in the hospice movement, which has spread to many countries all around the world. We know that people who are dying do not just need general care; they need personal, humane, gentle, loving care, right up and until they take their last breath. We also know that, unfortunately, with the best will in the world, the tight resources of the NHS mean that does not always happen. I agree with the noble Baroness, Lady Finlay, that sometimes that is because we do not get the integration of health and social care right. When people are suffering form a terminal illness, it is hard to separate one need from another. That is where our systems fall down sadly for many people. I was angered when I read an article in the Guardian on 1 July which said that,"““some people still suffer a death which is medieval in its pain and distress””." That is absolutely unacceptable in a country such as ours that has such high standards in its health and social care. The Guardian article also said that that happens despite the huge advances in drugs and technological systems for care over the past 30 or 40 years. This debate is so important because we need to talk more openly about dying and the process of dying. It is something that we will all face, and have already faced with our friends and families. So often, it is a taboo subject; one of the last taboo subjects. They are really dangerous subjects, because they often have dreadful results because of being taboo, so we have a result of poor treatment and bad care that remains hidden from the scrutiny that people deserve and the standards that should be available to everyone to protect us all. Many people are ignorant, particularly, as the noble   Lord, Lord Patel, has emphasised, people from ethnic minorities and older people from the general population. People are sometimes denied the excellent palliative care or hospice care that could be available to them if they knew how to make it available. We know that most people want to die at home because they believe that they will get more personal and loving care there than in hospital. Yet the majority of all people die in hospital. We must ask why that is and why only a minority benefit from hospice care or palliative care. I agree with the noble Lord, Lord Patel, that hospice-type care must be available in multiple settings today. To spend your last days in a hospital ward is often to die badly. We have heard so many horror stories of neglect. We have heard of discrimination on the grounds of age. We have heard of very inappropriate settings and lack of privacy, among other problems. Care in a hospital could and should be as good as that in a hospice. One area of all general hospitals could be made into a hospice environment. After all, we have managed to ensure that   most maternity units in the NHS incorporate an area that is gentle and friendly, which is a suitable environment, so crucial for when a child is born. When someone is dying is no less significant an event. We should have the same standards of environment suitable for that event too. As the noble Baroness, Lady Finlay, said, since the Shipman case there is a big problem, which has been reported in a medics’ survey recently, that doctors are more nervous and less willing to prescribe adequate pain relief to dying people since that tragedy. For some we know that pain relief is just not possible. Most of us want to be in control of pain at the end of our lives. One of the reasons why I supported the Bill proposed by the noble Lord, Lord Joffe, on assisted dying is partly because the safeguards built into it mean that palliative care must be delivered to anyone in that position. Therefore, we would have to have more palliative care available, and that must be a good thing. You cannot offer a service unless it exists. So, in my view, the amount of palliative care available has to increase. I strongly support the efforts of Marie Curie Cancer Care and other organisations that are trying to ensure that everybody who wants to die at home can do so. There are gross inequalities in the distribution of palliative and hospice care. Although I congratulate the Government on their investment in this type of care, all noble Lords have outlined that it is not enough, and we need more resources if we are to get it right. There also has to be a big cultural shift in attitude within the Department of Health and the NHS, especially about older people who often suffer from multiple conditions—not always cancer. We know that older people with cancer are far less likely to die in a hospice. The figure is 8.5 per cent of those who are 85 or over, compared with 20 per cent of all cancer deaths. We know that older people with dementia do not usually benefit from palliative care at all because it is not recognised as a terminal illness, although, of course, it is in its later stages. Even for those dying of cancer, NICE has concluded that the resources are inadequate, so there is a big demand. My first experience of somebody close to me dying was a very young woman with a husband and two young children. Tragic though it was, her death was beautiful. Her experience and that of others in the same position should be the standard for us all, regardless of age, ethnicity, disability or cause of death. Dying is a part of our lives.