---

Palliative Care

My Lords, I thank my noble friend for giving your Lordships the opportunity to discuss this important and emotionally moving subject. My noble friend Lady Finlay is a professor of palliative care, and is an expert. I speak from having had the honour of being the designated person to take decisions on behalf of someone dying of HIV/AIDS. I am also president of the local branch of the Motor Neurone Disease Association, and I have a husband with multiple disabling conditions, complicated by diabetes. Last year my husband had an enormous abscess on his lower gut, and spent three weeks in intensive care. I know only too well that one has to take one day at a time, and hope is of the utmost importance in these times. I agree with my noble friend that it is so important that real choice and personalised care is provided to all people facing the end of their lives. Palliative care is an approach to care that encompasses medical, psychological, social and spiritual aspects. It includes terminal care and, when possible, rehabilitation. For a moment, I would like to dwell on the spiritual aspects which mean so much to some people, especially around this time. I, myself, as a carer, get a great resource from the words of Pope John Paul II. He said:"““Human life is a precious gift to be loved and defended in each of its stages. The Commandment ‘You shall not kill’, always requires respecting and promoting human life, from its beginning to its natural end. It is a command that applies even in the presence of illness and when physical weakness reduces the person’s ability to be self-reliant””." When I heard that a hospital had decided to remove its crucifix from the hospital chapel and a Maltese lady was distraught, I could understand her feelings. Sometimes people need the chapels to pray in or just to meditate in sometimes, especially around the difficult time of coming to terms with terminal illness or death. Of course we should respect everybody’s faiths and beliefs, but it is wrong to be negative and take away such things as crucifixes, which can give help and comfort; surely, one should have chapels for Christian faiths to share and another room for the use of non-Christians. I believe that is what happens here in Parliament and it must be the correct course to take. The Motor Neurone Disease Association believes that specialist palliative care should be available to anyone with MND in a setting and at a time of his or her choice. Many people with MND are unable to access the palliative care services they require. In a survey carried out by the association in 2005, only 39 per cent of people with MND had been referred to specialist palliative care services. There are unacceptable geographical variations in the quality of service provision. That can have a negative impact on the quality of life of people with MND and their families. All people in need of palliative care, whatever the condition, should have a quick service to occupational therapists and the correct equipment, such as wheelchairs, hoists, slings, special mattresses to prevent pressure sores and so on. The wheelchair service needs updating and upgrading, as does the suitable equipment for people in hospital. On people with a swallowing problem, I discovered that adults do not have access to much-needed speech therapists, who can give vital advice in their lives, if they live in the communities of north Yorkshire. A child can get the service, but an adult has to wait a long time for an appointment in hospital. With so much emphasis on primary healthcare, I ask the Minister if he can encourage a better, quicker service for all who need it in hospital, hospice or at home, when they are in this condition. Hospices have historically been funded by cancer charities, so services have focused on people with malignant disease. I hope your Lordships agree that it is important that other service users, such as people with life-limiting non-malignant conditions, are given equal treatment. Palliative care should be determined by clinical need and not disease type. But if a person’s wish is to remain at home, all efforts should be made to make that possible. I hope that the National Health Service framework for long-term conditions will help to co-ordinate and promote better services for those people needing palliative care. I, too, would like to congratulate the noble and learned Lord, who has, with all his efforts crossing London on this day, made a splendid maiden speech.