The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am grateful for the thoughtful and constructive approach that noble Lords have taken to this important issue and for a number of considered proposals, which I will share with my colleague, Minister Stephen Kinnock, who is responsible as the Minister for Care. I know he will be interested.
I congratulate the noble Lord, Lord Farmer, not just on securing this debate but on the way he set out his thoughts, which enabled the debate to be so constructive and sensitive to the issues at hand. I share the thanks given by a number of noble Lords, and take this opportunity to thank all those working or volunteering—as my noble friend Lady Pitkeathley highlighted—in the palliative and end-of-life care sector, including in hospices, for the invaluable support, care and compassion that they provide to people and their loved ones when they need it most.
Like the noble Earl, Lord Effingham, and other noble Lords, I pay tribute to the contribution of Dame Cicely Saunders. She was indeed—and can be regarded very much as—a pioneer. Many people in this Chamber and outside have also played their part, and I thank them too.
Approximately 600,000 people die each year in the UK and that figure is set to increase as we have an ever-ageing population. That will mean an increase in the number of people who need palliative and end-of-life care. As we have heard today, palliative care can help in the hardest of times. It is care that makes a real difference. It can make something that seems quite unbearable a bit more bearable. It can give dignity. I was very interested to hear the noble Lord, Lord Farmer, state his definition of dignity. For me, dignity is crucial at all times and never more so than at the end of one’s life. It also makes it more manageable for not just the person being cared for but their loved ones too.
As a Government, we want a society where every person receives high-quality, compassionate care, from diagnosis through to the end of life. While the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part played by voluntary sector organisations. Many noble Lords know that it is difficult to quantify how much palliative and end-of-life care is being provided at national or local integrated care board level, because care is provided across multiple settings, including in primary care, community care and hospitals, as well as in hospices. It is delivered by a wide range of specialist and generalist health and care workers, who provide care for a wide range of needs. These include, but are not always exclusive to, palliative care.
I recognise that there are more than 200 charitable hospices supporting more than 300,000 people in the UK with life-limiting conditions every year. As noble Lords have observed, most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. On the point about funding, in England integrated care boards are responsible for commissioning palliative and end-of-life care services to meet the reasonable needs of their local populations. On the point raised by the noble Lord, Lord Farmer, and other noble Lords, ICBs are responsible to NHS England, which has published statutory guidance on palliative and end-of-life care to support commissioners with this duty. It includes specific reference to ensuring that there is sufficient provision of specialist palliative care services and hospice beds, and future sustainability.
The noble and right reverend Lord, Lord Sentamu, the right reverend Prelate the Bishop of London and the noble Lord, Lord Farmer, raised the issue of variation by ICB area. It is important to note that this is in part—I emphasise “in part”—dependent on what is already available in terms of services, along with local needs. Noble Lords will recall the Health and Care Act 2022, which was a key moment. I remember the noble Baroness, Lady Finlay, being very involved in getting palliative care services added to the list of services an ICB must commission in response to the needs of its local population.
In addition to the guidance and service specifications, NHS England has commissioned the development of a care dashboard. The relevance of that is that it brings together all the relevant local data into one place and it will help commissioners to understand the needs of their local population and give them the ability to filter the available information—for example, by deprivation or ethnicity. That is meant to enable ICBs to put plans in place to track and address the improvement in health inequalities.
I will refer to the highly sensitive area of assisted dying, which was raised by the noble Lords, Lord Farmer and Lord McColl, and other noble Lords. I reconfirm to your Lordships’ House that, if the will of Parliament is that the law on assisting dying should change, this Government will work to ensure that it is implemented in the way that Parliament intended and is legally effective. I add that, irrespective of whether the law changes on this matter, we will and must continue to work towards providing high-quality, compassionate palliative and end-of-life care for every person who needs it.
I shall briefly look to the future and say to my noble friend Lady Pitkeathley, who raised the matter of research, that through the National Institute for Health and Care Research the department is investing £3 million in a new policy research unit in palliative and end-of-life care. The unit was launched at the beginning of this year and it will build evidence in this area. To respond to the right reverend Prelate the Bishop of London, it will have a specific focus on inequalities, which I very much welcome.
Noble Lords will be aware that this Government have committed to developing a 10-year plan to deliver an NHS that is fit for the future. We will be considering a whole range of policies, including those that impact people with palliative and end-of-life care needs. I say to the noble Lord, Lord Howard, that one of the three shifts that the plan will deliver is around the Government’s determination to shift more healthcare out of hospitals and into the community. The noble Lord referred to a plan by Hospice UK and said it was looking to update it. We will certainly be pleased to hear from Hospice UK on that matter. Palliative and end-of-life care services, including hospices, will play a very big part in that shift from hospitals to the community.
I turn to some of the additional points that noble Lords have made. I say to the noble Baroness, Lady Finlay, who has made such a big contribution in this area, and the noble Lord, Lord Balfe, who has been a strong advocate, particularly in respect of children’s hospices, that we will indeed be delighted to look at the Welsh experience. Just this week I had a meeting with the Welsh Minister, so I will be following up on that.
The noble Lord, Lord Farmer, asked whether there will be a move to implement the recommendations in the APPG report that would ensure that funding flows to hospices. As I have said, we are determined to move more towards community healthcare and we will certainly work with hospice providers to understand their views as part of this work.
I am sure that we were all very moved to hear my noble friend Lord Monks share his experience of the sad loss of his son Daniel; my sincere condolences to my noble friend and to his family and friends. I heard what he and so many other noble Lords had to say about the quality of care received in hospices, and I too will pay tribute.
I will of course take up the points made by the noble Baroness, Lady Berridge, on gift aid with my colleagues in the Treasury.
I say to the noble Lord, Lord Balfe, and to other noble Lords that my colleague the Minister of State for Care has recently had meetings with NHS England to look at a way forward in the whole area of providing services. I know that he also met the noble Lord, Lord Balfe. We are particularly anxious to reduce inequalities and the work going forward will look at that.
I will review the debate and if there are particular questions that I have not answered, I will of course do so. I will also address the comments and suggestions made by the noble Lord, Lord Scriven. I thank all noble Lords, and particularly the noble Lord, Lord Farmer, for leading us in this debate.