Palliative Care

Lord Ribeiro Excerpts

Thursday 22nd October 2015 Grand Committee

[Lord Ribeiro (Con)]

My Lords, sadly, the ombudsman’s report documents many instances of poor care, poor communication, a lack of active review of cases and inappropriate discharge from hospital. However, I take issue with a statement in the conclusion:

“How we die is part of the core business of the NHS”.

As one who practises medicine and surgery I do not recognise this, as the core business for me was to save lives and prevent death. Death and dying should ideally take place in quiet surroundings with people we love and care for around us. That is at home or in a hospice, as has already been mentioned. We should do more to increase financial support for the nation’s hospices. What are the finances? In 2010-11 we spent £460 million on adult palliative care and end of life care, but there are wide variations with some areas spending £186 per death on specialist care and others £6,213 per death—a wide variation, as I have said. Some 61% of the PCTs at that time spent less than £1,000 per death. Will the Minister say what the latest costs are and whether the variations have been ironed out?

Another issue is that of training for all healthcare workers—doctors, nurses, care assistants and even porters—in dealing with patients who are terminally ill. For doctors, breaking bad news can be a challenge for many. The Royal College of Surgeons in its MRCS examination has a communications bay marked, “Breaking bad news”, where we use actors to simulate patients or relatives so that we can put the trainees through a process where they have to break bad news to patients and react when the patients react adversely. It is important that this is not limited to examinations but is refreshed as part of continuing professional development.

Finally, all of this care must be delivered on a seven-day basis, and preferably with access to specialist palliative advice 24/7. The challenge is how to achieve this without the introduction of a seven-day service, and we know the deliberations that are going on at the moment vis-à-vis the junior doctors’ contract. It was a common occurrence to have dying patients referred by their GPs for admission on a Friday. I recognise that many of the people who were admitted on a Friday would subsequently die. So when we are considering mortality at the weekends, it is important that we bear this in mind. As has been said, one of the drivers for seven-day working is to try to reduce mortality at weekends. Hospital admissions in the last year of life cost the NHS £1.3 billion for adults and £18.2 million for children. Transferring some of these costs to the community and commissioning more hospice care may not only generate savings, but provide for the kind of death that 74% of patients desire. But as the right reverend Prelate said, 58% find that they end up in hospital. I therefore support the words of the noble Lord, Lord Farmer.