Queen's Speech

Viscount Bridgeman Excerpts

Thursday 3rd June 2010 Lords Chamber

[Viscount Bridgeman]

My Lords, I join every speaker in this debate in congratulating my noble friend Lord Howe on his appointment. It will be a great reassurance to this House to have the benefit of his experience, which he has built up with such distinction over the past 12 years when we sat on the opposite Bench. The noble Baroness, Lady Murphy, has referred to him seeing off successive Ministers of Health. I suggest that his approach has always been one of constructive engagement.

I shall speak briefly about the hospice movement, in which the United Kingdom has led the world and in which we can take great pride. I particularly honour the memory of Dame Cicely Saunders, the founder of the movement. I declare an interest as chairman until two years ago of the Hospital of St John and St Elizabeth in St John’s Wood, London. Unusually, within it is St John’s Hospice, which is part of the same charity on the same site. With those two institutions I maintain close links.

Hospices have suffered under successive Governments from what I might call an “it will be okay on the night” approach. In the case of hospices, that means that any shortfall in funding by government will be made good by the public conscience through charitable giving. Successive Governments have not been slow to realise that this virtually always works. Having said that, it would be churlish not to mention the contribution of the last Government in making available a substantial additional sum for hospices, of which St John’s share was £600,000, applied towards the refurbishment of its in-patient unit. But the reality is that the maximum normal contribution by central government to running costs is 50 per cent of the total, so in every case the shortfall of a minimum of 50 per cent of total running costs has to be made good by fundraising, which is a drain on hospices’ time with limited staffing resources, which could more productively be put to other uses. In the case of hospices, there is no national tariff and some hospices receive significantly less than 50 per cent. St John’s is fortunate in receiving government funding at the upper end, and its case is not untypical, in that it must have separate negotiations with each of seven primary care trusts to which it has contracted. This, too, is a considerable drain on limited personnel resources. The remarks of the noble Lord, Lord Patel, who is not in his place, on the contraction of primary care trusts, will read very well with many hospices.

All this is in marked contrast to those hospitals that are acute care providers where there are national tariffs for a variety of procedures. St John’s is leading the way in London on a north-central network comprising hospices and PCTs whose aim is to agree a local tariff. I hope that that will encourage the Government to roll this out on a national basis. A further encouragement to the Department of Health will, I hope, be the example of Wales, where a funding formula has been agreed across the Principality. I make a further plea to the Government to introduce rolling three-year contracts, which will enable hospices to plan strategically and deliver sustainable high-quality end-of-life care for all.

I turn to the last Government’s plans, which I welcomed, for a national end-of-life strategy that lays much emphasis on the need for patients to identify with their doctor or nurse the preferred place where they want to die. That depends on adequate resources being available. St John’s is fortunate in that three out of the seven PCTs to which it is contracted—namely, Westminster, Kensington and Chelsea, and South Brent—make available such resources. Unfortunately, patients in many other PCTs do not have the same opportunities for excellence in care, and for some of those people the stark and only choice is between a nursing home and dying on a general nursing ward.

The importance of being given the choice to die at home, with friends and family around, cannot be overstated and the difference between those PCTs that are able to support home carers and those who are not is, indeed, marked. Patients need real choices in care, in their place of care and in the way that they receive care. The vast majority of patients wish to live independently until they die, and this can be achieved by good, patient-sensitive, hospice-at-home services, supported in many instances by excellent organisations such as, dare I say it, St John’s and the Marie Curie nursing service. I emphasise the need for a level playing field and ask the Minister to eliminate what is, effectively, a postcode lottery as it applies to hospice at home.

I have received much help and advice from the noble Baroness, Lady Finlay of Llandaff, who cannot be here today as she has a medical engagement. She has asked me to raise with the Minister the matter of education in palliative care. Her concern, which I fully share, is that palliative care should be taught in all nursing schools at undergraduate level, as it now is in all medical schools in the United Kingdom. There are increasing pressures on the curricula in both medical and nursing schools, but if we do not teach the next generation how to care for those who are ill and nearing death, the standard of care will slip back as new graduates flounder. They risk picking up bad practice from those older practitioners who have never been taught proper pain control and other fundamentals of care. Do the Government plan to ensure that a comprehensive palliative care module should become a statutory part of all the proposed new nursing degree courses, since such education is the foundation of good care for patients?

I take this opportunity to welcome my noble friend Lord Hill, not only to his appointment to the Department for Education but for his masterly and, if I may say so, superbly delivered speech. May I also take this early opportunity to bend his ear? Hospices get no help from the universities for the considerable expense which they incur in training young doctors, in marked contrast to the general practitioners who get paid for having them. Therefore, this is indeed addressed to both my noble friends on the Front Bench: may this anomaly not continue to fall between two departmental stools?