Palliative Care

Baroness Hollins Excerpts

Thursday 22nd October 2015 Grand Committee

[Baroness Hollins (CB)]

My Lords, end of life care must encompass body, mind and spirit. Minimising suffering in the final days, weeks and months of life once a cure is no longer possible is not just a medical task, it is also the chance to support each person to let go of life and experience a sense of completion, which may require support with physical, psychological, cultural and/or spiritual concerns.

If a palliative care service is to be available in every kind of healthcare setting seven days a week, there will need to be changes to the current system. Continuity of support will also be an important ingredient in the recipe, just as it is in the support needed at the beginning of life. In birth and in death, there is a comfort that comes with knowing that the person who is caring for you knows what is important to you. The Liverpool care pathway was an attempt to standardise and improve end of life care. The intention was good but, as we have seen time and time again both inside and outside medicine, where initiatives are not funded properly and are without sufficient training and supervision, protocol-based practice becomes a tick-box exercise and stifles creative thinking. End of life care needs to be flexible and creative. It is about responding to the needs of an individual. Some of those needs will be unexpected, requiring access to 24-hour support, be that telephone advice or access to a doctor or nurse.

There is no doubt in my mind that accessible and equitable palliative care services are required across England, just like other services that are fully NHS-funded. This morning I received some advertising material in the post from Macmillan. It made the point that in the south-east of England, it has only enough nurses to help around 25% of people with cancer. It is raising charitable money to subsidise the care provided for people with cancer at the end of their life.

Wales is a trailblazer and is already providing seven-day specialist care services, but it is critical that geographical equity also translates into equal access for all individuals in our society, not just for those who are better informed or who can shout the loudest. People with learning disabilities, children, individuals with severe mental illness and all those who do not at first come to mind when thinking about someone who is dying need to be explicitly considered. I was teaching some GPs in a hospice, one of whom said, “But people with learning disabilities don’t get cancer, do they?”. There is still quite a lot of ignorance, as the Minister is well aware, and the needs of some people in society are overlooked. Will he reassure us that the needs of these groups will also be taken into account in any new health policy about end of life care?