Access to Palliative Care Bill [HL]

Baroness O'Neill of Bengarve Excerpts

Friday 23rd October 2015 Lords Chamber

[Baroness O'Neill of Bengarve (CB)]

My Lords, this is a Bill on the right topic—on assisting the dying. That term has been used recently for a quite different Bill which was aimed at only a very narrow number of those who sought death and was about assisting their suicide. Here we have something that speaks to the many who die each year. So it is the right topic—and quite necessary.

It is also the right time, as the demography shows. We are going to have more deaths each year in the fairly near future. That may sound depressing but it arises out of a rather happy fact. Currently we have about half a million deaths in England each year, about 30,000 in Wales and about 55,000 in Scotland—so in round numbers, 550,000. The figure that has been referred to of 350,000 is the number of so-called expected deaths. But that figure of 550,000 will rise. Although we are all living longer, this increase in life expectancy is not a promise of immortality for any of us. The number of people who are likely to die is projected—it is only a projection but it is significant—to rise over the next 20 years to about 670,000 per annum in England, Scotland and Wales. That is a big increase on 550,000.

Every death will be sad in its own way but every death could be well or badly managed and it is clear that we know how to do it well in this country. The finding of the Economist Intelligence Unit is very reassuring in that respect. As my noble friend Lady Finlay of Llandaff said, the problem is the patchy availability, not the standard that we reach in many cases—not just exceptional cases. The quality of the best is excellent but it is availability at the time of need that is very bothering.

Unsurprisingly, availability at the point of need is less good for certain communities in the inner cities and for certain ethnic minorities, but I have personal experience of the fact that it is less good in many places that do not fall into those familiar categories. My brother died in leafy West Sussex. He was a well-organised person and when he knew he was dying, he contacted the local hospice and made arrangements to die there when the time came. When the time came and my sons and I could no longer look after him at home, I rang the hospice. They said, “Oh yes, we can take him in three weeks”. As he observed to me, “I shall be dead then”—as he was. We then turned to the GP, who was about to go on his Christmas holiday, and arranged admission to a care home. I cannot fault the standard of care given in that care home but the staff were not permitted to increase the dose of painkillers above what had been prescribed initially. It was Christmas weekend. He died on the day of the tsunami, in very great pain.

The continuation of that sort of event tells us that we are not doing it right at present and that it would not be complex to improve matters. Among the Bill’s many sensible provisions, those that focus on the unavailability of adequate pain relief at the point of need are particularly important. Pain comes in waves, as many people know. It does not wait for working hours, the end of bank holidays or for other events. He died with good care but appalling pain relief.

The problem is not that we do not know how to do it or that we cannot afford it—it would save money. It is a question of a will and a way, and this Bill points the way. I hope we can support it on to the statute book.