Hospices and Palliative Care Services

Lord Cavendish of Furness Excerpts

Wednesday 15th December 2010 Lords Chamber

[Lord Cavendish of Furness]

My Lords, with her formidable experience and knowledge, it is always humbling to follow the noble Baroness, Lady Finlay. I join other noble Lords in thanking most warmly the noble Viscount, Lord Bridgeman, for introducing this debate so ably.

I have to declare an interest: some 20 years ago, I helped to found St Mary’s Hospice in Ulverston in Cumbria. It is at the other end of Cumbria from the noble Lord, Lord Judd; Cumbria is enormous. I retain a connection, although I retired as chairman last year.

I should like to make two points. As I understand it, the independent report on end-of-life care by Thomas Hughes-Hallett has made an interim recommendation to the Government to the effect that hospice-at-home services should be the chief beneficiaries of whatever money may be available in future. I do not quarrel with that, nor do I want to second-guess the final report. However, I register two caveats. First, a significant minority of terminally ill patients want to die in a hospice or at least do not want to die at home. The other caveat is that a hospice building has uses beyond that of being where people are cared for as they approach death. It is a point of contact for members of the local community and provides a venue for day care, which is very important, bereavement counselling and much else besides. Perhaps most important of all, it has become the hub of expertise, especially where a hospice such as ours develops a speciality. In my case, because of the high incidence of mesothelioma in Barrow-in-Furness, which is the tragic legacy of asbestos in the shipbuilding industry, St Mary’s has become something of an international leader in this field. Hospices innovate, as does palliative care in general. It would be dangerous to ignore the strength that an institution derives from having a physical core, albeit modest, which provides the springboard for training and innovation.

The second point is that I believe that the hospice movement has stumbled on a formula that could be far more widely applied. With very little modification, it could do very much more in the fields of heart disease and end-stage respiratory illness. It could relieve much fear and distress among patients suffering from these complaints. It would also remove significant financial burdens from the NHS. The non-cancer element of hospice care averages, I think, only 10 per cent; at St Mary’s we have a slightly larger percentage and my contention is that nationally it should be significantly higher still.

The ratio of funding between the state and our own fundraising efforts results in our having to find rather more than 70 per cent of what we spend. The reason why we were able throughout my time to raise such prodigious sums in a not very well-off area was that we successfully persuaded local people that the hospice belonged to them. In effect, the state meets the clinical costs—about 30 per cent—and we find the rest. This means that our care is essentially needs-led. I agree with my noble friend Lord Patten that, in this rabidly secular age, spiritual support has an important place and is much needed. This model, with its built-in synergy between public and private providers, can and should in my view form the basis on which new and enduring partnerships can build. It is indeed, as has been said, the big society at its best.