Access to Palliative Care Bill [HL]

Lord Howard of Lympne Excerpts

Friday 23rd October 2015 Lords Chamber

[Lord Howard of Lympne (Con)]

My Lords, I declare my interest as chairman of Hospice UK, the umbrella organisation for all hospices in the United Kingdom.

The concept of a good death has, in recent years, been increasingly recognised, and recognised as something that should be available to all. This Bill will go some way towards achieving that objective in this country, and I add my thanks and congratulations to the noble Baroness, Lady Finlay of Llandaff, for bringing this forward.

The Economist Intelligence Unit survey, which placed the United Kingdom top of the 80 countries surveyed in terms of the quality of their palliative care provision, has already been referred to. It is worth noting that the previous survey carried out by the Economist Intelligence Unit, in 2010, five years ago, reached a similar conclusion—the United Kingdom was again rated as the best in the world. I hope that I can be forgiven for emphasising the contribution of hospices to that achievement, and I am grateful to those who have already spoken in the debate who have expressed their appreciation of what the hospice movement does. It is a movement, of course, that started in this country. People still come from all over the world to see how we do it. I am proud to stand here and say, without any fear of contradiction, that the care provided by hospices, both in hospices and for people who die at home looked after by hospices, is second to none. The recent ONS survey found that 85% of bereaved people whose relatives had died in a hospice or at home looked after by a hospice thought that the care they had received was “excellent” or “good”. The Care Quality Commission has rated more than 90% of hospices “good” or “outstanding”. In yesterday’s debate, the Minister referred to the observation of the chief inspector of the CQC, who said:

“I know from what my inspectors are finding”,

that,

“hospices provide amazing care and support for people at the end of their lives”.

To take up a point made by the noble Lord, Lord Crisp, hospices do not deliver professionalised care. Of course many of the people who work in hospices are professionals, but there are very many volunteers too. To illustrate the difference between hospices and hospitals, I tell the story of a man who was very reluctant to go into a hospice. Eventually, he was persuaded to by his family. When he got there, the first thing they said to him was, “Is there anything you really want?”. He said, “The one thing I would really like is a bowl of porridge”, and, within half an hour, he was provided with a bowl of porridge. With the best will in the world, no one can imagine that happening in any of our hospitals.

The ratings for hospices, which I have mentioned, are far superior to those that hospitals receive. So I repeat today my call to the Minister for help in reducing the number of people who die in hospital. Most people do not want to die in hospital—they do not need to die in hospital and they should not have to die in hospital. It would actually save the NHS money if these people were not in hospital but were transferred instead to hospice care. Many hospices work closely with the NHS trusts in their areas to achieve this. One example was quoted by my noble friend Lord Farmer in yesterday’s debate. We want to evaluate the best way of doing this so that we can put forward to the Government the most effective arrangements for taking the 50,000 people a year who currently die in hospital out of hospital and into hospices or hospice care at home. To carry out that proper evaluation would cost what in this context is the paltry sum of £250,000. I repeat my call to the Minister to make that available.

I particularly welcome the provisions in the Bill which would place a duty on clinical commissioning groups in relation to the funding of palliative care. Three-quarters of hospices have had their NHS funding, which on average provides only a third of their costs, either cut or frozen in 2014-15. The record of hospices in meeting the shortfall from charitable sources is breathtaking. Collectively, 200 charitable hospices in the UK raise £1.9 million a day from local charitable sources. It is an extraordinary achievement, but if that shortfall is increased, as it has been, it will be increasingly difficult for hospices to continue their successful work.

Finally, I draw attention to the briefing that we have received—I hope, in time—from Together for Short Lives, which looks after babies, children and young people with life-threatening conditions and is affiliated to Hospice UK. It has asked for some amendments to the Bill which no doubt we will return to and which I hope will receive sympathetic consideration when we get to Committee stage.

The Economist Intelligence Unit survey quoted the words of the national director for hospice care at Hospice UK. She said:

“The things that make a better death are so simple … It’s basic knowledge about good pain control and conversations with people about the things that matter”.

This Bill will help bring about a better death for many people. On behalf of the hospice movement, I whole- heartedly welcome it.