Hospices and Palliative Care Services

Lord Judd Excerpts

Wednesday 15th December 2010 Lords Chamber

[Lord Judd]

My Lords, the hospice movement is indeed fortunate to have a champion like the noble Viscount, Lord Bridgeman, with his compassion and detailed knowledge. I declare an interest as president of the West Cumbria Hospice at Home, a pioneer hospice in this kind of care for those who wish to die at home. It is impossible for me to speak too highly of the quality of commitment of its staff, volunteers and trustees. Volunteers provide a compassionate service of a highly professional standard and the sensitive staff are in many ways volunteers, serving well beyond the requirements of their contracts.

Hospices are usually charities with their own supporters from whom they receive the bulk of their funds. This is often an intensely local relationship, with communities feeling real ownership of the organisation. This is well illustrated in west Cumbria, where the local community has taken the hospice to its heart and where there is just such a widespread sense of responsibility for its work. This is well evidenced by the upwards of 1,500 women who each year participate in a midnight six-mile sponsored walk, cheered on even at that late hour by the local community.

Any legislation will have to be tuned to this spirit and recognise that, for example, any pressure to merge could all too easily destroy an ethos which is so essential for success. That is not to say, however, that there should not be encouragement towards collaborative working between neighbouring hospices. There is a risk that some hospice charities might in effect be perceived largely as fundraisers for the NHS. This must be robustly rebutted. Instead hospices should be encouraged to lead in their sphere and should receive absolutely essential financial support by commissioning.

In the NHS White Paper, there is a clear move from focusing on targets to focusing on outcomes and quality. Hospices have always focused in this way. This, of course, requires so-called soft measures where evidence is not always easy to provide. Again, any legislation needs to be considered against a very different background from what is more usual in the NHS. The central role of the GP commissioning consortia envisaged in the White Paper gives hospices a real opportunity to become the preferred provider for these services at the local level. Hospices which are already the main high-quality provider could in many cases, given the necessary support of commissioning, expand the services they provide to become far more comprehensive. This could be by providing more general palliative care services in the local community and by embracing activities not normally currently covered—education, dementia care, care for chronic and end-of-life conditions, as well as the essential and demanding care for the dying.

Finally, I make a plea: we must be wary lest unimaginative bureaucratic reporting requirements, such as detailed statistics and the standards expected in preparing them, at times place a disproportionate burden on the volunteer-dependent charities. This could inadvertently dampen the very spirit which is so essential to a hospice’s success.