End of Life Care

Lord Judd Excerpts

Tuesday 14th March 2017 Lords Chamber

[Lord Judd (Lab)]

My Lords, it is always challenging to follow the noble Baroness. Her knowledge and expertise are well heard in this House, and are informed by a direct, personal engagement in the front line that is outstanding. We all pay tribute to her on both scores.

We are dealing with a gigantic cultural and social problem. Modern, high-tech society has many benefits that we spend a lot of time debating but it has many casualties, too. Life goes faster and faster, pressure on families is greater and greater, and it is more and more difficult for them to provide the care which might have been more readily available in a more steady age when life was less frenetic. This is a reality we must face.

However, we must also be very careful about loose press reporting. Sometimes the pressure on staff trying to deal with these issues is immense. Perhaps understandably, sometimes things that go a little bit wrong can be played out of all proportion. Anyone who has been through a situation of this kind within the family knows very well that things are not always perfect. People are human and sometimes cannot live up to their own standards because the pressures are too great. So we need a great deal of understanding about the pressures being borne, carried on behalf of society.

I just want to raise several points. First, I am a vice-president of Hospice at Home West Cumbria and was previously president. I cannot speak highly enough of the quality and commitment of the volunteers and staff alike, and what they do not only in their immediate work but in relating to the wider community in a really remarkable way, drawing it into a sense of responsibility for the hospice at home movement and feeling that it is their movement to sustain.

Are we yet doing enough in our training and preparation of doctors for their profession to ensure that the care of the elderly, vulnerable and dying is central to their concerns? All of them will face this issue, and some will specialise in it. It should be a central part of medical training and preparation to take into account the needs of the dying and the elderly, and how that can be covered. Demography demonstrates the high and growing proportion of our population that this will affect. It is sheer madness not to make this a priority in the profession at all levels.

Still there is too much evidence of postcode lottery in the provision of services but the sort of thing that worries me when talking about the work of Hospice at Home West Cumbria, for example, is that it can have remarkable results when the health service co-operates and they work together.

But does the health service, as a matter of course, take that expertise and insight into consideration in the preparation of its plans, not only nationally but locally, and join all that up as part of the whole process of developing its work?

At the moment it is alarming that one in three health and well-being boards does not consider the needs of dying people when assessing health and care needs in its local population. Almost six in 10 health and well-being boards do not include the needs of dying people in their key strategies. More than one in four—27%—of clinical commissioning groups do not have a strategy for addressing end-of-life care. More than seven in 10 do not have a strategy for children and young people with life-shortening conditions.

These are alarming statistics. A tremendous amount has to be done. The Government have stated their intentions but the road to hell can be paved with good intentions. What matters is what is actually done and what resources are actually arriving to give effect to the intentions that are expressed.