End of Life Care

Lord Suri Excerpts

Tuesday 14th March 2017 Lords Chamber

[Lord Suri (Con)]

My Lords, in his foreword, the Parliamentary Under-Secretary of State, now the Minister for the Cabinet Office, quoted Dame Cicely Saunders, who said,

“we should see the last stages of life not as a defeat but as life’s fulfilment”.

I wholly subscribe to the spirit in this report of ensuring that everyone who dies in England can have a peaceful and compassionate death. It is one area where the Government can do some good and have a direct impact upon people’s quality of life, or, indeed, death.

In the government response to the report, point 2 lays out a commitment to put in place measures to improve care quality for all across different settings. This is an aim to which I wholly subscribe, and I wish to draw attention to one area in particular. In Wales, managed clinical networks are used to create a strategic and joint approach to children’s palliative care across local areas. This is a recommendation from the National Institute for Health and Care Excellence’s clinical guidelines on end-of-life care. Will the current Parliamentary Under-Secretary of State say whether they plan on implementing this recommendation, and if so, what steps are they taking? If not, why not? A recent Written Answer stated that this is a responsibility of English commissioning groups, which I understand, but I wish to know the plans in place moving forward.

Another important issue also rests on point 2, and on point 7: the commitment to strengthen accountability and transparency. The commissioning map of children’s palliative care produced by Together for Short Lives reveals a worrying lack of consistency across commissioning groups. One in six groups commissions children’s hospice services, and more than one in four groups does not commission out-of-hours community children’s nursing. I understand and support the arguments for devolution and for handing greater budgetary control over to the bodies closest to the patient, but some level of basic consistency must be maintained. Many of the clinical commissioning groups which fail to commission the aforementioned services are across the north of England and the south-west, and some have simply failed to answer freedom of information requests, which I hope the Minister can look into. Given that, my question is quite simple. Will the Government ensure that local commissioning groups are held accountable to NHS England for delivering comprehensive children’s palliative care to end this worrying inconsistency in palliative services?

There is, however, much to applaud in the report. The beefing up of the Ambitions for Palliative and End of Life Care website is to be welcomed, as it will become a more valuable and accessible source for patients, physicians and managers. I would recommend it host more blogs to share the first-hand experiences of physicians more directly. I also hope the new suite of metrics to measure progress in end-of-life care will cover the availability of support for young people, given that the current reporting mechanisms do not appear to provide immediately accessible information.