Health: Cancer

Viscount Bridgeman Excerpts

Thursday 11th November 2010 Lords Chamber

[Viscount Bridgeman]

My Lords, the whole House will be grateful to the noble Baroness, Lady Finlay of Llandaff, for securing this important debate. In her speech she once again reminded us of the leadership that she continues to give in this field, which is of continuing urgency. I declare an interest as a former chairman of St John’s Hospice in St John’s Wood, central London.

I will speak briefly on care at home in the context of cancer sufferers. A joint report by Healthcare at Home and Dr Foster estimates that delivering end-of-life care services at home could save the NHS £160 million, yet only a quarter of patients are able to die at home. It is worth talking through what a well organised hospice—and I am happy to say that there is a gratifyingly large number of them—is able to achieve with Hospice at Home.

The totem words are “hospital avoidance”. The core of the home service is a close relationship with community nurses and GPs. However, the important point is that there is also a team of carers without formal qualifications who are given basic training at the hospice. They will look after the patient's basic needs such as washing, bed-making and shopping. Often, they become effective counsellors, which is particularly important to long-term cancer survivors as it can restore their confidence to get back into the world around them. These carers not only provide a valuable human resources augmentation, but they can at any time call on the community support team of trained professionals and on the resources of the hospice. It has been said to me that the fact that the patient can be cared for at home is in itself one of the most valuable and effective palliative treatments. So it is, if one can use the term respectably in this context, a win-win situation. The patient, often very confused and terrified of any form of hospitalisation, has all the familiarity of home surroundings; at the same time, hospice and hospital beds are freed up and, significantly, Hospice at Home is a cost saving for the health service.

I have referred to long-term cancer sufferers, for an increasing number of whom life expectancy has been prolonged thanks to new and effective drugs. The noble Baroness referred to clinical developments in palliative care which are assisting this extension of life, which is of course pertinent to the subject of this debate. This extended life expectancy will provide additional demands on community and palliative care nurses.

The Government’s commitment to 24/7 community nursing is to be welcomed. More of concern, however, was the announcement in the comprehensive spending review that the Department of Health will no longer financially support the previous Government’s commitment, given by the then Prime Minister personally in a speech to the King’s Fund on 8 February, to provide one-to-one nursing services for every cancer patient. That said, however, I was encouraged by the remarks of my honourable friend Paul Burstow, the Minister for care services, in another place on the debate on rarer cancers on 27 October. He said that the Government are re-examining the question of one-to-one support. I shall very much welcome any further reassurance that the Minister can give on the current position and on one other small point. Can any initiative provide for the requirement that, wherever possible, a terminally ill patient’s preferred place of death is recorded? I do not need to point out how useful this information is in planning the care of cancer patients.