Access to Palliative Care Bill [HL] - Second Reading

Part of the debate – in the House of Lords at 10:19 am on 14th June 2019.

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Photo of Viscount Bridgeman Viscount Bridgeman Conservative 10:19 am, 14th June 2019

My Lords, I congratulate the noble Baroness, Lady Finlay, on her magnificent overview of the background to the Bill and on her patience in waiting for an opportunity for it to be read.

For some years I was the chairman of an independent hospital which, unusually, contains a hospice within its property and is part of the same charity. I had conversations with the current director of the hospice and he is totally behind the Bill, effectively, to close the wide disparity of the attention given by different CCGs across England in the resources they allocate to ensuring that palliative care is available to patients 24/7. It was interesting to hear the noble Baroness’s example of the Welsh experience, from which we can learn.

Well-organised palliative care services not only give comfort to patients who need it but represent a saving to the NHS by reducing the expense of unplanned admissions. Furthermore, the well-structured arrangements make it easier for experienced palliative care doctors—of which there is certainly not a surplus—to give valuable training to their generalist colleagues. The noble Baroness has given the advantages of those pacts in rather greater detail.

Turning to the provisions of the Bill, Clause 1 provides a general statement of intent and is a useful link to previous discussions in this House and elsewhere. However, by itself, it has limited teeth and a former CCG commissioner tells me that the task is often given to a junior member of the staff to satisfy the department of the CCG’s good intentions without the CCG feeling it necessary to do much about it.

However, Clause 2 is the valuable core of this short Bill as it imposes on all CCGs the obligations to prepare and publish a strategy on providing for palliative needs, identifying the needs of adults and children and how those needs will be met, and the circumstances in which palliative care services apply. It will, I hope, ensure that all patients throughout England will be assured of well-established palliative care provisions.

On the position of the Government, their reaction to the 2015-16 Bill was disappointing. The then Minister’s view was that palliative care was,

“best tackled by clinicians, ideally together with patients, carers and loved ones”.—[Official Report, 23/10/15; col. 942.]

I agree, provided the patient is within the responsibility of a CCG that has well set up palliative care facilities. However, if the patient is in the area of a CCG that is not well organised, the answer, I fear, is, “Well, tough”. That is not good enough.

Sadly, it appears that the Government’s position has not changed. In a Written Answer in another place on 14 May 2019, my honourable friend Caroline Dinenage stated at reply No. 252553 that,

“the funding and commissioning of palliative and end of life care is a local matter, over which individual National Health Services commissioners have responsibility”.

That is all fine, but the sad fact remains that the service across England is, in the words of the noble Baroness, Lady Finlay, “patchy”. That is why Clause 2 is urgently needed.

I welcome the noble Baroness’s initiative. I hope the Bill has swift passage through your Lordships’ House and that the Secretary of State for Health and Social Care, whoever he or she may be, will take on board the need for, in effect, an England-wide level playing field in the provision of palliative care.