My Lords, I declare an interest as a patron of Mary Ann Evans Hospice in Nuneaton.
One of the privileges of my calling has been to accompany people in the latter stages of their lives, visiting their bedsides, preparing them in soul and spirit for the next stage of their lives, and watching over their bodies when death has finally come for them. Through it all, I have tried to support their loved ones as they have travelled this hard road, all the time admiring the skills, diligence and compassion of nurses and medics in hospitals and hospices. I have seen that there is such a thing as a good, and even a beautiful, death.
“Lord, lettest thou thy servant depart in peace”,
is an ancient prayer of a Jewish sage. Whether people pray or not, a peaceful death is surely a near-universal hope, deep in the human heart, and it is why I am very glad to support the Bill introduced by the noble Baroness, Lady Finlay. With other noble Lords, I pay enormous tribute to her unswerving commitment to excellent and equitable palliative care for every person at every time, in every place, as the noble Baroness, Lady Hollins, has just said.
Of course, it is to be acknowledged that there is much to rejoice in. It is now more possible for people to die in physical peace than perhaps at any other point in human history, especially in the UK with our global leadership in the field. The compassion and skill of palliative care teams are a marvel. Our hospices are phenomenal, and the way that they were generated and remain sustained by local communities shows the deep longing for a peaceful death by ordinary people, for themselves and for their loved ones.
Nevertheless, it seems self-evident that the existing provision needs strengthening in disciplined and systematic ways. The 2011 NICE guidelines are laudatory. They set a high standard but, as we have heard already, clear evidence has been marshalled by Marie Curie, the BMA and others that they are not being reached everywhere and by everyone, and there is more such evidence now than at the time of the predecessor Bill. Indeed, the proportionately few references to palliative and end-of-life care in the 2019 NHS Long Term Plan do not inspire confidence that they will be given the priority they deserve.
I speak as a generalist but, to me, it seems that the Bill will provide that priority—that it will turn the NICE guidelines, the Government’s 2016 national strategy on end-of-life care and the present NHS plan into actual practice. It will provide—if I may be so bold as to draw on medical terms—a detailed diagnosis of the deficit and a remedy to put right the gaps in provision that have already been noted in terms of geography, ethnicity, age, income, type of illness and so on. It will help to ensure that everybody has access to the help that everyone needs, everywhere.
With its emphasis on both specialist and generalist palliative care and support services, and its focus on the needs of the person, the Bill will surely create a new culture of communication and co-operation between the three spheres of care—home, hospice and hospital. Each has its role to play and, used well, each will provide the care that is most suitable at any particular point.
Of course, given the origins of hospices in the good works and initiatives of local people—I think of one of my predecessors founding the Warwick hospice—hospices are unevenly distributed. With its focus on local responsibility through the CCG, the Bill will, as we have heard, highlight that patchiness and therefore, I imagine, reveal new funding challenges where hospice care is thin. However, even where provision is thicker on the ground than in other places, I am conscious of the constant and very pressing funding pressures that hospices presently find themselves under, with 78%, I gather, drawing on reserves.
The Bill will ensure that those realities are faced head on, yet at the same time I entirely agree that significant economic benefits are to be found in the better co-ordination of care between hospital, home and hospice, as envisaged by the Bill. Not least through its attention to psychological support and its requirement for information to be shared, the Bill gives in a very interesting way real agency to those in need of care and to their loved ones.
Most people will want to remain in their homes for the maximum amount of time. One’s home is not only a better environment to be but, as the 2018 IPPR report shows, it is good for the budget. However, home care will need co-ordinated support—specialist and generalist. For those who want to die at home—up to 82%, according to the Office for National Statistics—I hope that the Bill will encourage the development of the hospice-at-home service, making effective palliative care truly present in the place of need.
Although I welcome the Bill’s reference to psychological support, I would be interested to know whether the noble Baroness would welcome an amendment at some point to give greater prominence to spiritual support in line with the WHO’s definition of palliative care. I realise that “spiritual problems” are included in the Bill’s interpretation but I am conscious that, in recent audits of the NICE guidelines, the statements involving religious and spiritual needs or complementary therapy received especially low scores and therefore might need particular vigilance.
As I indicated in my opening words, I have found that very many people reach out for some sort of spiritual care as they approach death. Here, I am not sure that the Bill fully realises its intentions for holistic care and for the whole person’s needs to be met. The ancient prayer that I mentioned earlier was by a very elderly man, Simeon. It was when his spirit was at peace that he felt able to release the life that he could sense was fading away and come to terms with his own mortality.