My Lords, the noble Baroness, Lady Finlay, is a very powerful advocate. As we have heard, the House wants her to do even more, but she has explained her strategy quite clearly.
I have never felt it appropriate to speak entirely from my own experience in your Lordships’ Chamber, but today I will. After all, we are all informed by our own observations and incidents from our own lives, although I acknowledge that emotion is not the best basis for argument. My remarks focus on support by palliative care services for the family and friends of a patient. I absolutely take the point about equality and equity made by the noble Lord, Lord Browne. As a family member and friend of someone who died recently, I have been lucky enough to have had that support.
The patient did not have immediate family and when the palliative care team visited, they were met with a small group of her friends who were all involved with her support. I am sure that they encounter a great variety of people, but among my reactions at that first meeting was how well they coped with a group of articulate professionals, who were not short of questions and, in the nicest way, demands. My strongest impression was how reassuring they were. We may have been professionals, including as it happens two from the medical world, but this was unknown territory for us. The anxiety among this competent group was very high. We all felt such concern for our friend, such anxiety to ensure the best care for her and such a feeling of helplessness as to how to go about it, as well of course as to what to expect in the progression of her disease.
I pay tribute to the wonderful Dr Lucy Bernard-Qureshi, nurses Nichola Brown and David Cofino-Gonzalez, and the Camden, north-east Westminster and Islington palliative care team. They treated their patient so respectfully. They addressed questions to her, before asking us, and never talked over her, even when it was very unlikely that she was at all aware of their presence. They seemed to have all the time in the world for us and our anxieties, as well as for her—although I am sure they did not. I believe the phrase “support for … relatives” in Clause 1(b) of the Bill should be construed very widely.
At our first meeting with the team, the doctor was shadowed by a medical student. He told me that this was his one day of training in palliative care. I am sure it was a very intensive day, but even so, training is something for all health professionals, not only palliative care specialists. I felt I should volunteer to help role-play as part of the training on his course.
The team enabled my cousin to be at home until her death, as she wanted, and they supported her own decision regarding nutrition and hydration—she had left a very clear advance decision. That could not have happened without the team nor a number of very impressive carers, which takes me to my next point. I do not know the countries of origin of all the carers. At least one was an EU citizen and I suspect others were not British or EEA nationals by birth. The UK and the health service need people like them. Although this is not a debate about immigration, it is relevant because I suspect much palliative care at home could not work without 24/7 carers.
I discovered afterwards that neither of the principal carers who were with my cousin at her death had previously been with a patient at that point—they coped admirably—because most patients do not die at home. It was not in our minds but it is a reminder about how much palliative care can save the NHS budget. Above all, it enabled my cousin to depart in peace.