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Access to Palliative Care and Treatment of Children Bill [HL] - Second Reading

Part of the debate – in the House of Lords at 2:33 pm on 7th February 2020.

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Photo of Lord Stirrup Lord Stirrup Crossbench 2:33 pm, 7th February 2020

My Lords, I support the Bill and I thank my noble friend Lady Finlay for her persistence in seeking improvements to this crucial but neglected area of care. My father spent his final days in a hospice, and while his death was, of course, a matter of great sadness, the care he received, mental as well as physical, helped not only him but his family to deal with an inevitable but always traumatic aspect of life. This last point is crucial. Death is an inevitable, inescapable part of everyone’s life, and we, as a society, should recognise that quality of death is an integral part of quality of life.

In considering human rights, we talk about the right to life. I have some difficulty with that notion, since we cannot guarantee life, but we can and should guarantee our citizens help with the experience that every one of them will have to undergo. This seems to me an important part of human rights. There is no doubt that in this country there are many areas of excellent practice in this regard, but it is also clear that much more needs to be done to level up our approach to palliative care. The Bill is an important step in that regard.

The Government’s response to previous attempts to introduce similar legislation seems to have been to say that primary legislation is not the best way to deal with the issue. Frankly, that would be a more persuasive argument had they taken the matter forward effectively through some other route. While there has been some progress, I am not persuaded that it has been sufficient.

This is just one aspect of a wider debate over the need to consider physical and mental care holistically rather than as a series of separate issues. Just as social care needs to be considered alongside and be consonant with the provision of health services, so end-of-life care should be a integral part of the way we provide for the physical and mental well-being of our citizens.

Yesterday the noble Lord, Lord Hunt of Kings Heath, initiated in this House a very good debate on the NHS and social care. In it, I said that we were asking too much from the NHS and that this was creating unsustainable pressure on the system. It might therefore seem rather perverse for me to support a Bill that asks it to do even more, but that is not my intent. I am quite clear that the NHS does not and never will have the resources to permit it to do everything it might, but choosing what not to do at random or excluding services because they were the last to be proposed is no way to run any public enterprise, let alone one of such importance.

The evidence shows that the approach of clinical commissioning groups to the provision of palliative care is very uneven across the country, driven, I assume, by budgetary pressures rather than by strategic decisions. This cannot be right, but it is no good simply blaming the CCGs for this. The lack of a proper strategy for the provision of healthcare in England is, as I suggested yesterday, at the root of the problem.

Nevertheless, something needs to be done in the short term to address some of the most serious deficiencies in palliative care. Given the excellent work done by hospices, and considering the burden they lift from the shoulders of our primary and secondary care systems, it seems nonsensical to deny them access to the pharmaceutical services available within the NHS and to patients being treated at home.

If difficulties in accessing palliative care for adults approaching the end of life are distressing and unwelcome, how much worse must they be for children and their families? Yes, we are all going to die, but we expect and hope that it will be the conclusion of a fulfilling life. The death of a child must bring with it an anguish that simply cannot be understood by those who have not gone through the trauma. I accept that parents undergoing such stresses will not always be the best judges of what is right for a child, but sometimes they will have insights crucial to the provision of the best treatment. Cases of dispute between families and medical practitioners will sadly always arise from time to time and resolving them satisfactorily will always be difficult.

I understand some of the concerns that have been raised with certain aspects of the present Bill, but these can surely be addressed in Committee and on Report. It seems indisputable to me that attempts to reach a conclusion to dispute through mediation must be preferable to immediate court action.

The Bill will perhaps require some amendment if it goes forward and it is no substitute for a proper, non-partisan debate on a strategy for the provision of holistic physical and mental care in England. But unless and until we have such a national debate, the Bill of the noble Baroness, Lady Finlay, is a good vehicle for addressing some important shortcomings in the present system and I support its Second Reading.