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Health: Palliative Care

Volume 762: debated on Tuesday 23 June 2015


Asked by

To ask Her Majesty’s Government, in the light of the Parliamentary and Health Service Ombudsman’s report Dying Without Dignity, what steps they are taking to ensure that everyone in need has access to good palliative care.

The cases highlighted in the ombudsman’s report are appalling. Everyone deserves good-quality care, delivered with compassion, at the end of their life. Last year we introduced five priorities for care—the key principles that underpin the care that all people at the end of life receive.

My Lords, I thank the Minister for his reply. In the light of the parliamentary ombudsman’s report, Dying Without Dignity, is it the Government’s policy to encourage all schools of nursing to ensure that their graduates have core skills in end-of-life care by having the subject included in the formal assessments of their students’ competencies?

I thank my noble friend for that question. I cannot answer it specifically, but the report prepared earlier by the noble Baroness, Lady Neuberger, and other subsequent reports have stressed the need for nurses to be properly trained. That is true both in hospitals and in community settings. I agree with the sentiments behind my noble friend’s Question but would like to take advice on whether what he is suggesting is indeed incorporated into nurses’ core training.

My Lords, yesterday I was at the Royal College of Nursing, where a lot of work has gone into producing advice on end-of-life care. It has produced a small pocket handbook—and a larger one that goes with it. If the Minister has not seen the handbook, perhaps he would find it useful from the point of view of spreading it through care homes and hospitals. End-of-life care is in the curriculum for nurses but there is always a need for a reminder. These little cards that are to go in the pocket provide the essentials about end-of-life care.

My Lords, I thank the noble Baroness for those comments. Over the years I have spent quite a lot of time with nurses who are specialists in palliative care and I have always been hugely impressed by their work. I have not seen the booklet produced by the RCN to which the noble Baroness refers and I would certainly like to do so.

My Lords, was the Minister as shocked as I was, when reading some of the case studies in this report, to realise that the problems did not require further legislation or regulations but required staff who would follow guidelines and who had common sense, compassion and good communication skills? Why are people who lack these skills and attributes not being weeded out at the training stage, before they get anywhere near a patient?

My Lords, if Members of this House have not read the report by the ombudsman, I recommend it. It consists of 12 short, fairly straightforward case histories, which make for appalling reading. There are many nurses in hospitals and community settings who deliver wonderful care. The issue is their ability. The CQC is now making regular inspections of end-of-life care in all its hospital visits. It is one of the eight core services that it looks at. It has found that in the vast majority of cases, end-of-life care is caring. The noble Baroness asked why such care is so variable. I think that in hospitals it is partly because they are often busy places. They are not ideal places to die in. Who would wish to die in a clinical setting in a very busy ward unless they had to? That may be a part of the explanation.

My Lords, my father-in-law died this February. He died at home, surrounded by those he loved and who loved him. However, he died in profound agitation because he was denied the palliative care that he so desperately needed. The local GP surgery said that that had to be delivered by the local Macmillan nurse. She was rung repeatedly throughout the day but never answered the phone. Finally, at 4.30 pm she picked up the phone and said that she could not come until the next day—even when the nurse who was looking after my father-in-law said that he was likely to be dead by then. She said there was nothing she could do about it and rang off. He died later that evening, without the comfort of any palliative care. What assessment have the Government made of the ability of Macmillan nurses to deliver palliative care at home?

The noble Lord describes a truly tragic situation and I am very sorry for him and his family that this happened. I am afraid that variation is at the root of this. There are many parts of the country where good local care is delivered. The noble Lord’s story illustrates the fact that it is not just where people die but how they die that matters. It is clearly preferable that people should die in their own home with their loved ones, surrounded by the love that the noble Lord described, but symptom control, pain relief and everything that goes with palliative care are just as important. Indeed, most of the stories in the ombudsman’s report are about a lack of symptom control for people dying in pain. That can happen at home, as in his father-in-law’s case, but it can equally happen in hospitals. NHS England is reviewing this whole area and will come to some final views towards the end of this year, when I might report back to the House.

My Lords, I declare an interest as chairman of Hospice UK. Is the crux of this issue not the fact that most people do not want or need to die in hospital, and that not enough help is given to allow and help those people who do not need to die in hospital to leave hospital and get the palliative care which can be provided in hospices or elsewhere? Is my noble friend the Minister aware that Hospice UK has put forward a plan to the Government which would enable 50,000 people a year to leave hospital before they die so that they can get the proper palliative care that they need? That would save the Government money, and all we need is a modest sum to carry out an evaluation exercise to see what is the best way of achieving this eminently desirable objective. Will he go back to the department and urge his colleagues to make this modest sum available?

I thank my noble friend for that question. Perhaps I could suggest that he and I meet outside this Chamber, along with some colleagues from NHS England, to discuss his proposal in more detail.

My Lords, given that both NICE and NHS England have commended the services of spiritual, pastoral and religious care in the care of all people and in delivering great services to patients, clients and staff, can the Minister give us any assurances that a chaplaincy will be funded, going forward, in all NHS facilities that provide palliative care?

I thank the right reverend Prelate for that question. I share his sentiments entirely but that is a decision for local hospitals and local trusts.