HL Deb 09 February 1987 vol 484 cc423-5

2.47 p.m.

Baroness Lane-Fox

My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

The Question was as follows:

To ask Her Majesty' Government whether they will establish a national register of hospices, especially in view of their role in nursing those suffering from AIDS.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Baroness Trumpington)

My Lords, to establish a national register of hospices would pose considerable practical problems. There would need to be an agreed definition of a hospice and an agreed set of standards for medical, nursing and other forms of care. None of this has been established. At present an independent hospice must register with the district health authority as a private nursing home. Health authorities will know which homes in their area are able to care for terminal patients. At a national level, the hospice informaton service at St. Christopher's Hospice in Sydenham already maintains a list of most hospices in the United Kingdom.

Baroness Lane-Fox

My Lords, I thank my noble friend the Minister for that very informative reply. Does she agree that the hospice movement is a very important adjunct to the National Health Service in giving this special care, and as such deserves to be relieved of the huge burden of day-to-day fund raising to cover in-patient costs?

Baroness Trumpington

My Lords, I am sure that all your Lordships would agree that the hospice movement does wonderful work in caring for the dying. The level of spending in support of an individual hospice must be a matter for local health authorities. Thirty-eight hospices are now entirely supported by local health authorities. Where a hospice plays an essential part in a health authority's overall plans for terminal care services, we are asking health authorities to make an appropriate financial contribution. The relative costs of hospice and hospital care will depend upon the needs of the particular patient.

Lord Kilmarnock

My Lords, in view of the Secretary of State's recent visit to San Francisco—I think this was one of the matters he went into there—can the noble Baroness say whether the Government will make available to health authorities additional money where they feel it is necessary to assist the foundation of a hospice? Will she not also agree that a great deal of the cost of the terminally ill suffering from this unfortunate disease would be better borne by the hospice movement than by the National Health Service?

Baroness Trumpington

My Lords, my right honourable friend the Secretary of State for Social Services intends to hold a conference before Easter on the provision of care outside hospital for AIDS sufferers. It will bring together the experience of those in the relevant professions, the statutory and voluntary services, and the Churches. The aim is to identify more clearly what our priorities and response should be in the years ahead.

There has been much new thinking and work on this matter in the United States of America, where the average length of stay for an in-patient during the progress of the disease is 31 days compared with at least 50 days in England. This is particularly so in San Francisco, where the figure is 12 days. My right honourable friend will report on what he has learnt during the conference.

Lord Nugent of Guildford

My Lords, is the noble Baroness aware that I am well aware of what is being done in my part of the world by private hospices? That is supported. However, what resources does the National Health Service have for the provision of hospices?

Baroness Trumpington

My Lords, many health authorities, local authority social services departments and voluntary bodies are already working together to provide care for terminally ill patients in their own homes as well as in hospices and hospitals. As I said, the NHS itself runs 38 hospices as well as contributing towards the cost of many of the voluntary units. We shall shortly be issuing new guidance to all health authorities asking them to review their services for the terminally ill and to plan to rectify any deficiencies in collaboration with the voluntary sector.

Lord Wallace of Coslany

My Lords, is the noble Baroness the Minister aware that there is a considerable amount of voluntary effort at present being made in various parts of the country to raise funds to provide the hospices so urgently required? They are not always getting assistance from the Government. Can the noble Baroness give an assurance that such efforts will be given every possible assistance, within reason, to achieve that aim?

Secondly, will the noble Baroness reconsider the Government's attitude regarding the provision of a register? I agree with the noble Baroness who tabled this Question that this is a very important matter and that such a register should be provided.

Baroness Trumpington

My Lords, with regard to a register, it is important that local people should know what is provided locally. It is useless for someone who lives, for example, in Canterbury and who wishes to go to a hospice to know that there is a hospice in Glasgow. It is the local picture that is most important.

Baroness Masham of Ilton

My Lords, in view of the increasing death rate of people suffering from AIDS, does not the noble Baroness the Minister agree that there may not be enough nurses who are trained in the care of young people who are dying? Does she not further agree that there could be a danger of these dedicated few nurses becoming burnt out?

Baroness Trumpington

My Lords, as I said, we are discussing, through the means of this conference, the various ways and means in which we can improve care for the terminally ill. I am sure that training will form part of that conference. My right honourable friend will be interested to learn what nurses have to say at the conference.

Lord Cledwyn of Penrhos

My Lords, as regards the hospice movement and the proposals the noble Baroness has described which the Government are now making, and in view of the fact that the Question refers to AIDS, is the noble Baroness saying that separate and additonal hospices are now required for this terrible disease?

Baroness Trumpington

My Lords, I am saying that a variety of methods of care is needed for AIDS patients. It is not necessary for them to be in hospital for the whole of their illness. They may need very specialised care which can only be provided by a hospital. They may prefer to be in a hospice, for different reasons. There is also care in their own homes, where many sufferers may prefer to be looked after. A variety is needed.

Baroness Macleod of Borve

My Lords, can my noble friend the Minister tell the House the latest figure for deaths from AIDS in this country?

Baroness Trumpington

My Lords, the figures that I have are today's figures. There have been 686 cases of AIDS, of whom 355 have died.

Baroness Lane-Fox

My Lords, is my noble friend aware that she spoke of 38 hospices that are funded, yet in a recent Written Answer the number given was 83? I believe that the true number is well over 100. It is that discrepancy which worries us. Is my noble friend aware that it is thought that hospice care is a great deal cheaper than keeping terminally ill people in hospital?

Baroness Trumpington

My Lords, I have an awful feeling that the figure of 83 should have been 38. I apologise if there has been a slip-up in the correspondence from that point of view. There are about 100 hospice units in the United Kingdom with between two and 40 beds. Thirty-eight of those units are NHS-run, but they may still receive some voluntary income.