HL Deb 16 September 2004 vol 664 cc1289-92

11.21 a.m.

Baroness Finlay of Llandaff asked Her Majesty's Government:

What action they are taking to ensure equal access to palliative care.

The Parliamentary Under-Secretary of State, Department of Health (Lord Warner)

My Lords, I refer the noble Baroness to the Government's response to the recent Health Select Committee inquiry into palliative care, published earlier today. Copies of that response have been placed in the Library. We welcome the 30 recommendations of the committee, which contribute towards our commitment to ensuring that, over time, palliative care is available to all who need it, irrespective of diagnosis and in whatever setting they are receiving care.

Baroness Finlay of Llandaff

My Lords, I thank the Minister for his reply and the Government for their response to the report. I declare an interest as one who works in palliative care. The Government's response recognises that funding has been inequitable and over-reliant on the voluntary sector. How will service planning be equitable without central co-ordination, particularly in exploring Marie Curie's model, and how will the Government ensure increased culturally sensitive education and training, particularly for healthcare professionals who work in areas of deprivation?

Lord Warner

My Lords, it is worth hearing in mind that the Health Select Committee praised the initiatives that the Government have taken to double the palliative care workforce. They have invested £50 million through the NHS Cancer Plan and provided specific funding for black and ethnic community projects and services for children. We have been working with Marie Curie on its economic model, which contains some interesting ideas. However, we recognise, as does Marie Curie, that some practical issues surround that particular model. As the Government's response shows, we are also taking issues forward as fast as is possible and practicable on a cooperative basis with the voluntary sector.

Baroness Greengross

My Lords, do the Government have plans to ensure that "whatever setting" includes facilities for those people who exercise their choice to die in their own home?

Lord Warner

Yes, my Lords, we support that approach. Following their commitment in the Building on the Best End of Life Care Initiative, the Government will be investing an additional £12 million during the next three years to improve care for people coming to the end of their lives, irrespective of diagnosis and setting.

Baroness Masham of Ilton

My Lords, is the Minister aware that some GP surgeries are putting a charge on nursing advice for those people who are living at home and who have to acquire nurses through agencies? Is that fair?

Lord Warner

My Lords, this is the first that I have heard of this problem. I am not briefed to give an authoritative answer, but I shall certainly look into the matter and write to the noble Baroness.

Earl Howe

My Lords, when one thinks of palliative care, one perhaps thinks most immediately of care for cancer patients, but there are many patients with other terminal conditions where palliative care is necessary. What work are the Government doing with the various non-cancer voluntary organisations to ensure that the programme for enhancing palliative care is rolled out equitably?

Lord Warner

My Lords, we have a range of contacts in the voluntary sector. As the noble Earl rightly said, we are committed to extending palliative care to people irrespective of their diagnosis. It is right that the major effort thus far has been made in relation to patients who suffer from cancer, but we are taking the issue forward on a co-operative basis with the voluntary sector and, after a cross-cutting review, the Government are committed to full cost recovery in the voluntary sector, which will help in this area.

Lord Patel

My Lords, does the Minister agree that a lack of integration of health and social care budgets for patients in palliative care is having an adverse effect on their care? What plans do the Government have to eliminate that anomaly?

Lord Warner

My Lords, it is always important to ensure good co-operation between social services and health services at the local level. There have been major advances in palliative care, which reflect rather well on co-operative working between the two services. That is reflected in the Health Select Committee's report. I am not quite as pessimistic as my noble friend because we have seen an expanding range of palliative care services in the community and in hospices. The trend is ever upwards. We are seeing good relationships also with the voluntary sector.

Lord Walton of Detchant

My Lords, in light of the Minister's previous point, does he agree that there is a widespread public misconception that palliative care is provided only in hospices and hospitals? Does he accept that palliative care is a philosophy of care that is increasingly extending out into the community? The public are to some extent misinformed about that. Does he accept that extending palliative care into the community is a major priority for the future?

Lord Warner

My Lords, the noble Lord, as so often, is absolutely right. The end-of-life care initiative that I mentioned will enable us also to skill up existing staff who already contribute to supportive and palliative care. Many of them are working to help people who wish to exercise their choice to die at home. I remind the House that the Government have provided 67,500 extra nurses since 1997. That is enabling us to increase the number of district nurses and palliative care nurse specialists, all of whom will be able to expand services for people who want to die at home.

Lord Addington

My Lords, it has been suggested to me that as the delayed discharges legislation did not cover hospices, there has been considerable slowness in discharging people from hospices to spend their last few days at home when they wish to do so. Will the Minister look into the matter to see whether it needs legislation?

Lord Warner

My Lords, there have been discussions on this matter. I know that it is under review. I shall look into it further and write to the noble Lord.

Lord Hayhoe

My Lords, in view of the splendid work that is done by children's hospices, has there been an increase in the support that is given to children's hospices from public funds in recent years?

Lord Warner

My Lords, more money has been going into hospices generally, as is recognised in the Health Select Committee's report. As to children's hospices, we know that the Big Lottery has provided £15 million to expand those facilities in recent years.

Lord Laming

My Lords, I am sure that the Minister would wish to pay a warm tribute to the many volunteers who contribute so much to that work. Does he also agree that it is very important that those volunteers are not exploited?

Lord Warner

My Lords, the noble Lord is absolutely right. A good deal of palliative support for people who are coming to the end of their lives is provided by volunteers, sometimes in hospitals and sometimes in people's own homes. I am sure that everybody in this House pays tribute to that splendid work. It is right that such people should not be exploited. The Government are expanding public services in those areas to achieve a good partnership between volunteers and public services.