Terminally Ill Patients: Care (Hansard, 3 December 1997)

§ The Minister of State, Department of Health (Baroness Jay of Paddington)

A number of guidance documents are available to help professionals caring for terminally ill patients. The Standing Medical Advisory 195WA Committee and Standing Nursing and Midwifery Advisory Committee published a report in 1992 on the Principles and Provision of Palliative Care. The National Council for Hospices and Specialist Palliative Care Services, working with the then Clinical Outcomes Group in the Department of Health's NHS Executive, has produced a document entitled Managing Cancer Pain in Adults. A further document, Changing Gear—care of people in the last few days of life, is to be published shortly. In addition, as part of the implementation of the policy framework for improved cancer services, a series of guidance documents on site specific cancers is being produced by a group chaired by Professor Bob Howard and disseminated by the NHS Executive. Each of these will include guidance on care for the terminally ill. Improving Outcomes in Breast Cancer and Improving Outcomes in Colorectal Cancer have already been published. Copies of these documents will be placed in the Library.

All doctors training at undergraduate and postgraduate level learn about the principles of caring for the dying as part of their medical training and also about the legal and ethical implications.

Doctors training for a career in hospitals will be in contact with terminally ill patients to a greater or lesser degree depending upon the specialties in which they train and some doctors choose to receive specialty training in palliative care.

Those doctors intending to enter general practice will, during their year of general practice training, regularly see patients with terminal illnesses and will learn about their treatment. Trainee general practitioners may well also see patients with terminal illnesses during their two-year hospital rotation. Additionally, doctors are expected to continue with their medical education after qualification and they will spend some of this time learning about the illnesses and conditions they most commonly encounter.

The medical education curriculum is a matter for the medical schools in collaboration with the General Medical Council's Education Committee, which has a statutory responsibility to determine the extent of the knowledge and skill required for the granting of primary medical qualifications in the UK, and the relevant Medical Royal Colleges and, in the case of general practice, the Joint Committee on Postgraduate Training for General Practice. All of these have an interest in ensuring that doctors are equipped to deal with the problems they will encounter in practice—both in hospital and in general practice. It is not however practicable or desirable for the Government to prescribe the exact training that any individual doctor will receive.

Nurses also receive training at pre-and post-registration levels about the principles of caring for the dying as part of their medical training and also about the ethical implications. Within pre-registration nursing programmes, the Common Foundation element addresses issues of nursing patients with terminal illnesses and associated ethical and moral implications. Many pre-registration nurses will have the opportunity to experience a clinical placement within settings 196WA offering this type of specialist care. This may be with a hospital palliative care team, community team or a local hospice.

There are also a number of post-registration packages available to qualified nurses who wish to pursue this particular area of specialist care. Ethical and moral issues are integral components in all courses for qualified nurses focusing on care for people with any life threatening illness. There are also specific, specialist courses on palliative and terminal care for those qualified nurses who wish to pursue this particular area of specialist care.