Palliative Care Bill

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The provision of end-of-life care services is still inconsistent, argued Caroline Spelman (Con, Meriden).

In the second reading of the Palliative Care Bill, Spelman highlighted the gold standards framework for palliative care, drawn up by Dr Keri Thomas. Palliative care provision is likely to affect most people in the country, she added.

The Bill aims to confer on patients a right to choose where to receive end-of-life care.

Palliative care is still heavily dependent upon the voluntary sector, she said. Emphasising that the majority of people with a terminal illness want to die at home, Spelman expressed her concern that only one in five achieve that.

Oliver Letwin (Con, West Dorset) highlighted the importance of palliative care for children.

Acknowledging the expense of keeping a patient in an acute hospital bed, Spelman said there is still no lever to enable the funding to follow a patient out of hospital and into the community.

A lack of funding or training often means that care homes must admit residents to hospital. However, the funding streams for care homes and hospitals are quite different.

“There is a real crisis in adult social care provision”, she said.

Spelman highlighted the difficulties faced by hospices in the current economic climate. Provisions in the Bill would enable the money to “genuinely follow the patient from an acute care setting back to a hospice”, she said.

The end-of-life care strategy did nothing to address the continued underfunding by the government for the hospice sector, she argued.

She also called for end-of-life-care training for all health care professionals.

Dr John Pugh (Lib Dem, Southport) welcomed the objective of the Bill, but said that candidates for palliative care are not always easily identifiable.

Pugh said the NHS does not have the capacity to fund or provide spiritual help.

Letwin highlighted the contrast between palliative care in hospitals and hospices.

“A hospice can provide the degree of psychological support that can make an enormous difference to the quality of those last days and weeks of a person’s life,” he said.

The government, NHS and social care services must “seek to understand the preferred circumstances in which an individual wants his or her life to come to an end,” Stephen O'Brien (Con, Eddisbury) said..

He argued that the fulfilment of patients’ wishes must not be affected by patchy delivery of palliative care services.

“It has remained the NHS’s poorer cousin for perhaps too long,” he said.

“A collaborative approach to care from the health and social services can enable palliative care to exceed the bounds of hospitals and hospices”, he added.

Oliver Letwin also highlighted the significance of palliative care for sufferers of dementia.

There remain major obstacles to better end-of-life support, acknowledged Dawn Primarolo.

The health minister admitted a traditional bias in provision and access to specialist palliative care services.

Medical advances can cause unwillingness on behalf of professional staff to accept that someone is dying, she said.

However, she argued that the Bill is not “the best way to deliver better end-of-life care”. Councils and trusts are not yet in a position to deliver a full range of options, she said.

The Bill duplicates the government’s efforts to improve palliative care through the end-of-life care strategy, the minister argued.

The House divided against the Bill; ayes 13, noes 26.

Progress

House of Commons

First reading: January 21 2009 [HC Bill 20]

Second reading: April 24 2009