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Baroness Masham of Ilton: My Lords, I thank my noble friend for giving your Lordships the opportunity to discuss this important and emotionally moving subject.

My noble friend Lady Finlay is a professor of palliative care, and is an expert. I speak from having had the honour of being the designated person to take decisions on behalf of someone dying of HIV/AIDS. I am also president of the local branch of the Motor Neurone Disease Association, and I have a husband with multiple disabling conditions, complicated by diabetes.

Last year my husband had an enormous abscess on his lower gut, and spent three weeks in intensive care. I know only too well that one has to take one day at a time, and hope is of the utmost importance in these times. I agree with my noble friend that it is so important that real choice and personalised care is provided to all people facing the end of their lives. Palliative care is an approach to care that encompasses medical, psychological, social and spiritual aspects. It includes terminal care and, when possible, rehabilitation.

For a moment, I would like to dwell on the spiritual aspects which mean so much to some people, especially around this time. I, myself, as a carer, get a great resource from the words of Pope John Paul II. He said:

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When I heard that a hospital had decided to remove its crucifix from the hospital chapel and a Maltese lady was distraught, I could understand her feelings. Sometimes people need the chapels to pray in or just to meditate in sometimes, especially around the difficult time of coming to terms with terminal illness or death.

Of course we should respect everybody's faiths and beliefs, but it is wrong to be negative and take away such things as crucifixes, which can give help and comfort; surely, one should have chapels for Christian faiths to share and another room for the use of non-Christians. I believe that is what happens here in Parliament and it must be the correct course to take.

The Motor Neurone Disease Association believes that specialist palliative care should be available to anyone with MND in a setting and at a time of his or her choice. Many people with MND are unable to access the palliative care services they require. In a survey carried out by the association in 2005, only 39 per cent of people with MND had been referred to specialist palliative care services. There are unacceptable geographical variations in the quality of service provision. That can have a negative impact on the quality of life of people with MND and their families.

All people in need of palliative care, whatever the condition, should have a quick service to occupational therapists and the correct equipment, such as wheelchairs, hoists, slings, special mattresses to prevent pressure sores and so on. The wheelchair service needs updating and upgrading, as does the suitable equipment for people in hospital.

On people with a swallowing problem, I discovered that adults do not have access to much-needed speech therapists, who can give vital advice in their lives, if they live in the communities of north Yorkshire. A child can get the service, but an adult has to wait a long time for an appointment in hospital. With so much emphasis on primary healthcare, I ask the Minister if he can encourage a better, quicker service for all who need it in hospital, hospice or at home, when they are in this condition.

Hospices have historically been funded by cancer charities, so services have focused on people with malignant disease. I hope your Lordships agree that it is important that other service users, such as people with life-limiting non-malignant conditions, are given equal treatment. Palliative care should be determined by clinical need and not disease type. But if a person's wish is to remain at home, all efforts should be made to make that possible.

I hope that the National Health Service framework for long-term conditions will help to co-ordinate and promote better services for those people needing palliative care. I, too, would like to congratulate the noble and learned Lord, who has, with all his efforts crossing London on this day, made a splendid maiden speech.
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3.54 pm

Viscount Bridgeman: My Lords, I am grateful to the House for its indulgence in allowing me to speak during the gap. I am also grateful to the noble Baroness, Lady Finlay, for initiating this valuable debate. I declare an interest as chairman of St John's Hospice in north London, which is one of the relatively few hospices that offers palliative care for three of the main life-threatening complaints—cancer, HIV/AIDS and, I am happy to reassure the noble Lord, Lord MacKenzie, and the noble Baroness, Lady Masham, motor neurone disease. I am also happy to reassure the noble Baroness that today the hospice has made available six emergency beds for St Mary's in the light of today's events.

My message is simple; it has been the theme of the debate. Governments—this applies to this Administration and the previous one—have underfunded the hospice movement by at least 50 per cent. The figure of 35 per cent was mentioned by my noble and learned friend Lord Lyell in his excellent and informative maiden speech, and by the noble Lord, Lord Hayhoe. It means that the balance has to be funded through the good will of the public. I do not like to use the word "cynically", but the Government have cynically traded on that in the assurance that the shortfall will be made up.

Furthermore, while other branches of the National Health Service have been given a 5 per cent uplift this year, the independent hospice movement has had to be content with 3 per cent. Why? In our case, we feel sensitive about that, because all our clientele come from the National Health Service through contracts with 11 primary care trusts across London.

Our hospice is fortunate, in that it is part of the same charity and on the same site as the Hospital of St John and St Elizabeth, for which the hospice is its charitable objective. A large part of the hospice's establishment cost is picked up by the hospital. Other hospices that stand alone are less fortunate. If that underfunding continues, there is a continuing danger that the viability of some of them will be called into question.

The hospice movement in London is overwhelmingly independent. I venture to suggest that hospices give huge support to the National Health Service in releasing acute hospital beds, providing high-quality palliative care and, as I have said, giving the National Health Service a service on the cheap, frankly. We are grateful for the money that the Government have made available to the hospice movement in recent years, but I urge the Minister and his right honourable friend the Secretary of State to revisit the problem.

3.57 pm

Lord Slynn of Hadley: My Lords, I too ask the indulgence of the House to make a brief intervention. I am told that I can do so as long as I am finished by four o'clock; I hope to be finished by 3.59 if I try very hard.

I have two points to make. Before I do so, I join in congratulating the noble and learned Lord, Lord Lyell of Markyate, on his marvellous maiden speech. He
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was my first pupil at the Bar. I tried hard not to take him—not because there was anything wrong with him, but because I did not think that I was adequate to take a pupil of such ability at that early stage in my career. His father insisted, and I am very glad that I took him as a pupil. I am not at all surprised that he showed in his speech today that the qualities that he began to show then have flourished and blossomed.

As a member of the board of a hospice, and as one who has seen people in the last days of a terminal illness desperately needing what can be provided by the hospice movement, I realise how important the debate has been. I too congratulate and thank the noble Baroness, Lady Finlay of Llandaff, on and for raising the issue. It is important as a public discussion, and in terms of asking the Government to do more than they already generously do.

My second point is to emphasise, as the noble Lord, Lord Patel, stressed, that we are not talking only about cancer. People with many other diseases—for example, motor neurone disease, which increasingly seems to be a problem—also desperately need the help of the voluntary movement. As has already been stressed, the fact that it is voluntary should be emphasised in any debate of this kind.

Tribute has been paid to Dame Cicely Saunders and I add the warmest tribute to her work. The most informative, moving and agreeable fund-raising dinner at which I ever spoke was in support of Dame Cicely's hospice and her movement. There are many other volunteers. Who, I ask rhetorically, could have done more to help the joint care home movement, of which I saw something as Prior of the Order of St John, or to help the Dame Cicely movement than Her Royal Highness Princess Alexandra? She has given the greatest support in this area, beginning at the top and moving down, as have many others.

I apologise for not having put my name down to speak in this debate. I thank your Lordships for giving me two-and-a-half minutes in which to contribute, and I congratulate the noble Baroness, Lady Llandaff, on her speech.

4.1 pm

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