Palliative care: fourth report of session 2003-04; volume 2; oral and written evidence

1.. As one of our witnesses observed, "we all die … 100% mortality is an immutable fact and it is not actually a sign of failure".[1] However, death remains the last taboo. Every year about 520,000 people die in England, around a quarter of whom access some form of palliative care. Many patients experience "severe symptoms" and "psychosocial problems" in their last months of life.[2]

2. Palliative care has much to offer in terms of addressing these problems, with its goal of achieving the best quality of life for the patient with advanced progressive illness, and for their families, friends and carers. Sir Nigel Crisp, Chief Executive of the NHS, has described better care of the dying as "a touchstone for success in modernising the NHS" and "one of the really big issues" which must be addressed.[3]

3. We announced our inquiry into palliative care on 23 January 2004 with the following terms of reference:

The Committee will inquire into the provision of hospice and palliative care by the NHS and by independent services, including the related support services of local authorities and other agencies for both adults and children. The inquiry will examine the extent to which the needs and wishes of patients of different ages are taken into account, including their care choices, ethnicity, cultural and spiritual beliefs. It will address the financing, governance, staffing, location and quality of palliative care.

In particular the Committee will examine:

• Issues of choice in the provision, location and timeliness of palliative care services, including support to people in their own homes.
• Equity in the distribution of provision, both geographical and between different age groups.
• Communication between clinicians and patients; the balance between people's wishes and those of carers, families and friends; the extent to which service provision meets the needs of different cultures and beliefs.
• Support services, including domiciliary support and personal care.
• Quality of services and quality assurance.
• The extent to which services meet the needs of different age groups and different service users.
• Governance of charitable providers, standards of organisation, links to the NHS and specialist services.
• Workforce issues, including the supply and retention of staff and the quality and adequacy of training programmes.
• Financing, including the adequacy of NHS and charitable funding and their respective contributions and boundaries.
• The impact and effectiveness of Government policy including the National Service Frameworks, the Cancer Plan and NICE recommendations.