On 14th March 2017, Baroness Finlay of Llandaff led a short debate on the question of ‘how the Government intends to ensure that Clinical Commissioners respect the undertakings made in Our Commitments to You for End of Life Care: The Government Response to the Review of Choice in End of Life Care’. The Bishop of Durham, the Rt Revd Paul Butler spoke in the debate, paying tribute to the importance of chaplaincy to end of life care.
The Lord Bishop of Durham My Lords:
“The medical side of a patient’s health is not always the key to treating them”.
So said a medical student recently, describing what he had learned from a leading end-of-life care specialist at St Benedict’s Hospice and Centre in Sunderland. Another medical student said:
“Palliative care is not just end-of-life care. It is a very holistic approach which supports the patients’ needs very well”.
End-of-life care must be about the whole person, so the Government’s commitments in this regard are to be welcomed. While The Government Response to the Review of Choice in End of Life Care does not explicitly mention the word chaplain, it is clear that the contribution of chaplains is central to holistic end-of-life care. I am sure that all in this House will join me in paying tribute to chaplains in the NHS and independent hospices for the work they do in walking alongside people at the end of life.
Well-resourced chaplaincy, involving paid professionals and trained volunteers, plays a role in meeting every part of the commitments detailed here. But I want to focus particularly on the commitment that says that people should,
“have honest discussions about your needs and preferences for your physical, mental and spiritual wellbeing, so that you can live well until you die”.
Spiritual well-being is neither an add-on nor the monopoly of these Benches. No matter who you are, end-of-life care would be incomplete without space for reflection on the meaning of death and life. This point was underlined forcefully to me by the staff, medical and administrative, of St Cuthbert’s Hospice in Durham when I recently visited there. They also raised with me the struggle they face in providing care to those of specific faiths. In particular, they wanted to highlight the difficulty of resourcing end-of-life religious care for those from smaller faith communities. Rightful consideration that everyone has a spiritual well-being must not crowd out an attentiveness to the particularity of one’s religious convictions, and the requirement on clinical commissioners to provide religious care to those of all faiths.
A family coming to terms with a diagnosis recently got in touch with an NHS chaplain in my diocese to express how much of a comfort it is to know that she is simply there for them. It struck me how vital it is that the NHS makes sure that in each and every context where end-of-life care takes place, there is someone there for them. Action 5 of the report states:
“We will ensure we have the right people with the right knowledge and skills to deliver high quality personalised care”.
This makes it clear that it is the responsibility of the NHS to provide chaplaincy services. In partnership with faith and belief groups, yes, but the responsibility for adequate religious and spiritual care lies with the NHS. This is a point underlined in quality statement 6 of the 2011 NICE quality standard for end-of-life care for adults, which requires that:
“People approaching the end of life are offered spiritual and religious support appropriate to their needs and preferences”.
The NHS chaplaincy guidelines 2015 also underscore the importance of NHS chaplains in providing pastoral, spiritual and religious care. I therefore look forward to hearing more on how the Government will ensure that clinical commissioners will provide well-supported chaplaincy for those of all faiths and none as part of integrated care for those at the end of life.
In closing, I add my support for the call by the noble Baroness, Lady Finlay of Llandaff, to ensure that palliative care is truly seen as a top priority for all CCGs and that the Government ensure that they are held to this and provide specific funding to enable it.
I leave my final word to a consultant from St Benedict’s Hospice, Sunderland:
“Many palliative care professionals will tell you of a time that the involvement of the chaplain was the key intervention in a person’s care. Not so much the drugs, the nursing care, the therapy support or the hospice bed. Instead it was the confession, the sacrament, or the calm and unhurried listening ear that brought a person peace at the end of their life”.