Health Bill

I am glad to add my name to Amendment No. 96A which, as the noble Baroness, Lady Finlay, has pointed out, deals with the situation at primary care trust level. This small group of amendments is obviously probing to enable the Committee to have a sensible debate about palliative care and its place in the whole range of health and caring services. The White Paper, Our health, our care, our say, has a small section on end-of-life care, as it is termed in the document. There is a useful analysis in nine paragraphs of a very large document. As has already been explained, palliative care expertise is needed from the time of diagnosis, which is something rather different to end-of-life care. At paragraph 4.101, the White Paper points out:"““Over 500,000 adults die in England each year. Although over 50 per cent of people say they would like to be cared for and die at home if they were terminally ill, at present only 20 per cent of people die at home””." Paragraph 4.103 states:"““we will establish end-of-life care networks . . . The networks will bring together primary care services, social services, hospices and third-sector providers, community-based palliative care services, as well as hospital services””." That relates directly to Amendment No. 82A, moved by the noble Earl, Lord Howe and Amendment No. 96A. Finally, in paragraph 4.107, the White Paper states:"““For disabled children, children with complex health needs and those in need of palliative care, PCTs should ensure that the right model of service is developed””." What progress has been made with the establishment of those end-of-life care networks and how many PCTs have ensured that the right model of service is developed? We know that there has been an increase in the number of consultant posts in specialist care—by more than 100, I believe—but a large number remain unfilled. Can my noble friend explain what happens to the money if the post is unfilled? Does it go into the general pot—with the financial pressure on PCTs, one can see what might happen—or does it remain unallocated and held in reserve until the post is filled? To take one practical example of the need for palliative care plans at PCT level, in the area where I live in Wiltshire there is a substantial financial deficit in the NHS. The plan to deal with the deficit in two primary care trusts has two options. The option with the biggest net saving involves the closure of seven community hospitals and two health clinics, with four primary care centres being considered. I understand that there is no agreement yet with GPs, who will become the prime movers in the provision of services; and no guarantee that the primary care centres will be up and running when the seven community hospitals are closed. As I said, that plan involves two primary care trusts, but it has just been announced that the two involved in the plan that I have just described are to be merged with a third, whose closure programme is not involved in the figures that I have cited. I do not expect my noble friend the Minister to comment on that situation, but it is an example of what is going on at PCT level. With all the upheaval that will follow the implementation of one of the three options proposed by two of the primary care trusts, and the merger of these two with a third, we can only guess what will happen to palliative care in the absence of a proper plan as set out in the amendments. I hope my noble friend will recognise the importance of this subject and that we will be able to put something constructive on the face of the Bill.