Report states end-of-life care needs improvement

Topics covered: Ridouts professional advice

A Commons Health Committee report has found that two-thirds of people say they want to die at home but more than half end up dying in hospital.

The report said there was ‘unacceptable variation’ in the care received by people in England. End-of-life care is defined as people expected to die within 12 months, with most having an incurable or progressive illness. Care minister Norman Lamb said the government was looking carefully at a policy of free end-of-life social care.

The health committee report was based on evidence from clinicians, charities and palliative care experts. It found that there was, ‘great variation in quality and practice across both acute and community settings.’ It recommended that one senior person in each NHS Trust be given responsibility for monitoring how end-of-life care is delivered.

Committee chairwoman Dr Sarah Wollaston MP said: ’We must make sure that specialist palliative care expertise is accessible within hospitals and community settings as well as within our hospices.’ Around 500,000 people die each year in England and Wales.

According to The Cicely Saunders Institute which conducts research into palliative care, approximately 53% of deaths occur in NHS hospitals, with around 21% occurring at home, 18% in care homes, 5% in hospices and 3% elsewhere. This is despite the fact that two-thirds of people say they would prefer to die at home.

The committee said too often staff felt they lacked the confidence and training to talk about end-of-life issues with patients and it recommended that all staff should also be given relevant training on care planning, and bereavement support should be offered to families. It also said it wanted the government to ensure that no-one died in hospital, rather than at home, “for want of a social care package of support”.

Care Minister Norman Lamb said the government was examining the merits of free social care at the end of life. He said: ‘We are looking carefully at the costs and benefits of this policy, but we know that thanks to the hard work of health and care staff and carers, many people already receive good end-of-life care. We are determined to improve further, and by April, 70% of clinical commissioning groups should be capable of using electronic records to share end-of-life care choices across the health and care system so people’s wishes can be respected.’

Dr Jane Collins, chief executive of charity Marie Curie, said the current situation had to change. She said that: ‘The challenge for the next government is clear – there needs to be a dramatic improvement in access to high-quality care in the community, available for people early on in their illnesses so that they can live well and stay out of hospital for as long as possible.’

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