Hospices need to change

The UK’s population is rapidly getting older, with a rising number of people living well into their 80s and beyond − many with multiple, complex health conditions. The number of people aged 85 and over alone is expected to double in the next 20 years and the number of centenarians is expected to increase more than eight-fold by 2035. In addition, more young people with life shortening conditions are living for longer.

‘The Commission into the Future of Hospice Care highlights how demand for palliative and end of life care will surge over the next 10-15 years’

This “demographic ticking time bomb” presents huge challenges for hospices and other providers committed to improving care for people who are dying or bereaved. They will need to think creatively and differently to find ways to meet their needs while working with limited resources.

A recent report by the Commission into the Future of Hospice Care, in response to Demos’ 2010 report Dying for Change, highlights how demand for palliative and end of life care will surge over the next 10-15 years, and calls on hospices to respond. It invites them to adapt and change the way they work so they are equipped to meet these future needs.

It also makes some recommendations for other stakeholders, including health and social care commissioners and hospitals, which would help create a context in which hospice care can flourish, thereby helping to improve end of life care in a wide variety of settings.

• How to contribute to HSJ’s Commission on Hospital Care for Frail Older People

The commission, set up by Help the Hospices and comprising leaders with a broad range of views around palliative and end of life care, is convinced that hospices can play a key role in developing new ways of working to meet this challenging future. Hospices grew out of a desire to address deficits in care for people facing the end of life and have a strong history of innovation to meet people’s needs, as well as of providing high quality, compassionate care.

Creativity and care

Data from the 2012 National Bereavement Survey from the Office for National Statistics confirms high ratings for hospice staff in their demonstration of dignity and respect for patients and relatives (84 per cent said always for hospice doctors and 82 per cent said always for hospice nurses, compared with 59 per cent for hospital doctors and 52 per cent for hospital nurses). Hospices are therefore well placed to consider and meet future challenges and, as they did in the past, once again lead a revolution to help transform care.

‘Hospices need to find a way of working more closely with organisations inside the NHS, local authorities, care homes and other voluntary organisations’

The commission urges hospices to become “champions of change” for care in their local communities, extending their impact beyond service provision by forging new partnerships and sharing their expertise more widely to help transform care across all settings.

It calls on hospices to review how they operate in the next two to three years, in particular to become more agile in responding to changing demands and to take the lead in developing new models of care and adapting existing services. Some hospices are already doing this, proactively approaching local health and social commissioners and other partners to develop new approaches.

Hospices enjoy a high degree of autonomy and many have operated independently of mainstream care for years. While this has been key to their creativity and innovation in the past, the commission highlights how they now need to find a way of working more closely with organisations inside the NHS, local authorities, care homes and other voluntary organisations in the future to influence and contribute to the wider systems supporting people with life threatening or life limiting conditions.

Close the gap

Some hospices are well ahead on this, delivering education and training for colleagues in primary care, hospitals and care homes and actively contributing to health and wellbeing boards.

Hospices also need to reshape and rejuvenate their workforces for the future by, for example, investing further in volunteers, who already play an important role in their work but who could do more, such as delivering more care and social support for people at home.

The commission also heard repeated requests from the public and from care organisations that hospices make their care available to people other than those with cancer, including frail, older people with conditions such as dementia. Some hospices are already addressing this gap, working in partnership with other organisations.

The report comes at a critical juncture for care, amidst persistent failings in the system, and offers some practical suggestions about how hospices and other organisations can start to prepare for the future. Hospices must take a lead, creating new partnerships and sharing their expertise; other players must respond, engaging hospices in finding radical solutions to a very real challenge in the future.

Heather Richardson is national clinical lead at Help the Hospices