Fundamental change is required to end of life care

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There is a perfect alignment between what terminally ill people want and what the NHS and wider health and social care system need

Most people (whether they are living with a terminal condition or not) want to die somewhere other than in a hospital bed. We also know that many people who end up in hospital at the end of life have no clinical need to be there and their bereaved relatives report a poorer overall quality of care.

‘We spend so much on end of life care − surely we must ensure that we spend in the right way’

The latest HSJ barometer results underline why so many people end up in hospital at the end of their lives. Sixty six per cent of commissioners who responded stated that the lack of 24/7 services in the community was a major or very major challenge.

We know the NHS and acute hospitals face severe resource pressures in the short, medium and longer terms. These will require us to do things radically differently and shift more resources to community-based care. For once we have a perfect alignment of what people want and what the system needs. There are three key ways that NHS England, local commissioners and their partners can give everyone more of what they want.

First, we must have the confidence to shift resources from acute hospitals back out into the community. There is growing evidence underlining the impact that community based services, including voluntary sector services such as the Marie Curie nursing service, and the right social care packages can make to people’s experiences at the end of life.

The Nuffield Trust’s independent evaluation of the Marie Curie nursing service showed those using the service were far more likely to die at home and used much less hospital care than matched controls.

Perfect storm

Second, we must redesign services so they are closer to what people want at the end of life. This means determining which services are most effective and delivering more of them. Over the last nine years, Marie Curie has worked with commissioners across the UK, including in Somerset and North Somerset and Lincolnshire, to deliver improvements in care and outcomes.

Finally, we must invest in training and education to ensure staff across the health and social care system have the knowledge and skills to deliver high quality care for terminally ill people. Our partnership with the Royal College of General Practitioners is just one way we are supporting this.

The coming perfect storm of harsh winters, ongoing austerity and demographic pressures associated with our rapidly ageing society should help focus our minds on what needs to be done. We spend so much on end of life care − surely we must ensure that we spend in the right way.