The bottom line is commission for quality, not just savings

When it comes to end of life care, the impact of poor services extends beyond the patient. It can have a long term impact on their family, who may be left with doubts about the services their loved one received.

‘We should be shifting people and resources away from hospitals towards community nursing and hospices, not the other way around’

Commissioners rightly think about the effectiveness of the services they commission while considering the bottom line. Commissioners across England are responding to this challenge in very different ways. 

This has sometimes made them more likely to commission charities such as Marie Curie because they know this can help ensure better outcomes at a lower cost. We know from the Nuffield Trust’s analysisthat access to Marie Curie nursing means fewer days spent in hospital beds, fewer emergency admissions and therefore less cost. 

Other commissioners are bundling end of life care into bigger collections of contracts for older people’s care.

Drastic action

Some have taken the more drastic decision to squeeze contracts, for example by moving to “face time” arrangements. These contracts only pay for the time a nurse or healthcare assistant spends with a patient, but not for travelling time for example. Such contracts are not viable for many community nursing providers, such as Marie Curie, who care for relatively small numbers of people spread over a large area.

‘The bottom line is that immediate savings may not be all they seem’

This trend risks undermining end of life care in those areas where it’s strongest – community nursing and hospice care. A recent Help the Hospices survey underscored these concerns.

It found 11 per cent of hospices had had their NHS funding cut and 39 per cent frozen (particularly concerning as on average the NHS only funds 32 per cent of such care). The VOICES bereavement survey and the latest hospital audit highlight concerns regarding the quality of end of life care in hospitals, and about the ability of community based services to continue to provide high quality care.

The logical choice

Logically, we should be shifting people and resources away from hospitals towards community nursing and hospices, not the other way around. 

The bottom line is that immediate savings may not be all they seem. While commissioners may save money on the contract initially, the real cost is likely to be borne by service users and the wider health and social care system.

Lack of access to high quality, effective community based nursing and reduced hospice provision will ultimately lead to poorer experiences, more unnecessary hospital admissions, longer hospital stays and more people dying in hospitals rather than their place of choice.

Phil McCarvill is head of policy and public affairs at Marie Curie Cancer Care