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Community specialist palliative care enabling more people to die at home

But more still needs to be done to open up services to non-cancer patients, says report

Caroline White

Tuesday, 03 June 2014

Specialist palliative care services in the community are enabling an increasing number of people to die in their own home—the preferred place of death—finds a report* published jointly today by the National Council for Palliative Care (NCPC) and Public Health England (PHE).

But more needs to be done to open up these services to patients with life limiting conditions other than cancer, says the report, which is based on data from services across the country.

Almost half (46.2%) the people receiving specialist palliative care in the community died in their own home compared with just over 1 in 5 (21.8%) nationally, the figures show.

The report also finds that nearly half (45%) of the people referred to a specialist palliative care inpatient service are discharged. Of these, most (85%) were discharged to their home, dispelling the myth that people only go into a hospice to die.

Continued progress has also been made in opening up specialist palliative care services to non-cancer patients, but much more needs to be done, says the report.

The most striking increase has been in levels of hospital support, where diagnoses other than cancer in outpatient and day care services now account for over a quarter (27%) of new patients.

For specialist palliative care inpatient units, the proportion of new patients with a diagnosis other than cancer has risen from 3% in 1997-98 to 12%. But cancer still accounts for around 29% of all deaths.

Almost two thirds (66%) of specialist palliative care providers responded to the survey, which informs the report, but response rates varied widely across the country, ranging from 89% in Cheshire and the Mersey to just 33% in Northern England.

And it continues to be difficult to capture comprehensive data on the ethnicity of people being seen by specialist palliative care services.

Professor Julia Verne, Clinical Lead for PHE’s National End of Life Care Intelligence Network, said that someone dies every 70 seconds, but around half of all deaths were still happening in hospital.

“Specialist palliative care services working together with community services are essential to supporting patients if they choose to die at home,” she added.

Simon Chapman, Director of Public and Parliamentary Engagement for the National Council for Palliative Care, commented: “It’s encouraging that specialist palliative care services in the community are enabling more people to die at home, which is where most of us say we would want to be. However, despite progress many people are still not able to access the services and support they need, when they need them.”

He continued: “We only get one chance to get it right for people who are dying, why is why reducing variations in end of life care must be a priority for policymakers, commissioners and providers.”

Dr Bee Wee, National Clinical Director for End of Life Care said the variable response rates around the country were concerning.

“High quality comprehensive data is essential if we are to improve services, position them appropriately and secure appropriate funding,” she said.

National Survey of Patient Activity Data for Specialist Palliative Care Services, Minimum Data Set for 2012-2013 (MDS). The National Council for Palliative Care/ Public Health England.

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