The content of this website is intended for healthcare professionals only

NHS can’t afford not to transform end-of-life care

Better palliative care throughout NHS is economically beneficial as well as ethically right

Louise Prime

Wednesday, 07 September 2016

We can’t afford not to transform end-of-life care in the NHS as doing so would make economic sense as well as being the ethically right thing to do, according to a palliative care expert. She has called today for more focus on supporting patients to have a good death at all levels of the NHS – considering people’s last months and years rather than just their last few days.

Dr Katherine Sleeman is NIHR clinician scientist and honorary consultant in palliative medicine at the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation (at Kings College, London). She told delegates at the Health and Care Innovation Expo in Manchester that the NHS is facing a crisis as the number of deaths in England is predicted to increase by 20% over the next 20 years – meaning that the NHS will face one of its greatest challenges, in providing care for an extra 100,000 people dying every year.

She pointed out that not only do most terminally ill people not prioritise quantity of life over quality; but also that there is good evidence that as well as improving quality of life and death for people with terminal illnesses, palliative care makes good economic sense. She said: “Five randomised control trials (RCTs) in recent years have shown that palliative care, provided early and collaboratively, improves symptoms, reduces depression, and improves satisfaction with care. In addition, people who receive palliative care have fewer emergency department attendances, fewer hospitalisations, and more home deaths… a systematic review of evidence showed that palliative care is frequently cost saving – the expense incurred by the team itself is offset by the fact that patients are having fewer interventions and expensive trips into hospital. … It’s clear that high quality person centred care, delivered early and collaboratively, is a high value intervention.”

She called on the NHS to start taking palliative care more seriously. She cited an audit that found that fewer than half of NHS Trusts have appointed a lay member for end-of-life care to their board (as recommended), and just one in three meet NICE recommendations to provide seven-day face-to-face palliative care services. Furthermore, she said, more than half of health and wellbeing boards do not include the needs of the dying in their strategies, and a third of clinical commissioning groups surveyed by the Care Quality Commission had not undertaken any assessment of local end-of-life care needs.

She said: “The current situation, where a few people see a specialist palliative care team and the rest take their chances on a bad death is unfair, unethical and frankly uneconomic.

“There is no shortcut to good end-of-life care. We need to embed it in our clinical culture – make it everyone’s business and support everyone to do it.”

Dr Sleeman argued that when the late Dame Cicely Saunders took palliative care out of the NHS 50 years ago and founded the modern hospice movement to demonstrate good care of the dying, she did not expect it to left there.

She added: “It is our duty, as leaders in the NHS, to anticipate the needs of people living with terminal illness, and to ensure that that extra layer of support is available whenever and wherever it is needed. This isn’t about the last days of life; this is about the last months and years.”

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470