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Exclusive: Palliative care threatened by staff shortages

Palliative care is under threat due to a shortage of specialist nurses, a report is expected to warn this week.

The report, due to be published on Wednesday, will reveal details of the latest workforce survey by the National Council for Palliative Care. It will warn that an ageing palliative care workforce coupled with nursing staff shortages could threaten quality of care for terminally ill patients.

The report will reveal that the number of specialist palliative care nurses peaked in 2008, before dropping by 6.9% over the next two years.

It will also show the average vacancy rate for palliative care nursing positions in 2010 was 8.7% – higher than the rate for consultants of 7.8%. This compares with NHS Information Centre data for 2009-10 which showed the overall vacancy rate for registered nurses was 0.6%.

The report will also reveal that palliative care nursing is an ageing specialty, with nearly 40% of palliative care specialist nurses over the age of 50.

The workforce findings contrast with expected demand for palliative care. The council highlights that currently around 500,000 people die each year in England and Wales, but that figure is expected to reach 586,000 by 2030.

However, a separate report published last week praised the high standards of palliative care currently provided generally within hospitals.

An audit led by the Marie Curie Palliative Care Institute Liverpool, together with the Royal College of Physicians, looked at performance data on eight areas of the Liverpool Care Pathway for the Dying Patient, involving more than 7,000 patients at 127 trusts.

  • The Department of Health is also asking for expressions of interest from NHS organisations interested in piloting a new method of funding palliative care.

The pilots will involve testing a new patient care pathway. Nurses will be involved in gathering information on the stages of treatment and the condition of patients.

Readers' comments (10)

  • Palliative care needs enough nurses, as do other areas of care - it probably also needs better training (in terms of legal understanding) and much less 'fudging' than is happening at present (last comments are off-specific-topic, I admit).

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  • Not sure about the legality aspect you mentioned in the comment above. However, back onto the point. You are right about the suitability of current training but the crux of the matter is that there is not joined up thinking about the government plans. They want more people to die at home but there are less staff and less resources to care for them. Society has changed and the capitalist mentality does not account for anything emotional but is money driven. Families are dissipated not nuclear so care is often not kept 'in the family'. Even in nursing, the attitudes have changed. As an over 50 Palliative Care trained nurse myself, I can't remember a time when nurses were so frequently, openly or publicly accused of neglect, poor care or lack of empathy. Is it just nurse training or social morality and sensitivity that is lacking? The point is, (sorry, I am rambling), palliative care is a very emotional and autonomous nursing speciality. Many people do not choose to go into it because of this. Many nurses want the money but not the responsibility. Likewise Palliative Care is not full of gadgets to tweek or machines to attend to. Palliative caer is not seen as 'very sexy' in our highly desensitised health service. No Holby City or real life A& E. Also don't forget there are going to be a whole heap of elderly, burnt out, exhausted nurses who are working beyond the retirement age stopping the younger nurses from getting jobs so perhaps people will take up these 'difficult to fill posts'? Oh, the future of health care is dire!!!! Please will the Government start to think sensibly about all these changes and plan properly and not on some whim of an idea. Think joined up!!!

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  • Anonymous | 6-Dec-2011 11:47 am

    You are right about the lack of joined-up thinking, and especially of joined-up behaviour (especially for patients who are at home). To compound the problem, clinical guidance is simply not in line with the law. And the 'emotional aspects' are used as excuses to avoid proper discussions about 'the death part' of EoLC.

    I just sent an e-mail to a group of people, and (I'm just pasting, so this might de-format) I get annoyed by the lack of clear understanding about CPR:

    Guardian today, pages 1 and 10 – I am very ‘grumpy bear’ ! Doctors train for years, and nursing is becoming all-graduate – it cannot be too much to ask, that the medical profession understands Bland ! And Bland says, to be clear about this, that if a patient has not refused CPR, there is an obligation to try and preserve life. It does not get beyond those two things, but the in-between bit logically follows from the existence of NICE and things such as section 14 of last year’s GMC guidance, and the fact that we all have different tolerances, expectations and enjoyment from life, as individuals.

    I briefly touched on this (highly misunderstood) area in my DNAR/RITE/RIP e-mail, but as Scotland has pointed out ‘patients are the judges of quality of life issues’.

    Although the report in the Guardian is both over-simplified and ‘confused’, the section at the bottom of page 10 states:

    ‘The law on resuscitation suggests the final word lies with doctors. Their regulator, the General Medical Council, says there is no obligation to prolong life if doctors think treatment is not in the best interests of a patient’ is rubbish – doctors can legitimately not offer CPR if they are ‘certain it would fail to restore life’, but doctors do not ‘judge the quality of any (potentially) restored life’. Patients make that judgement !

    ‘…says the patient “must be regarded as absolutely central to considerations on DNR notices’ (UHB guidance) is an absurdity (if not the patient, what else could be ‘central’ ?).

    And as for ‘It must be stated that relatives and friends cannot make a decision on behalf of a competent adult’ well, nobody except the patient can, so neither relatives nor doctors can do that !

    Why does CPR cause so many problems, emotional issues apart ?

    Leave the decisions where they are supposed to be:

    If CPR might work – ie if it might restore ‘life’ of whatever quality – a patient can forbid CPR;

    If CPR can be ‘argued/shown’ (how, I cannot fathom !) to ‘definitely be non-viable as a clinical procedure – ie ‘even if we tried it, the heart would not be re-started’ – doctors can decide to not offer CPR (but it does not automatically follow that you also have the right to not tell patients of the decision);

    ‘The system’ – whoever is paying for healthcare – can impose a ‘blanket’ decision of ‘We will not offer you CPR, because we do not offer CPR to any patient in your condition, as the ‘outcome costs’ of any resuscitation, are too high': this is exactly what NICE does with other treatments, so it logically can be extended to CPR !

    I am very ‘miffed’ about this, best wishes Grumpy
    PS You cannot prevent arguments by getting the rules right - but you can introduce clarity ! You will not be able to remove 'the NHS deliberately killed my wife' as an opinion, when patients and relatives do not agree with 'clincial' DNACPRs (although you could simply agree to try, resouce issues apart - sort out 'RITE' and put it squarely where it rests, with 'the system' as opposed to with clinicians).

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  • Anonymous | 6-Dec-2011 11:27 am
    AND
    Anonymous | 6-Dec-2011 3:19 pm

    For crying out loud Michael Stone. You are now publishing under the veil of anonymity in order to hijack another discussion about your one eolc issue. At least have the decency to take it elsewhere. Perhaps you could also stop making comments about those who post anonymously.

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  • michael stone

    Anonymous | 6-Dec-2011 6:40 pm

    Well spotted, but I posted anonymously in this one, to try and preclude any personal attacks on me from interferring with the discussion.

    And EoLC is pretty-much identical to 'pallaitive care' in most contexts - where do you get 'elsewhere' from ?

    I don't like anonymous posting, as it is too confusing: but as I am permanently trolled, on RARE occasions I try to avoid 'trollference' by using anonymity.

    But people really would be doing something useful, if when posting anonymously during potentially long debates, they started their posts with something like:

    Anonymous: etc

    Posting as Pyramid: post no 1

    and then posted their comment, so that other readers could subsequently 'link together' who said what !

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  • As an "over 50" but certainly not "burnt out" nurse, I would like love to take an alternative career route into palliative care but just haven't seen the roles advertised - it appeared to me the funding for the posts just weren't out there........

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  • I have tried to get into community palliative care to follow through EOLC, but have failed to get a job, the reason being that I don't have community experience! I have extensive ward-based experience in EOLC though. So what do they want? If I was an employer, I would want someone who knew what they were doing. So much for transferrable skills, community care looks like it is a 'closed shop'

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  • Further to the comments made by another anonymous and several others

    "michael stone | 7-Dec-2011 11:04 am

    Anonymous | 6-Dec-2011 6:40 pm

    Well spotted, but I posted anonymously in this one, to try and preclude any personal attacks on me from interferring with the discussion.

    And EoLC is pretty-much identical to 'pallaitive care' in most contexts - where do you get 'elsewhere' from ?

    I don't like anonymous posting, as it is too confusing: but as I am permanently trolled, on RARE occasions I try to avoid 'trollference' by using anonymity."

    you seem to ignore other commentators wishes. why don't you just leave the website to nurses to debate about their professional needs and then, as you put it, you would not be 'trolled' although you do not seem to be using the term correctly or understand what it means.

    As has already been pointed out to you by several commentators who appear to be mainly nurses this is a place for nurses to debate nursing issues and not for your 'trolling'.

    please could you explain what you believe you are contributing to these debates or are you just USING the site and trying to use healthcare professionals to try and achieve your own personal ends. By nature of their job and training, nurses are highly perceptive of the behaviour of others!

    If you are unable to explain the usefulness to the advancement of nursing knowledge the matter of your annoying intrusions will have to be taken up with the editors of the NT who generously open the comments to the public but most of whom are not abusive, in this manner, of the limitations and of online etiquette and respect for other users.

    You were asked politely on several occasions initially to withdraw from making irrelevant comments which you chose to ignore and now as can be seen on several pages other commentators have had enough and many have, unfortunately, withdrawn themselves from what had promised to be some very useful discussions.

    Is it really you intention to obstruct the advancement of nursing knowledge? If so this is not in anybody's best interests.

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  • michael stone


    Anonymous | 12-Dec-2011 12:57 pm

    I have just sent the following to the moderator, as a comment on your post - please contact the moderator, and can we attempt to sort out exacty what it is you dislike about my opinions ?

    'Can you please find out who it is that 'my mere existence' appears to offend, because much of the time people agree with my postings and analytical points, but I consistently get 'attacked' by what seems to be a small group of people, who always post anonymously.

    I have asked NT previously, and your staff told me this is not a site merely for nurses, and that the prime requirement for postings is 'valid contribution' (my phrase).

    I think this poster believes that I am 'anti-nurse' and that is simply untrue, but I cannot explain why the beliefs of operational nurses is so relevant to my EoLC discussions with the DH, BMA, etc, unless the person is willing to exchange some e-mails with me (which allows me to send attachments, etc).

    Please e-mail this person, and ask if they are willing to contact me by e-mail ?'

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  • michael stone | 12-Dec-2011 2:03 pm

    it would be helpful, as I requested in my previous post, to reflect upon and clarify your motives for your own benefit and for those commenting on a site which is primarily for nurses as you bring Eolc into many debates, even when it is not relevant thus breaking up several debates where nurses wish to discuss the issue in question rather than your personal ones.

    Furthermore, it is not even possible to carry on a reasoned debate on this site about the issue of palliative and other types of nursing care which are being seriously affected by inadequate staffing levels without your intrusion. Such debates are important exchanges between nurses, for nurses and to the advancement of nursing knowledge which may in the long run help to find solutions which impact upon working conditions and thus quality of care. This is a useful platform to thrash out issues and problems in order to present a case when and when appropriate in order to advance our profession.

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