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Hospices call on NHS to offer more choice on where patients die

A hospice charity has launched a bid to reduce the number of people dying unnecessarily in hospital.

Help the Hospices wants the government to back a major programme to cut the number of people dying in hospital by 50,000 each year – around a fifth of the total annual hospital deaths in the UK.

“Hospital should be the last resort at the end of life, not the first one”

Michael Howard

The charity claims it would lead to higher quality, better targeted care for dying people and could generate savings of up to £80m per year for the NHS.

The new initiative will offer people increased choice about where they die, in line with their personal preferences. It will be aimed at dying people who often “fall through gaps” in the care system and remain in hospital at the end of life because alternative options have not even been considered.

Under the scheme, the charity is offering a partnership between the NHS and the hospice movement to fund six nationally co-ordinated pilot projects to evaluate the impact of hospice-led interventions in reducing unnecessary deaths in hospital that would begin in April 2015.

Following completion of the pilots, the programme would then be rolled out nationally from April 2017.

Michael Howard

Michael Howard

Announcing the new programme, Help the Hospices chair and former Conservative Party leader Lord Howard said: “Hospital should be the last resort at the end of life, not the first one.”

Dr Ros Taylor, director of the Hospice of St Francis in Berkhamsted, Hertfordshire, and a trustee of Help the Hospices, said: “Hospices are already successfully delivering alternative models of care and also working with other organisations in their local communities to better co-ordinate care for dying people.

“However, this needs to be radically scaled up if our society is to address the crisis of care facing dying people and enable them to access the support they desperately need and deserve.”

“We only have one chance to get it right for people who are dying”

Claire Henry

National Council for Palliative Care chief executive Claire Henry said: “We welcome this initiative by Help the Hospices and share their concerns about the importance of tackling the challenges in care for dying people.

“We only have one chance to get it right for people who are dying, which is why there needs to be a much greater focus on meeting people’s end of life wishes, including by supporting more people to be cared for and die in the community rather than in hospital which for many people isn’t where they want to be.”

National Council for Palliative

Claire Henry

Ciarán Devane, chief executive of Macmillan Cancer Support, added: “It is crucial the government understands the needs of people at the end of life and puts in place the support they need so that they can spend their last few days or weeks in the place of their choosing.

“An estimated 36,000 people with cancer die in hospital each year when they would have preferred to have died at home, so this is a hugely important issue.”

Readers' comments (5)

  • This is a massively important and necessary initiative and one that I welcome with open arms. The needs of the person facing their imminent death need identifying well before their last few weeks/days of life and the push for an increase in 'Advance care Planning' is the first step in identifying the patients 'Preferred Priorities for Care'. Not wishing to put a downer on this at all, we have to address practical issues at the same time, for instance, does the geographical area in which the patient lives has the resources both human and equipment wise to provide this twenty-four hour care provision. I live and work in a very rural area, whereby it depends upon the location you live in, what day of the week it is and whether it is a school holiday as to whether you can get access to the nursing resources that may be required to support such patients at home. This can be distressing to all concerned when one cannot support the patient and family wishes to deliver care at home due to a lack of human resouce availabilty. We must provide in this country a twenty-four hour district nursing service which offers reliability, rather than going out to agencies that are at times not reliable and are more costly.
    I don't mean to burst anyone's bubble here, we have been attampting to achieve this for years, but until the infrastructure is right, we are dreaming of that perfect situation which may or may not happen at the expense of the patients wishes.

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  • One of the complexities about this situation is around the timing of questions: asking people when they are well where they would like to be cared for when they die may well result in the answer of 'home'; but when the reality of the experience is upon them and the carers, then home may feel unsafe and frightening.
    The consequences for carers is also not well considered - how many carers are assessed before this role is given to them?

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  • Wonderful idea, but cost? we need all Drs and Nurses to be trained in paliative care or have the Gov. to invest in more hospices. They give excellent care and no one needs suffer in their last days. Write to MPs for this please.

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  • Whilst I agree with the sentiment behind this initiative, I agree with the previous comments, where is the money to come from to pay for it? Since when did dying in a place of safety, with nurses available 24/7, with access to medicines and palliative care specialists 7 days a week become such a bad thing? Death in hospital should not be seen as an automatic failure. The community support just isnt there!! Dying patients with continuing health care funding can get a maximum of 4 calls per day and 3 or 4 night sitters, this is by carers not registered nurses who can administer breakthrough medications should the person have pain or be distressed. A district nurse would need to be called, which providing they respond within 4 hours, this is seen as satisfactory. Is that really satisfactory? Of course patients should be given choice, and encouraged to document their wishes and preferences but to make an informed decision about such a thing as where to die, patients and their families would need to know that there is not 24 hour care available at home and it is inaccurate reporting and bold statement, like the ones made in the statement by Mr Howard, that falsely raise expectations.
    Families should not feel guilty if their loved one dies in hospital and staff should not feel like they've failed if we dont get somebody home to die, what is important is good communication and appropriate decision making in terms of stopping interventions that perhaps wouldn't be done if the patient was dying outside the hospital setting. That requires education for Doctors and nurses working in the acute settings to ensure that where possible those patients that could die elsewhere get the chance, and those who are too unwell to move are afforded the same comforts regardless of location.

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  • District nursing is the key but we are drowning in admin and suffering from lack of investment. Local teams of nurses based in GP surgeries provide the best palliative care at home. The move to big teams just increases inefficiency and make what was a can do service into a it's not our job service.

    I used to say that district nursing was the best service in the NHS but we are suffering from "being fixed when we weren't broken". Tragic

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