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Dying at home could save NHS £34m - Marie Curie

  • 9 Comments

Cutting the hospital stay of 30,000 patients in the last stages of life by just four days could save the NHS £34 million, a charity has said.

Figures suggest 63% of all people want to die at home but only one in five (21%) actually do.

Marie Curie Cancer Care estimates that cutting the hospital stays of just 12% of all people who currently die in hospital in England each year could save the NHS millions.

At present, some 53% of all deaths happen in hospital - in 2010 this meant 245,570 people died there.

Imelda Redmond, director of policy and public affairs at the charity, said: “The NHS has to save £20 billion by 2015.

“Savings on the scale required can only be achieved through service redesign that can be rapidly implemented across the NHS.

“Ensuring that more people who are terminally ill are able to be cared for and die at home can release funds.

“Even small reductions in the number of days people at the end of life spend in hospital can lead to substantial savings.”

A Department of Health spokesman said: “We are committed to giving people more choice and control over the care they receive at the end of life and, in particular, to support people to be cared for and die at home.

“We are pushing forward with implementation of the End of Life Care Strategy, which will help deliver

 

  • 9 Comments

Readers' comments (9)

  • Anonymous

    It still needs a serious culture change to line up all of the services from GP through to paramedics, in order to properly implement patient choices. It would presumably save money, and also quite a lot of stress for various people, if it were sorted out properly - but so far, it still has some way to go.

    The problem is that when a person's role changes - doctor to nurse to paramedic - then their experience and perspective also changes, along with their views about what seems most important, and paramedics in particular are inappropriately worried about what Coroners will subsequently make of their behaviour.

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  • It does need a culture change including Marie Currie nurses who think it is acceptable to sleep on duty when some one is dying, and then the management trying to cover it up

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  • End of Life Care Strategy

    I hope this doesn't mean that everybody who is seriously ill and especially the elderly are shoved onto an 'End of Life Care Strategy'. What sort of treatment is this?

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  • Dying at home could save NHS £34m....
    Well that's a comforting thought now, isn't it?
    Money should never be 'saved' from such a priceless service. Any, so called, 'savings' must be immediately redirected towards offering more to the needs of the patients. This government, aren't they a bunch of commedians?

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  • Anonymous | 11-Mar-2012 0:29 am

    well said. the government seem totally obsessed about saving instead of spending where it is needed! It hardly inspires faith and confidence in the health services and unfortunately nurses and doctors take the brunt!

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  • wonderful as the patients will then have to pay for the care they need themselves if they can afford it.

    MC nurses are for cancer care. who looks after the rest of the patients as not all who are terminally ill suffer from cancer as the article seems to assume.

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  • michael stone

    A Bit Dim is correct, and this ‘role and perception’ issue gets even worse if police and coroner’s officers become involved, when they shouldn’t be there.

    I was talking on the phone to the East Midlands lead for End-of-Life for almost 2 hours only last week, and she sees almost exactly the same problems as I do (the phone call was an insertion into an e-mail discussion, to sort of see where we did share common ground instead of discussing the technical points in detail). In fact, most of the people who are involved at the higher levels in EoL are aware of the problems with existing understanding and beliefs/behaviours – but I don’t agree with ‘the NHS’ about the best way to resolve the issues.

    The problems include that a surprisingly large number of very senior clinicians do not properly understand the law, and are distorting the law in their interpretation of it within the guidance they write, and that the guidance gets even worse as one moves from very high-level (the GMC seems to understand the law, but isn’t entirely helpful with regard to being clear in its writings: the GMC is now very precise in its wordings, but not adequately instructive) to local-level authoring. There are serious problems hinging on what a decision is, and who can make what decisions – nurses, who seem to thinkt hat doctors have to authorise decisions, even though doctors know full-well that patients can make refusal of treatment decisions, seem to be placed very awkwardly. The police, who are usually deliberately excluded from ‘expected’ deaths, are a menace if they become involved when they should not be present, because they attempt to apply their experience of the deaths they do attend (sudden) to a type of death they can’t properly understand.

    Everyone agrees that more discussion of what the NHS calls ‘the dying phase’ is needed – and everyone agrees that almost everyone is very reluctant to talk about ‘the dying bit’: the question is how best to promote those currently missing discussions.

    Interestingly, in an e-mail the day before the phone call, the EM EoL lead had written ‘..but I am just a nurse, I’m not an expert on the Mental Capacity Act’ (I chastised her for ‘just a nurse’, pointing out that I lack both the patience and empathy necessary to be a decent nurse) but the second bit is probably relevant. Lots of EoL leads and facilitators seem to be nurses, and I think they seem to lack the confidence to tell other people that guidance is wrong, because it does not actually make sense, if you have read the MCA. Or, it could be also that many nurses, and many women, are too polite to just tell people that the stuff they are writing is ‘nonsense’ – especially if the writings come from consultants, BMA, GMC, etc.

    The main issue I have ‘about the way forward’ for EoL patients in the community, is whether the current approach of MDTs and stronger record keeping makes sense, or whether my position of ‘get the patient, the GP, the relatives and the DNs to openly talk to each other, then tell everybody who cannot regularly talk to the patient, to believe whatever anyone from that group tells them’ makes more sense. Basically, I want the distinction to be primarily based on who has been able to regularly talk to the patient, and who has not been able to do that: not, as is currently the way the guidance works, between clinicians and amateurs.

    So I send out little ‘teasers’, such as this one.

    An EoL patient who is at home, and might perhaps be clinically recoverable from a future CPA, says this to his GP:

    ‘Paramedics rush to arrests, because after a few minutes my brain starts to die irreversibly, right ? Well, at the moment my position is that I am wiling to risk a resuscitation attempt, provided that someone phones 999 as soon as my heart stops beating – I do not want to risk ‘delayed’ CPR’.

    How does the GP, deal with that one, using the type of CPR/VoD guidance which currently exists ? That is definitely an issue, and a valid concern on the part of the patient, because traditionally paramedics have tended to attempt CPR on anyone who isn't either stone cold or decapitated !


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  • DH Agent - as if ! | 11-Mar-2012 12:48 pm

    Why don't you read the article Michael Stone and stick to commenting briefly on that!

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  • Albert's Mum

    Anonymous | 11-Mar-2012 1:32 pm

    Surely Mike Stone did comment on the article, and on why people currently die in hospital when they wish to die at home - I can't see why you believe his comments were about something else ?

    And why do comments need to be brief - Tinkerbell has posted reams of stuff recently !

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