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End of life care must be prioritised to avoid A&E admissions


Healthcare commissioners must prioritise end of life care to ensure people’s choices are met and to avoid unnecessary emergency hospital admissions, according to advice published today.

The guidelines, issued by the National Council for Palliative Care and the National End of Life Care Programme, includes recommendations such as ensuring each GP practice identifies people likely to die in the next 12 months, ensuring professionals know how to initiate conversations about end of life care and carry out advance care planning, appointing a clinical commissioning board member to lead on end of life care, and agreeing local priorities for end of life care services.

The move follows the publication of the report of the independent palliative care funding review, which revealed “stunning inequities” across the country in end of life care.

Seven in ten (70%) people say they would like to die at home but more than half continue to die in hospitals, often after unnecessary and expensive trips to Accident and Emergency departments, the charity said.

Four in 10 (40%) patients had no medical need to be in hospital, according to the National Audit Office.

Eve Richardson, chief executive of the National Council for Palliative Care and the Dying Matters Coalition said: “Too many people towards the end of their lives are being needlessly admitted to hospital against their wishes, causing unnecessary pain and suffering.

“We only get once chance to get end of life care right for people who are dying which is why commissioners must ensure high quality end of life care and support is available for all those who need it, where and when they need it.”

Anita Hayes, deputy director of the National End of Life Care Programme said: “New healthcare commissioners will doubtless face a full in-tray but there are compelling reasons for prioritising end of life care.

“There has been considerable - but inconsistent - progress since 2008. We know there are tools and sources of support out there for commissioners to build on that progress.

“If they tap into that and work with partners they can achieve some quick wins.”

Professor Sir Mike Richards, clinical director for end of life care at the Department of Health added: “This excellent new publication will help commissioners lay the foundations for providing real patient choice when it comes to end of life care.

“That will not only help ensure that patients are at the centre of decisions about the type of care and support they want and need; it will also help save time, money and resources which can then be re-directed into NHS services.”

Mike Hobday, head of policy of Macmillan Cancer Support, said: “We agree wholeheartedly with the report’s advice that new commissioners need to prioritise early action on end of life care. Far too many cancer patients are dying in hospital against their wishes.

“The most important aspect to delivering quality end of life care is by providing access to 24/7 community nursing. It significantly reduces emergency hospital admissions and enables patients to fulfil their end of life care wishes.

“It is vital that all new commissioners make community nursing a reality so that people who wish to die at home with the right level of expert care are able to do so.”



Readers' comments (4)

  • michael stone

    Two things would help here. Firstly, paying attention if an EoLC patient tells someone 'I am not going to hospital - I am staying at home'. And secondly, stop assuming that for patients at home, their live-with relatives are somehow 'passive bystanders' and accept that relatives care for their loved ones, and are actively involved in ensuring that the patient's wishes are turned into reality !
    This is improving - but not quickly enough.

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  • We need to seriously look at the point where treatment should stop. Not to save money but to ensure that the patients aren't subjected to treatments that are going to cause them more suffering and deny them the death that they want. Why put people through needless procedures when they aren't going to get better. It's not euthanasia, just common sense.

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  • Wow some worrying statistics here ! I agree with Michael in that paying attention to the ELoC is paramount in ensuring that patients wishes are respected. I work in a lot of care homes where it is usually very clear and we rarely see residents being admitted to hospital at the end of their life, instead they and their families are supported in the care home. However I have no experience as to what happens in the community , any district nurses out there like to comment ??

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  • Offering patients their choice of where to die is fine, but there has to be the infrastructure to make it possible. In my geographical area the community nurse team has been decimated by redeployment and demoralising managerial restructuring. And when somebody needs basic nursing care there is often an argument between Social Services and health to decide who should provide it, with Continuing Care changing the goalposts to make it almost impossible to get funding for those who deserve it. It makes some satisfactory deaths at home more a matter of luck than judgment unfortunately.

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