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National payment structure could release millions for end-of-life care

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A new funding system for end-of-life care would save millions of pounds and focus on individual patient needs, according to a government-ordered review.

A national payment structure would cut variation around the country in what the state pays for and what it does not, and support far more people to be cared for in their own homes.

At the moment, the amount PCTs in England spend on end-of-life care varies widely, from £186 per patient in one area to £6,213 in another.

Access to services, including round-the-clock nursing care, also depends on where people live.

Far more people die in hospital than wish to, and experts estimate that more than 90,000 people are not having their palliative care needs met.

The Palliative Care Funding Review, ordered by health secretary Andrew Lansley last summer, proposes a “fair and transparent” funding system where the money is linked to the individual patient.

Under the scheme, people would receive an initial assessment of their needs, which would then be combined with other factors such as their age and capabilities.

This “needs classification system” would have 25 separate classes (13 for adults and 12 for children), each with its own pot of funding.

The funding would take account of things such as personal care needs, including help with washing and eating, the provision of 24/7 nursing care to support people at home and a co-ordinator to help patients work out their state entitlements as well as access to local charitable services.

Thomas Hughes-Hallett, chair of the review and chief executive of Marie Curie Cancer Care, said: “No other country in the world has introduced such a system for both adults and children, so the step is both a bold and necessary one.”

Professor Sir Alan Craft, adviser to the review, said: “The government must act on the recommendations contained in the review because evidence shows us that incentivising the provision of palliative care leads to better outcomes for patients, supports choice and is the most cost effective way of using NHS resources.

“We need to remove the barriers within the current system to enable this to happen.”

Responding to the review findings, Macmillan Cancer Support chief executive Ciarán Devane said: “We welcome the findings of the funding review especially the emphasis placed on choice and coordination of care. Currently these two elements of end-of-life care are woefully inadequate.  

He added: “24 hour community nursing services are crucial to the delivery of choice and to the realisation of these ambitious recommendations. It is now up to the government to incentivise commissioners to provide these services as standard across the country. We need to see a massive improvement on the 56% of PCTs who currently provide 24 hour community nursing to end-of-life patients.”

Sue Ryder chief executive Paul Woodward said the review had came “at a critical time for hospices” due to pressure on statutory and voluntary funding. 

He said: “We support the recommendations made by the review, particularly to create a tariff system based on a person’s needs rather than their condition or postcode. The voluntary sector now needs to work together to show the government how a uniform system of funding can work.”

David Praill, chief executive of Help the Hospices, described the review is an “important first step in creating a fair and sustainable funding system for palliative care”.

He said: “At the heart of the review is the integration of health and social care. Dying is not just a health issue, so in order to give everyone the choice over where and how they are cared for we need to make sure all their needs can be met. To do this we have to have a system in place which is simple, un-bureaucratic and can join together the social, emotional and psychological elements that are so central to hospice and palliative care.

“However, with NHS funding already under pressure, it is vital that independent charitable hospices and other providers of palliative care are protected during the long transition to a new system. We can not risk destabilising the current provision of funding, which would have serious implications for people facing the end of life and their friends and family.”

Barbara Gelb, chief executive of Children’s Hospices UK, added: “While the devil will be in the detail, it is good that the new ‘per-patient’ funding system will be based on need and will apply equally to all providers. We urge the government to implement the review’s recommendations in close consultation with families, providers and other stakeholders.”

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Readers' comments (1)

  • michael stone

    Responding to the review findings, Macmillan Cancer Support chief executive Ciarán Devane said: “We welcome the findings of the funding review especially the emphasis placed on choice and coordination of care. Currently these two elements of end of life care are woefully inadequate.

    Yes, the fact that patients make their own choices seems to get lost somewhere in the tick-box lists, and coordination of things, or even different people actually talking to each other, are things which tend to not happen.

    But that looks rather too prescriptive, although I have not seen its exact details.

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