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Staff shortages and rising caseloads prevent effective pain management at home for dying

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Only around half of healthcare professionals who support dying people at home say staffing levels are sufficient to meet their pain management needs, according to new research.

A further 35% – around a third – said staffing levels were not sufficient, according to survey results, published today by two leading end of life care charities.

“We hope this research will serve as a wake-up call for commissioners and providers”

Tracey Bleakley

In addition, many healthcare professionals supporting dying people reported being over-stretched, with 20% of respondents describing their caseload as “not manageable”.

Hospice UK and the National Council for Palliative Care surveyed 370 healthcare professionals who care for dying people at home in England, including community nurse specialists, hospice service leads and GPs.

The survey also found 29% of respondents described the availability of end of life care training in their area as either “requiring improvement” or “inadequate”.

Meanwhile, 25% said they had no access 24/7 telephone end of life care advice for people at the end of life, their families and carers.

“It’s essential to make sure people dying at home have round the clock access to effective pain relief”

Claire Henry

The charities highlighted that many people wanted the choice to be able to stay at home at the end of their lives, which is supported by government and NHS England policy.

However, they noted that pain management for those approaching the end of life at home lagged far behind that of other care settings, including hospice inpatient units, care homes and hospitals.

A joint report – titled No painful compromise and published today by the charities – includes new guidance for service providers and clinical commissioning groups that is designed to help improve pain management for dying people at home.

It reinforces existing policy guidelines on end of life care such as the National Institute for Health and Care Excellence quality standard and the Ambitions for Palliative and End of Life Care framework.

Hospice UK

Quarter of CCGs lack end of life care funding strategy

Tracey Bleakley

Tracey Bleakley, chief executive of Hospice UK, said: “Inadequate pain management for dying people being cared for at home due to issues such as staff shortages is unacceptable.

“People approaching the end of life should not be forced to make a trade-off between staying at home, where they would prefer to be, or going into hospital for effective pain relief,” she said.

“We hope this research will serve as a wake-up call for commissioners and providers to take concerted action to tackle the underlying issues depriving dying people of effective pain management at home,” she stated.

Claire Henry, chief executive of the National Council for Palliative Care, added: “We know both that people’s top priority for their end of life care is being pain free, and that most people would choose be at home when they die.

“So it’s essential to make sure people dying at home have round the clock access to effective pain relief,” she said.

National Council for Palliative

Claire Henry

Claire Henry

“We need new approaches to achieve this, including giving training and support to carers so they can give injections if that’s wanted. Everyone has a right to good end of life care,” she added.

The survey follows recent research by Dying Matters, which found 39% of people would be willing to give an injection after receiving some training, in order to relieve pain or ease symptoms in someone who was dying – rising to 61% if a doctor or nurse was on hand to supervise the first few times.


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