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Emergency admissions at end of life to ‘sky rocket’, warns charity

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The NHS is already struggling to cope with accident and emergency admissions involving patients who are in the last year of their lives and is heading for a “crisis”, a charity has warned.

The terminal illness charity Marie Curie said the situation would hit crisis point if care provided in the community was not significantly improved.

“We need to address the provision of care now in order to avoid further crisis”

Simon Jones

Data collected by Marie Curie has revealed there were over 1.6 million emergency admissions for people in the last year of their life in Britain in 2016, amounting to around 11 million days in hospital.

The charity highlighted that emergency admissions to hospital for patients in the last year of life could often be avoided if adequate care in the community was provided.

It also warned that the significant rise in the number of deaths over the next 20 years meant the cost of emergency admissions for people in the last year of life could almost double.

In its briefing document published today, it estimated that this would cost the NHS an extra £2bn and up to 8,000 extra hospital beds could be needed by 2038 – the equivalent of an extra ward in every hospital with a major A&E unit.

“Social and community care plays a vital role in helping people avoid the need to go to A&E”

Adrian Boyle

Marie Curie collected data from NHS Wales, NHS Scotland and NHS Digital on the number and duration of emergency admissions for people in the last year of life between 2011 and 2016.

It said its analysis of the data painted a “particularly bleak picture” in England, when compared to Scotland and Wales. The average number of emergency admissions in the last year of life in England was nearly twice as many as in Scotland and Wales.

Simon Jones, the charity’s director of policy and public affairs, said: “As the number of people dying each year is set to increase significantly, we need to address the provision of care now in order to avoid further crisis.

“Urgent attention should be given to ensuring there is proper care available in the community to avoid unnecessary pressures on A&E services,” he said.

“While some emergency hospital admissions for people living with a terminal illness are appropriate and necessary, many are not and can often be avoided entirely if appropriate care in the community is provided,” he noted.

“The adult social care system is under significant pressure”

Izzi Seccombe

He added: “Being rushed repeatedly to hospital is stressful and upsetting, particularly when someone may have little time left. A&E should be a last resort, not the first port of call for care.”

The charity cited research by the Nuffield Trust think-tank showing that hospital costs were by far the largest cost involved in end of life care.

In addition, a report from the National Audit Office recently warned that said emergency admissions posed a “serious challenge to both the service and financial position of the NHS”.

Dr Adrian Boyle, chair of the quality emergency care committee at the Royal College of Emergency Medicine, said: “This analysis shows the urgent need for investment in more hospital beds and social care.

He said: “Social and community care plays a vital role in helping people avoid the need to go to A&E in the first place, then getting them back home where they want to be when ready to leave hospital.”

Saffron Cordery

Saffron Cordery

Saffron Cordery

Saffron Cordery, deputy chief executive at NHS Providers, said: “This report makes clear that we need to boost NHS community services so there are enough beds and staff to ensure good end of life care.

“It is urgent that we confront the realities of an aging population and its impact on our health and care services. People are living longer, but with more complex care needs and often multiple long-term conditions. This is driving emergency admissions up unsustainably,” she said.

She said NHS Providers would shortly publish its annual State of the provider sector report, which would include a “clear focus on the challenges facing community services”.

Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, said: “End-of-life care is becoming more significant for health and social care services.

Izzi Seccombe

Izzi Seccombe

Izzi Seccombe

“Councils are working closely with the NHS to avoid unnecessary admissions to hospital through better self-management of conditions, better community support and better advice and information,” she said.

“However, due to historic underfunding, the adult social care system is under significant pressure and community-based services are being reduced, which is impacting on inpatient services,” she said.

She added: “Social care needs to be put on an equal footing with the NHS and government needs to address immediate pressures as part of funding gap facing social care, which is set to exceed £2bn by 2020.”

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