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'We have a new approach to tackle lack of choice in end-of-life care'

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Why are so many people dying in hospitals who have no clinical need, or indeed wish to be there?

Just over 500,000 people die in England and Wales each year, with around half of them dying in hospital. While hospitals are important providers of end of life, paradoxically this is the place of care and death that people least prefer.

Research shows that nearly 80% of the public would choose home or a hospice as their preferred location for care and place of death.

In addition, the standard of care for people dying in hospitals in England often falls short. This was highlighted both by Baroness Neuberger’s report on the use of the Liverpool Care Pathway and more recently by the National Care of the Dying Audit for Hospitals.

Help the Hospices is calling on the government to back a new partnership between hospices and the NHS that would ensure that people approaching the end of their lives have greater choice about where they receive care and where they die. It will focus on people who often fall through gaps in the care system and remain in hospital at the end of life because alternative options have not even been considered.

Hospices offer excellent end-of-life care, as highlighted in the latest VOICES survey. Many are already successfully collaborating with other organisations to deliver alternative models of care in their local communities. They include: assisting with rapid discharge for people who no longer need to be in hospital and wish to die elsewhere; providing alternative inpatient care to hospitals; and offering home-based hospice care. However, there is far greater potential for providing this care on a larger scale nationally.

Our programme seeks to reduce the number of people dying in hospital by 50,000 each year. We believe our programme will lead to higher quality, better targeted care and could generate savings of up to £80m per year for the NHS. It is also a timely intervention given widespread concerns about how our society can meet the care needs of the UK’s rapidly increasing ageing population.

We are offering a partnership between the NHS and hospices to fund six nationally coordinated pilot projects to evaluate the impact of hospice-led interventions as alternatives to hospital care. We plan to begin the pilots in April 2015 and roll out the national programme from April 2017.

Nurses will be at the forefront of helping deliver our programme. For example, hospice nurses can provide advice alongside hospital staff, working as part of hospital discharge teams.

In one hospice-led scheme in Somerset, the discharge nurse identifies terminally ill patients in hospital who are approaching the end of their lives and wish to be cared for in the community. The nurse then works closely with care professionals in the hospital and community and the end-of-life care coordination centre to ensure that patients are discharged without unnecessary delays.

In another scheme, a hospice is piloting four nurse-led end-of-life care beds to help facilitate rapid discharge from an acute hospital in Yorkshire. This has increased patient choice, enabling patients to receive high-quality end-of-life care in a hospice setting.

Our programme offers a bold new approach to tackling the lack of choice in end-of-life care. It will enable more hospice nurses to work with their counterparts in acute care hospitals - to expand a range of approaches to better support dying people and help ensure they receive a continuum of quality care, wherever this is provided.

Marie Cooper is a nurse and practice development lead at Help the Hospices

Help the Hospices has recently undergone a rebrand and is now known as Hospice UK. Its new website will go live in mid-October.

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