Review says NHS must ensure good palliative care

Smiling nurse talking to elderly patient Many people do not end their lives in the place they would wish to

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The NHS in England has failed to take responsibility for ensuring good end-of-life care, according to an independent review.

The analysis, by the head of Marie Curie Cancer Care, says this has led to a "postcode lottery" in funding and service quality.

Tom Hughes Hallett's report calls for the NHS to provide key services such as round-the-clock community care.

Health Secretary Andrew Lansley said people needed "compassionate" care.

A "good death"

The theme of the report is how to ensure a good death on the NHS. The paper highlights some organisations that are doing "excellent" work.

But it says funding and services have developed ad hoc.

It cites a Department of Health survey in 2008 which revealed that palliative care expenditure across primary care trusts ranged from £154 to £1,684 per death.

The report says this variation has had damaging consequences.

"The 'postcode lottery' within palliative care means that patients with the same diagnosis in different geographical locations can expect very different levels of service", it states.

The review says although most people say they would like to be cared for and die in their own home or care home, the proportion who achieve this is "very small".

New NHS duty

It warns that more people will need care and support at the end of their lives in future, with the annual number of deaths expected to rise by 17% from 2012 to 2030.

The report calls for the NHS to take on a new statutory duty that would enable people to be cared for and to die in the place of their choosing.

Under this plan the state would assume a responsibility to fund "core services". These will be defined in the final report next summer. They may include round-the-clock community care, bereavement support for families and carers, and palliative care in hospices and care homes.

This would be a radical change. Adult hospices currently receive about a third of their income from government funds. The figure for children's hospices is lower still.

The report added: "It is essential that there is access to palliative care services to support people in the community at all times.

"This will prevent unnecessary emergency admissions to hospitals and deliver improved outcomes for people."

In a statement the health secretary for England, Andrew Lansley, said: "We need to ensure that the care people receive at the end of life is compassionate, appropriate and gives people choices in where they die and how they are cared for.

"I am pleased to see that the review is making good progress and I look forward to receiving the final report next summer."

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