'Stunning inequities' in end-of-life care, report says

Hands of elderly woman Too many people end their days in hospital against their wishes, the report suggests

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An independent review is calling for a set of universal standards for care of the dying after uncovering "stunning inequities" in provision in England.

The inquiry, requested last year by the government, says the current system is confusing and inconsistent.

Its report proposes a set of guarantees on what the state will provide, and a new payment system to help more people die at home rather than in hospital.

It estimates that thousands of people miss out on palliative care each year.

Health charities have welcomed the findings.

The review, led by the the chief executive of Marie Curie Cancer Care, Thomas Hughes-Hallett, describes huge variations in the quality of end-of-life services.

It praises the "many highly committed professionals" who are doing their best, but concludes that thousands of people who need help do not benefit from their expertise.

Unmet needs

The report estimates that of just over 470,000 people who die in England each year, some 355,000 require palliative care - to prevent and relieve suffering and help them to live as well as possible.

However, only 171,000 receive specialist palliative care.

It says some at the end of life may get the help they need from other health workers, but it estimates that more than 90,000 people do not even discuss their end-of-life care.

It warns that this figure is growing and that too many end their days in hospital against their wishes.

Citing figures from the Department of Health, it reports that in the last financial year one primary care trust spent approximately £186 per death while another spent £6,213.

And it says the system faces increasing pressures from people living longer, with more complex needs as they approach the end of life.

The report proposes a statement from the government setting out the support and services patients, carers and families can expect to receive from the NHS.

It also calls for a new system of tariffs to incentivise high-quality care.

This should reflect the complexity of patients' needs and the type of care required.

It would also be designed to encourage community-based services, enabling more people to end their lives at home if they wish to.

Mr Hughes-Hallett says there is an urgent need for change.

"You get better clinical and economic outcomes when patients receive palliative care. But there is no tariff for this in hospitals or the community so it is no surprise that good outcomes are not achieved. We are left with stunning inequities."

The tariff would cover all patients' clinically assessed needs, regardless of setting, just as with other types of NHS care.

Each patient would have an appointed co-ordinator to help guide them through the different services. They would also have their social-care needs covered at the end of life.

The report says a similar system has been tried and tested in Australia and is working well.

'One chance'

It estimates that providing more community-based services could reduce the number of hospital deaths by 60,000 a year by 2011. The authors calculate that the annual saving to hospitals would be £180 million.

Simon Chapman, from the National Council for Palliative Care, says it is vital that the government acts on the review's recommendations.

"Although the majority of us would prefer to be cared for and die at home, in a care home or in a hospice, more than half of us die in hospital.

"We only get one chance to get it right for dying people, which is why it must be a priority to ensure everyone who needs it can access palliative care round the clock."

Ciarán Devane, chief executive at Macmillan Cancer Support, said: "Twenty-four hour community nursing services are crucial to the delivery of choice and to the realisation of these ambitious recommendations.

"It will be up to the government to ensure that these services are standard across the country. We need to see a massive improvement on the 56% of PCTs who currently provide 24-hour community nursing."

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