We need to refocus end of life care as a health priority
An ageing population, ongoing pressures on public spending, the Francis report and current NHS reforms mean that now is a good time to think about how to refocus care for people who are dying. As the number of people dying and the proportions of those who have multiple morbidities increase, so the need to rethink end of life care becomes more urgent. In rethinking such care, we are now aided by a growing evidence base, which gives us a clear picture of what people want and what they get from end of life care. Death and Dying brings together data previously published elsewhere, much of which is available via the Marie Curie End of Life Care Atlas . The Atlas has been developed to help Clinical Commissioning Groups (CCGs) and others identify gaps and differences of experiences across all end of life care services. It enables commissioners to see how their area compares, to address unmet needs and improve care for all. Death and Dying draws on recently published data from the Atlas, the VOICES Survey of the Bereaved People, the Nuffield Trust's reports on social care at the end of life and the independent evaluation of the Marie Curie Nursing Service . What is new is the analysis that explores what this evidence tells us about current services and needs.
The report reveals a complex picture; however it makes clear that many people who die in hospital have no medical need to be there, do not want to be there and ultimately experience poorer care. We must consider how we can move those who neither want nor need to be in hospital during the last weeks of life into the places where they wish to die. We are not calling for a mass clearance of hospital wards, but rather for a well-planned, system-wide programme to shift resources and support available in care homes, hospices and people's own homes. This approach requires all who work in health and social care to play their part. For those working with dying people at home, we must work together to improve pain management. Care homes must learn from each other to ensure that more people are able to die in their care homes and are not simply shunted off to A&E at the first sign of decline. More generally, all services must work together to ensure rapid access to community and home based services when they are needed most. We must also increase the number of people with Advance Care Plans , so that we can tailor services and responses to what individuals want. Care works best when we all work together to avoid unnecessary admissions to hospital, ensure rapid discharge for those who do not need to be there and ensure that individuals have the right community-based support. For commissioners, the challenge is clear – they must shift resources from acute hospitals to community-based care, including hospices, care homes and people's own homes. What we have learned over the past twelve months provides us with the evidence base required for such a shift. The first step will be to ensure that community based end of life care is a top-level local priority. The second, that local commissioning encourages co-operation and co-ordination, so that people get the services they want and need. The ongoing pressures set out above underscore why we need such a major shift now. Rebalancing of care for dying people will not only help ensure the long-term sustainability of the health and social care system, but also give people more of what they want. This can only be good news for both individuals and the system. This post first appeared on the Guardian Healthcare Professionals Network on Thursday 27 March.