New report highlights variation of specialist palliative care in London

The first report on specialist palliative care services across London has found that despite some excellent provision, there are significant variations in care provision across the capital[i].

Specialist palliative care (SPC) can be accessed by anybody with an advanced progressive life-limiting illness, regardless of whether they have terminal cancer or any other terminal illness.  Every year 46,000 people die in London (10 per cent of total UK deaths)[ii] so it is vital that everybody has access to SPC services in their area, at the time they need them.

The aim of specialist palliative care is to provide physical, psychological, social and spiritual support to people with an advanced progressive life-limiting illness and their families, and is provided by a multi-professional team who have undergone recognised specialist palliative care training.

This report reveals that despite pockets of excellent provision, significant improvements are needed to ensure that people with advanced progressive life-limiting illnesses have access to SPC services at weekends.

The findings show that over two-thirds of hospital services and over a third of community services are not meeting the recommended NICE guidance and accepted best practice for the provision of 24/7 access to specialist palliative care telephone advice and 9am – 5pm, seven days a week access to face-to-face visiting[iii].

Dr Jane Collins, Chief Executive at Marie Curie said: “Out of hours SPC service provision is vital for people living with a terminal illness and their families.  We know that poor provision of services can add stress and confusion for patients and families. We also know that good provision can prevent unnecessary hospital and A&E admissions, as well as helping to reduce the strain on already stretched NHS hospitals.  This report shows more must be done to address the variation in service provision across London, to ensure that people get the services they need and deserve, no matter where they live.” 

The report also highlights variation in service provision within individual clinical commissioning group (CCG) areas, with some patients experiencing different levels of access to care depending on where they live in the borough. 

Another key finding reveals that whilst access to SPC services for people with conditions other than cancer has improved over time, they were less likely to get access to this specialist type of care compared with those with cancer.

Dr Sarah Cox, Consultant in Palliative Medicine and Chair of the London Cancer Alliance Palliative Care Group, said: “Specialist Palliative Care services in London provide some of the country’s best care for people with life limiting conditions. In south and west London the in-hours provision now fully meets NICE guidance and there has been some improvement in SPC availability out of hours.  We welcome the report’s findings although we acknowledge that the report is unable to comment on the quality of services owing to the lack of nationally agreed outcome measures. These are in development from Public Health England. We hope that this data and the national work will support planning and commissioning decisions to ensure every patient has access to high quality specialist palliative care where and when needed.”

The report - A review of Specialist Palliative Care provision and access across London – Mapping the capital – was jointly produced by the London Cancer Alliance, PallE8 and Marie Curie in collaboration with specialist palliative care providers across London – and is the first time data on specialist services has been recorded in this way.

The report provides data for commissioners and SPC providers to support planning and commissioning decisions to help improve care and reduce inequity in access to, and the provision of, services for people with advanced progressive life-limiting illnesses, and their families, across London.

The London Cancer Alliance, PallE8 and Marie Curie want to ensure that everyone, regardless of their condition, where they live or the services they use, get the best possible specialist palliative care whenever they need it.

Dr Adrian Tookman, Consultant Physician in Palliative Medicine and Co-Chair of PallE8 says: “The desire to provide the very best end of life care is a priority for the membership of PallE8. This report has exposed the areas in London where there is the best and the poorest access to care. We now have solid data that we will use to advise, support and influence commissioning decisions. We are committed to ensure that our population can receive end of life care that matches the best in the UK.”

Based on the findings of this report, the London Cancer Alliance, PallE8 and Marie Curie are calling on commissioners to review their specialist palliative care service provision within their CCGs and to address any short fallings highlighted.

ENDS