Palliative care review urges free end-of-life social care

By The Press Association15th March 2015News EnglandEnd Of Life Care, News England, Older People, Palliative Care

Free social care should be provided at the end of life so that no one dies in hospital for want of a package of support, a review into palliative care by MPs has said.

The report by the Health Select Committee looks at the state of palliative care since the independent review of the controversial Liverpool Care Pathway (LCP).

The LCP, which recommended that in some circumstances doctors withdraw treatment, food and water from sedated patients in their final hours or days, was scrapped in 2013 after the review panel discovered appalling cases of care with some patients left on it for weeks.

Today’s report found there are still unacceptable levels of variation in care that people receive and makes a number of recommendations for improvement, in particular that free social care be provided at the end of life.

It said most people who express a preference say they would like to die at home, but this is made difficult by the shortfall in community nurses and specialist outreach palliative care.

MPs concluded that round-the-clock access to specialist palliative care in acute and community settings would greatly improve the way that people who are seriously ill – and their families and carers – are treated.

They also said sustainable, long-term funding for the hospice sector needs to be addressed along with recognition of the importance of the voluntary sector, while bereavement support for families should be included as part of end of life care.

Conversations need to be started with patients about their wishes as the situation is unlikely to improve unless clinicians feel confident to address people they believe to be near the end of life, they said.

They also suggest giving a senior named person in each NHS trust responsibility for monitoring how end of life care is being delivered within their organisation.

Committee chairwoman Dr Sarah Wollaston MP said: “The care that people receive at the end of their lives has a profound impact not only upon them but also upon their families and carers.

“At the most difficult of times, their experience will be made worse if they encounter poor communication and planning or inadequate professional expertise.

“There are unacceptable levels of variation in the care that people receive and this needs to be addressed so that high quality end of life care is available to everyone regardless of their age, medical condition or where they live.

“We must make sure that specialist palliative care expertise is accessible within hospitals and community settings as well as within our hospices.”

Sarah Wootton, chief executive of the charity Compassion in Dying, said she welcomed the report.

“We know from calls to our free information line, and our community outreach work, that there is a real need for greater information and support for people approaching the end of life to enable them to think through their choices and plan ahead,” she said.

“Patient choice in end-of-life care must be a priority for the next Government and the recommendations in this report should be put in to action without delay.”

A spokesman for the British Heart Foundation (BHF) said it was important the report had noted that introducing palliative care is fairly straightforward for people with cancer where a terminal phase is more easily defined, but is more difficult for patients with other life-threatening illnesses.

People with heart failure can show signs of being at the end of life for over a year, whilst others can die suddenly without warning.

BHF director of policy Mike Hobday said: “Heart failure patients have been getting a raw deal at the end of life and these recommendations are well overdue.

“For too long heart patients have been denied the option to die in the comfort of their own home or choose their end of life care and support because the health system does not encourage conversation with heart patients about the end of life.

“Health services must now act to ensure that patients with heart conditions get the same access to specialist care as other terminally ill patients.”

Steve Ford, chief executive at Parkinson’s UK, said: “Although we welcome the report, particularly the recommendation of free end of life social care, the system as it stands is culturally in the dark ages in its capacity to assess anyone who doesn’t have cancer as being at the end of their life.

“Huge numbers of people with Parkinson’s lie unidentified as being at the end of their lives, so wouldn’t have access to this support. These recommendations are not going to have an impact unless there is a seismic cultural shift among clinicians, which has to be led by NHS England, to initiate conversations about this difficult and sensitive issue.”