Macmillan warns Government end-of-life care heading for ‘meltdown’

End-of-life care in England is heading for a “meltdown”, a leading cancer charity has warned.

Many dying patients are not getting proper pain relief, they are not being involved in key decisions about their care and many are unable to die at home, Macmillan Cancer Support said.

The charity said that growing demand for end-of-life care will put an “intolerable” strain on the NHS and social services.

It has estimated that by 2020 there will be around 144,000 people a year in England dying from cancer – which equates to one person every four minutes.

The figure also represents an additional 15,000 cancer deaths compared with 2010.

The estimate, based on population projections and cancer trends, highlights an “urgent need” to tackle the country’s approach to end-of-life care.

It is calling on the Government to make investments in services such as out-of-hours community care.

“It is shocking to think that one person will die of cancer every four minutes, but worse still that many people dying of cancer may not get the care they need, and that their final wishes will remain unfulfilled,” said Lynda Thomas, chief executive of Macmillan Cancer Support.

“It is unacceptable for a person dying of cancer to have to go to hospital when they don’t want to be there, because care and support wasn’t available at home.

“If the Government really wants to improve end-of-life care for everybody, then investment is vital. If nothing is done and the country’s deeply imperfect arrangements continue, then end-of-life care is heading for a meltdown.

“Without action now, thousands of people with cancer will not have the high-quality, compassionate end-of-life care that everybody should experience.”

Commenting on Macmillan’s estimates, Simon Chapman, director of policy and external affairs at the National Council for Palliative Care, said: “Although the majority of people die from conditions other than cancer, people with cancer are more likely to be able to access palliative and end-of-life care than others. Macmillan’s warning of a looming crisis is therefore a serious concern for us all.”

Figures released last week revealed that some people in their final days of life are not getting enough help to eat or drink and are dying in pain.

More than 20,000 relatives and friends of people who died last year shared their views of end-of-life care for an Office for National Statistics (ONS) survey.

The results showed that one in five people who saw their relative or friend die last year also felt decisions were taken about their care that the person would not have wanted.

Asked if the person had adequate support to relieve thirst, hunger, pain and other problems, around three-quarters of relatives and friends agreed this was the case. But one in eight (13%) disagreed or strongly disagreed that the patient’s need for food or nutrition was met in their last two days of life.

And 12% said there was not adequate support for the patient to receive fluids.

One in 10 people did not think that pain relief was sufficient for their loved one in the last two days of life.

The poll found that hospital doctors and nurses showed less dignity and respect for loved ones than those working in other places, such as care homes and hospices.

Hospital staff received the lowest ratings of always showing dignity and respect (60% for hospital doctors and 54% for hospital nurses) of all staff, although this has improved compared with previous surveys.

A separate article in a leading medical journal found that many doctors do not view kindness as an “essential” part of their work.

Writing in the Journal of the Royal Society of Medicine, Dr David Jeffrey, an honorary lecturer in palliative medicine at the Centre for Population Health Sciences in Edinburgh, said: “Our medical culture does not consistently support the practice of kindness, doctors may view kindness as ‘nice’ but not an essential part of their practice.

“In a management culture which measures success in numbers, league tables and throughput, time spent with the patient addressing their concerns is not valued so is not seen as an essential part of a doctor’s duty.”

Dr Jeffrey advocates that kindness should be restored into medical care by teaching medical students to value kindness, tolerance and an open approach to others. “Kindness is an integral part of what makes us fully human and should be established as one of the doctor’s duties to a patient.”

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