Pumping Marvellous opinion on Palliative Care

Palliative care in England is not delivered consistently or fairly, according to an independent review. The inquiry into care for end of life patients was commissioned by the government last year, and has pointed to “stunning inequities” in the present system. Figures from the Department of Health show that one primary care trust spent £186 per death whilst another spent £6,213 which indicates the real difference in attitude to end of life care.

The report proposes that a set of guidelines should be put in place to ensure a basic standard is guaranteed by the state and a new payment system is developed to help people die at home rather than in hospital. Simon Chapman, from the National Council for Palliative Care, expressed his support for the review’s recommendations and urged the government to act. He said:”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.”

Around 470,000 people die in England each year and the report estimates that of these 355,000 need palliative care, but only 171,000 receive it.

Ciarán Devane, chief executive of Macmillan Cancer Support, welcomed the review and said: “We need to see a massive improvement on the 56% of PCTs who currently provide 24-hour community nursing to all end of life patients. “It is now up to the government to ensure that these services are standard across the country,” he added.

The report says that the system is under increasing pressure from people living longer and having more complex needs in the later stages of their lives. It suggests that a new set of tariffs should be put in place to incentivise high quality end of life care. A tariff system would be similar to a successful system which operates in Australia and would cover all clinically assessed needs of the patient. Each patient would also be provided with a coordinator who would help them use the different services which are available.

Dr Mike Knapton, associate medical director at the British Heart Foundation, has argued for a more equal system of palliative care which doesn’t disadvantage patients with heart failure. He said: “There are 750,000 people living with heart failure in the UK and they often have a poorer quality of life, more limited access to palliative care services and a worse life expectancy than many cancer patients. “This review is an important first step to readdressing the balance so heart patients get the care they deserve based on need, not diagnosis.”

The Dilnot Commission is due to report on Monday and is expected to call for individuals and the government to pay more to help rebuild the UK’s care system.

If there was a consistent approach to palliative care through the NHS mechanisms eg palliative specialist nurses run within the specialist heart failure nursing teams directed through the clinical leads then money wouldn’t be spent assessing the need as the facility would be there. The number of heart failure patients that need palliative care compared to the total of number of patients in the group are significant therefore it doesn’t require too much analysis. Or does this just keep more people in jobs managing the treacle of NHS decision making.

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