Sunday, 15 March 2015

Call for free social care for those at the 'end of life'.

Each year around 500,000 people die in England and Wales. In 2013, approximately 80% of those who died were people aged over 65. One third of all deaths are people aged 85 and over, but only 15% of those who receive specialist palliative care are in this age group.

In a report published today, the Health Select Committee of the House of Commons recommends that social care should be free in end of life situations.

The report looks at the state of end of life care since the independent Review of the Liverpool Care Pathway, chaired by Baroness Neuberger,  and finds great variation in quality and practice across both acute and community settings.  They call for round-the-clock access to specialist palliative care in acute community settings saying this "would greatly improve the way that people with life-limiting conditions and their families and carers are treated, especially if there were opportunities to share their expertise with other clinicians."

This is a key ingredient of proving effective, person centred care with dignity and understanding. Those cared for come with individual histories and wishes.  The care must be centred on the person and the expertise of all the involved  should be more equitably available to people with a non-cancer diagnosis, older people and those with dementia, for whom early identification and sensitive discussion and documentation of their wishes is also important.

The question of when and how it is determined that a person is in an 'end of life' situation  and how best this can be discussed is difficulty. The reports calls for all staff providing palliative and end of life care to people with life limiting conditions to receive training in advance care planning, including the different models and forms that are available and their legal status.

They make the point that most people who express a preference, would like to die at home but that is also made more difficult by the shortfall in community nurses and specialist outreach palliative care.

The large majority of deaths follow a period of chronic illness such as heart disease, cancer, stroke, chronic respiratory disease, neurological disease or dementia. Most deaths (53%) occur in NHS hospitals, with around 21% occurring at home, 18% in care homes, 5% in hospices and 3% elsewhere.  This is despite the fact that 63% of people say that they would prefer to die at home, while 29% would prefer to die in a hospice.

Hospital was found to be the least preferred place of death in a study carried out by the Cicely Saunders Institute. Other sources put the figure for home as the preferred place of death even higher: ComRes polling for the Dying Matters Coalition in April 2014 showed that 72% of people would want to die at home. Macmillan Cancer Support cite evidence that shows that 85% of people who die in hospital would have preferred to die in another setting.  People do change their minds however and the stated preferred place of death may change as death approaches.

Social care should be more flexible and coordinated to meet patients wishes as best as possible.

The key recommendation is that free social care at the end of life should be provided to ensure that no one dies in hospital for want of a social care support in the best environment that meets the wishes of the person whose life is coming to an end.








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