Skip to main content

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.








Comments

Popular posts from this blog

Ian Duncan-Smith says he wants to make those on benefits 'better people'!

By any account, the government's austerity strategy is utilitarian. It justifies its approach by the presumed potential ends. It's objective is to cut the deficit, but it has also adopted another objective which is specifically targeted. It seeks to drive people off benefits and 'back to work'.  The two together are toxic to the poorest in society. Those least able to cope are the most affected by the cuts in benefits and the loss of services. It is the coupling of these two strategic aims that make their policies ethically questionable. For, by combining the two, slashing the value of benefits to make budget savings while also changing the benefits system, the highest burden falls on a specific group, those dependent on benefits. For the greater good of the majority, a minority group, those on benefits, are being sacrificed; sacrificed on the altar of austerity. And they are being sacrificed in part so that others may be spared. Utilitarian ethics considers the ba

Prioritising people in nursing care.

There has been in recent years concern that care in the NHS has not been sufficiently 'patient centred', or responsive to the needs of the patient on a case basis. It has been felt in care that it as been the patient who has had to adapt to the regime of care, rather than the other way around. Putting patients at the centre of care means being responsive to their needs and supporting them through the process of health care delivery.  Patients should not become identikit sausages in a production line. The nurses body, the Nursing and Midwifery Council has responded to this challenge with a revised code of practice reflection get changes in health and social care since the previous code was published in 2008. The Code describes the professional standards of practice and behaviour for nurses and midwives. Four themes describe what nurses and midwives are expected to do: prioritise people practise effectively preserve safety, and promote professionalism and trust. The

When Finance Drives Destruction

Tackling climate change means stopping the funding of rainforest destruction, says a significant study commissioned by the World Wildlife Fund.  The UK's financial services have provided directly over £8.7 billion to 167 different traders, processors, and buyers of forest-risk commodities (cocoa, rubber, timber, soy, beef, palm oil, pulp & paper) from 2013 to 2021.   With direct and indirect investment,  the figure rises to a staggering £200 bn.  Whilst not all that investment is in destructive projects,  the study concludes there is little transparency on the risk.  Finance is the oil in the economic machine.  But it also drives decisions. We all know the importance of money. We borrow to invest. So much depends on it, such as company pensions.  Do we really know what our pension pots are doing? We invest for the future. But what kind of future? Is all investment good?  Much investment is bad. Investment drives the nature of our economy. It drives our decisions as individuals,