MPs criticise NHS in England for forcing patients to spend their last days in uncaring hospital surroundings
Newly allocated funds aimed at improving end-of-life care are at risk of being spent on other medical priorities, the Public Accounts Committee (PAC) suggests.
Half a million people die in England every year; almost two-thirds of them are over 75. The vast majority of deaths follow a period of chronic illness such as cancer or heart disease.
About 60% of those deaths occur in an acute hospital despite the fact that “there is no clinical need” for the person to be there, the study says.
“Most people express a preference to die at home [surrounded by friends and family]. People should have the right to die in the place of their choice.
“[Health authorities should increase] the availability of community services, such as 24-hour district nursing, and access to advice and medication out of hours to help reduce the number of unnecessary hospital admissions.”
Those who die in hospital are often deprived of effective pain management and not accorded adequate “dignity and respect” in their last days and moments by NHS staff, the report states.
“Because someone is approaching the end of life it should not mean we abandon concern for their quality of life. End of life care should seek to sustain people’s quality of life as a priority.”
There should be more checks, the paper suggests, to ensure staff receive education and training in end of life care. Specialist palliative care teams should always be deployed to deliver pain relief.
Residential homes, especially those without qualified nursing staff, often feel ill equipped to care for people in the final stages of life and send them to hospital or refuse to take residents back after a hospital admission.
In one local study, the report shows, at least 40% of patients who died in a Sheffield hospital “did not have medical needs which required them to be admitted”. Many had been occupying a bed for more a month – suggesting that resources could be freed up and redirected to home care.
The National Audit Office has estimated the cost of caring for cancer patients (who account for 27% of all deaths) in the 12 months before death was £1.8bn. Reducing emergency admissions by 10% and cutting the average length of stay to three days would release £104m for redistribution to other end of life care services.
The Department of Health has allocated £286m over the next two years to improving end-of-life care. But the PAC warns “there is a risk that the additional [sum] will not be used as intended. The department should require primary care trusts to account for how the additional funding is spent.”
Co-ordination between health and social care services in this area is “generally poor”, the report notes.
“That health and social care providers have traditionally given a low priority to end-of-life care is shown by the lack of training in basic end of life care among front-line staff,” the chairman of the PAC, Edward Leigh, said.
The catalogue of problems discovered in hospitals include poor support for basic comfort; lack of privacy for the patient and their family; poor communication by staff; and staff recognising too late that somebody is about to die.
“It is appalling that people dying in hospital are not always being given the end of life care they deserve,” Leigh said, “including effective pain management and being treated with dignity and respect.”