End of life care / National Audit Office.

  • Great Britain. National Audit Office.
Date:
[2008], ©2008
Catalogue details

Licence: Open Government Licence

Credit: End of life care / National Audit Office. Source: Wellcome Collection.

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    SUMMARY 11. Independent hospices have an important role in the delivery of end of life care services, both in inpatient care and increasingly in day care and in services in care homes and peoples’ homes. Independent hospices currently provide around 2,150 inpatient beds, compared to 450 provided by NHS hospices. Although traditionally focused on cancer, hospices are also increasingly offering services to people with other conditions. Whilst the proportion of non-cancer patients receiving hospice services is low, it is growing. Meeting the needs of patients and carers 12 NHS and social care services are not meeting the basic needs of many people approaching the end of their life. The findings of published research and work carried out by the Healthcare Commission were that people approaching the end of their life are not always afforded the dignity and respect they deserve. Our focus groups identified a similar picture, where the standard of hospital care and social service provision was below what had been expected and care plans for patients had not been drawn up and agreed. These issues had unnecessarily caused stress for people approaching the end of their life and those caring for them. 13. Despite all carers being entitled to an assessment of their health and social care needs, our census of PCTs found that only 29 per cent provided such assessments as standard. PCTs also do not routinely record whether carers have received an assessment. Caring for a person approaching the end of their life can place a heavy burden on the physical, emotional and mental wellbeing of carers but only 24 per cent of PCTs stated that they offer respite care to all who need it. The skills and training of health and social care staff 14 Many healthcare professionals will come into contact with people approaching the end of their life, but our surveys found that only 29 per cent of doctors and 18 per cent of nurses had received any pre-registration training in end of life care. In addition, only 39 per cent of doctors and 15 per cent of nurses had received pre-registration training in communicating with patients approaching the end of their life. 15 Ninety care homes responding to our survey (74 per cent) stated that they provide specific training on end of life care, but in less than half of cases was this training compulsory. Data collected by Skills for Care in 2007 show that as few as seven per cent of care home workers and five per cent of nursing care home workers have an NVQ level 3 qualification which includes 6 END OF LIFE CARE optional training in supporting people at the end of life. Staff turnover rates also suggest that care homes are training fewer staff than they lose on an annual basis. Approaches to improving the delivery of end of life care 16 ‘Fifty four per cent of general nurses and a third of doctors reported being trained in the use of at least one of the three National Institute for Health and Clinical Excellence (NICE) recommended approaches to end of life care (Gold Standards Framework, Liverpool Care Pathway or Preferred Priorities for Care). For those specialising in palliative care, the figures were 91 per cent of nurses and 95 per cent of doctors. These approaches, rolled out as part of the End of Life Care Programme between 2003 and 2007, are well regarded by a range of users and both doctors and nurses reported that their use had improved their confidence in delivering end of life care. There has, however, been little measurement of the benefits for patients of using these approaches and the direct benefit to patient care associated with their use has yet to be fully demonstrated. What research has been done has shown that their use can decrease unnecessary hospital utilisation and increase the likelihood of people dying in their preferred place of care. Commissioning services 17. PCTs’ expenditure on specialist palliative care services does not reflect the pattern of need. Although there is likely to be some variation in expenditure depending on need and the delivery models used, our census of PCTs and data collected by the Department found large variations in the average amount spent on specialist palliative care services for individuals approaching the end of their life (£154 to £1,684 per death). There is also variation in the availability of palliative care beds, and in the number of staff within hospital and community specialist palliative care teams. The provision of care home places and hospice services is also in many cases not proportional to need. 18 Coordination between health and social care services in relation to the planning, delivery and monitoring of end of life care is generally poor and is hampered by different funding streams. It can be difficult to determine what proportion of patients’ needs are medical and fall under the NHS budget, or non-medical (social care) and are funded, in part, by local authorities and by the patient based on a needs assessment. A lack of integrated services and an absence of a single point of contact to coordinate care can lead to particular frustration.