THE BLOG

Dying to Be at Home - Why We Need to Get Serious About End of Life Care

11/12/2015 11:36 GMT | Updated 11/12/2016 10:12 GMT

Once again national news headlines are warning us of the pressures that hospitals in England will face this winter. The Nuffield Trust's new research shows that we need more beds in care homes and other community settings to ease the pressures on hospital beds.

Meanwhile, new figures reveal that NHS Trusts have run up a deficit of £1.6bn - the worst financial performance in the history of the health service.

According to the King's Fund, the figures show that the NHS is "in the grip of an unprecedented financial meltdown".

And these aren't the only reports testifying to the growing pressures on the NHS. In October it was revealed that NHS Trusts had racked up a collective deficit of £930m in the first three months of the financial year - more than the entire overspend last year. This announcement came less than a year after NHS England's five-year plan, The 'Five Year Forward View', made clear that a gap of £30 billion in NHS funding needs to be closed by 2020.

More recently, NHS England data showed that key targets such as discharge of people who had been treated, and four-hour A & E waiting times, have been repeatedly missed.

With such pressures, it's imperative that hospitals are not spending money caring for people at the end of life if they don't have a clinical need to be there.

Many of them don't want to be in hospital, either: in fact, most of us say that we don't want to be in hospital when we're in the final stages of life (research commissioned for Dying Matters Awareness Week 2013 showed that 67% of British adults want to die at home).

Last month the Economist Intelligence Unit ranked the UK first in the world for end of life care. This assessment in the 2015 Quality of Death index was encouraging - but the picture behind this headline is a complex one, with huge pressures on services that provide end of life care.

The National Council for Palliative Care, together with Hospice UK and Marie Curie, have published a new report calling for commissioners of health and social care services, as well as service providers themselves, to work together to enable people who are dying to stay out of hospital if they neither need nor want to be there.

Our report, 'Getting Serious about Prevention', shows that it's crucial for adequate community care to be available, with support available 24/7 - because dying people and their carers need support at all times of day or night. We also show how hospitals and community care services can work together properly to ensure that people can get the care they need at home, or can be transferred from a hospital to a community setting as quickly as possible.

Enabling people to die at home is part of enabling the choices that all of us would like to make when we die - among them, where we are cared for and where we will die. This year, the Review of Choice in End of Life Care made recommendations for how commissioners and service-providers can help to enable choices like this, and called for the government to set aside £130m to make this possible.

Relieving the significant pressures on the NHS is therefore a key reason for enabling dying people to stay out of hospital. However the most important reason is surely to enable them to have the end of life that they, and those important to them, would want. In our report a lady called Kate tells of how her father ended up dying in hospital - something which neither he nor the rest of his family had wanted - simply because staff had failed to identify the fact that he was dying.

Kate's story shows just how important it is for commissioners and service-providers to do their best to help people who are approaching the end of life to stay out of hospital. They can save on costs and beds in a severely over-stretched NHS - and most importantly, they can help make it possible for dying people to be cared for in the place they want to be.

Getting Serious about Prevention is free to download at: http://www.ncpc.org.uk/publication/getting-serious-about-prevention-enabling-people-stay-out-hospital-end-life