NHS England is currently consulting on its long-term plan for the NHS. Covering the next ten years, the plan will set out how the NHS will deal with the challenges of providing care to an ageing population under extreme financial pressure. At the time of writing, NHS England will not be prioritising the care that people need when they are dying in its plan for the next decade.
Let’s put this into perspective. Everybody dies. In the next ten years 5.5 million people will die. Most of those people will need palliative care. Most of those people will die at an older age than their parents did and with significantly more complex care needs. Yet the NHS is not considering in any significant way in its 10 year plan how to provide care for these people.
At best this is an oversight. At worst, it is breathtakingly reckless.
The adage has always been that the NHS is there for the citizens of the UK from the ‘cradle to the grave’, but in England that seems to have been changing.
NHS England has taken a hands-off approach with clinical commissioning groups (CCGs) on the issue of end of life care, which has led to huge variations around the country in the availability of palliative care. In some parts of the country you will wait less than 48 hours to get out of hospital at the end of life, in others you can be stuck there for nearly two weeks.
By not prioritising end of life care in a strategy that looks at improving NHS care for the next ten years, NHS England seems to be signalling that they don’t particularly care where people die or how people die. It’s as if once illness becomes no longer treatable you are no longer a priority.
NHS England has instead focused much of its policy-making attention on preventative measures – keeping people healthy. This is to be applauded. We all want to live longer, healthier lives. However, the consequence of this is that if you help people stay healthier for longer then they will die at an older age, have developed more long-term conditions - and have much more complex conditions. It’s good to keep people healthy, but you still have to plan for what happens when they eventually become incurably ill.
What’s strange about NHS England’s stance is that they are seeking to maximise the effectiveness of acute care for people who need it. One of the best ways to do this is by ensuring that people are able to access palliative care.
About one in four of all emergency admissions are for people in the last year of life. Research by the Nuffield Trust has shown that only one in 10 people with access to the Marie Curie Nursing Service had an emergency admission compared to over a third of people who did not have access. Marie Curie patients were more likely to die at home, less likely to die in hospital, and had hospital care costs that were £1,140 less than people without a Marie Curie Nurse.
Even when factoring the cost of the Marie Curie Nurse and additional support from social care services, Marie Curie patients’ total care costs were £500 less than those who did not receive this care. The lesson here is very clear. If you want to maximise the availability of emergency beds and other hospital resources, invest in palliative care services in the community.
NHS England need to pause and think about ‘cradle to grave’. It’s not just an old saying. It’s a guide to running the NHS effectively. They must plan care for the population of England from the very start of life to the very end. Failing to prioritise what happens to people at the very end of life is inefficient, short-sighted, and makes the NHS less effective for all of us. It also isn’t fair to the millions of people who will die in the coming years ahead.