Action needed to prevent unnecessary and costly hospital stays at the end of life

Categories: Care.

Entitled ‘Getting serious about prevention: enabling people to stay out of hospital at the end of life’, the report argues that the NHS is paying too much to care for people approaching the end of life in hospitals, where they often don’t want or need to be.

NHS England’s Five Year Forward View sets out an ambition to make £30 billion worth of savings by 2020, while also noting the high costs of hospital admissions for people near the end of their lives and the problems with transferring patients out of hospital.

Among the report’s recommendations to improve this situation are commissioning 24/7 care in community settings, better use of anticipatory prescribing of medicines, and improving the coordination between hospitals and community settings.

The report also suggests sharing of records of people’s end of life wishes and a more proactive approach by health and care staff to identifying and meeting the needs of people approaching the end of life.

Jonathan Ellis, director of policy and advocacy at Hospice UK, said: “The current over-reliance on hospital care for dying people goes against what the majority of people say they would prefer at the end of life. Economically, it also makes little sense, particularly in these especially straitened times when NHS resources are under more pressure than ever before.

“Hospice UK is calling on the government to back more local partnerships led by hospices offering alternative care which, if expanded nationally, could reduce the number of people dying in hospital by a fifth and also generate £80 million in savings for the NHS.

“Healthcare commissioners and service providers must embrace more palliative care options beyond hospital, if dying people are to receive the care they need and to ensure more cost-effective care delivery.”

His words were echoed by Simon Chapman, director of policy, intelligence and public affairs at the NCPC.

“High quality end of life care and support should be available for everyone who needs it, where and when they need it – which sadly too often isn’t happening at present,” he said.

“If we are to better meet the needs of dying people then we need to make more appropriate use of hospital provision and not use it as a default option when people would rather be cared for elsewhere.

“This will not only help ensure people’s wishes are met, but will also help save time, money and resources that could be better directed.”

Chapman also emphasised the need for changes in light of the increased demand that will be placed on hospitals over the winter.

“It has never been more important for commissioners and service providers alike to work together and to take action. Getting end of life care right is an essential part of putting the NHS onto a sustainable footing,” he explained.

“Local providers and commissioners need to be much more proactive about making sure that people approaching the end of life are identified and plans are put in place for them to get the care they need in the place they want to be.”

Marie Curie’s director of policy and public affairs, Simon Jones, added: “Most people in the last year of life will experience an emergency admission. However, if the right community-based palliative care nursing services were in place to care for terminally ill people, many could be avoided.

“Local commissioners can effect change now by moving more care for terminally ill people from hospitals to the community. We know more people want to die at home than currently do. We also know that making this shift can lead to cost savings and reduce unnecessary hospital readmissions, which can be distressing for everyone concerned.”

The full report can be downloaded from the NCPC website.

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