Patients should have right to choose where they die, says care inquiry
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Version 0 of 1. People nearing the end of their lives should have the right to choose where they die, says a report commissioned by ministers in England. What’s important to me was written by representatives from charities, professional bodies, the NHS and Department of Health. The Choice in End of Life Care review board recommended that dying patients’ choices and preferences on care and treatment be recorded in personal plans that are easily accessible electronically by health and social care professionals. A named senior clinician should also be responsible for a dying patient’s care. The review board said 24/7 end-of-life care for people opting to die out of hospital must be available to everyone in the last year of their lives within five years. Despite some “great strides forward”, far too many dying people still received inadequate or ill-suited care. Claire Henry, the review board’s chair, said they had taken a “pragmatic” approach, sticking to realistic state funding increases of £130m a year from the next government’s first funding review after the election. Almost half a million people die in hospital each year. To help reduce that number by a fifth, older people who have to contribute to their own care will have to pay more, while charities will also have to find more money. The review board would like to see a 40% reduction in the number of people who die in hospital but takes the view that insisting on extra state funding of more than £800m a year is not an option in the current financial climate. Annual spending is £2.7bn by the NHS, £450m by the voluntary sector, mainly hospices, £360m by council-funded social care, and £430m by people funding their own care, according to the review board’s estimates. Henry, who is the chief executive of the National Council for Palliative Care, said care could be transformed by “listening and acting upon” what people wanted instead of “the enormous sadness, pain and regret that barriers to choice” caused. The way a country cared for its dying people was “a measure of our society”, said Henry. ”It is time that these high aspirations were matched by the reality of what people experience.” In 2013, 48% of deaths were in hospital, 22% at home, 21.5% in a care home and 5.5% in a hospice, yet research suggests a third of people at the end of their lives who died in district general hospitals could have been appropriately cared for at home. Two in five people with dementia die in hospital, a higher proportion than in other European countries. People who live in deprived areas are more likely to die in hospital and less likely to die at home, possibly because of lack of out-of-hours services, limited knowledge of other options, limited social support and inability to bear the costs of care at home. The report comes as NHS England tries to change the models of funding where health and social care budgets are split – a proposed devolution of state funds to greater Manchester to help conquer that problem was announced on Wednesday. Those behind the report have kept Labour as well as the coalition in the loop as to their thinking. Norman Lamb, the Lib Dem care minister, said: “We fully support the review’s vision that every person should receive care in line with their choices and preferences, and we urge local health and care organisations to work together to ensure that this is achieved for as many people as possible.” |