Care of terminally ill attacked

Palliative care is becoming more complex

The standard of care of the terminally ill in the NHS in England has been criticised by MPs.

Palliative care has been given a low priority, said members of the Committee of Public Accounts.

They said lack of services and poor co-ordination of health and social care meant many people were denied their wish to die at home.

NHS end of life care was also criticised in a National Audit Office report published last November.

It is appalling that people dying in hospital are not always being given the end of life care they deserve Edward Leigh Chiarman, Committee of Public Accounts

Approximately 500,000 people die in England each year, and around 75% of these deaths follow a period of chronic illness.

Although most people would rather die at home, the majority (60%) end their days in hospital - even though there is no clinical need for them to be there.

The MPs said front line health workers often lacked training in basic end of life care.

They said people who died in hospital did not always receive first rate care, such as the most effective pain management, and were not always treated with dignity and respect.

The MPs also highlighted problems of poor co-ordination between different branches of the caring professions which meant that the wishes of terminally ill patients were often not known.

And even when a patient had made it clear they wanted to die at home, that wish was often not satisfied because of a lack of services to care for them outside hospital.

Protected funds

Committee chairman Edward Leigh said: "It is appalling that people dying in hospital are not always being given the end of life care they deserve, including effective pain management and being treated with dignity and respect."

Age discrimination continues to haunt older people even at the end of their lives Michelle Mitchell Age Concern and Help the Aged

Mr Leigh said the government had made new funds available for palliative care, but said primary care trusts must ensure the cash was spent on improvements to the service, and not diverted to other areas.

They said hospices should be given an expanded role, offering training to care home staff and outreach services to improve the quality of care for people in their last year of life.

The MPs also warned that the provision of end of life care was becoming increasingly complex, with people living longer and developing multiple health problems.

Thomas Hughes-Hallett, chief executive of Marie Curie Cancer Care, said work carried out by the charity had shown that if health and social care agencies worked together the number of people able to die at home could be doubled at no extra cost.

He said: "This report again highlights the need for better end of life care."

Age discrimination

Michelle Mitchell, director for Age Concern and Help the Aged, said: "Age discrimination continues to haunt older people even at the end of their lives.

"Towards the end of life, older people often need support from a range of health and social care services, however availability is patchy, staff lack training and coordination can be poor.

"Because of this, older people who wish to die in familiar surroundings at home often die in hospital and suffer needlessly from lapses in standards of care."

Care services minister Phil Hope said the government had already committed to investing £286m over three years to back up its End of Life Care Strategy published last year.

He said: "People coming to the end of their lives deserve high quality, compassionate and dignified care, on their own terms.

"Guidance issued to primary care trusts has made it clear that we expect the extra funding to be used for end of life care services. The NHS locally should have proper monitoring in place to make sure this happens."