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Palliative care in Scotland "needs to improve"

Access to good palliative care in Scotland needs to improve and it must be more consistently provided for the thousands of people who need it each year.

An Audit Scotland report published today looked at the provision of care for people with terminal illnesses. This care is provided both by "generalists" such as GPs, hospital doctors, district nurses, care workers, and friends and families, and by "specialists" such as hospice staff and specialist palliative care teams.

The report says most people are cared for by generalist staff, but patients with any condition who need care from specialist services should be able to get this. Currently, specialist care mainly focuses on people with cancer.

The availability of specialist care also varies significantly across Scotland and different areas have different models. For example, the number of specialist staff per 100,000 people ranges from 4.1 in NHS Ayrshire and Arran to 7.3 in NHS Greater Glasgow and Clyde and 11.2 in NHS Highland.

Caroline Gardner, the Deputy Auditor General for Scotland, said: "More than 55,000 people die in Scotland each year. Palliative care should be an integral part of the support given to patients and their families and carers during the last months, days and hours of their lives.

"In many areas of Scotland the voluntary sector and the health service provide excellent and much appreciated care. But access to good quality palliative care varies across the country."

Generalists who are involved in palliative care need the support and guidance of specialists so that they can recognise palliative care needs and improve the quality of care they give to patients and their families. But good practice guidelines for palliative care are not being applied everywhere that care is provided.

The report finds that the total cost of providing palliative care is unknown. About £59m was spent on specialist palliative care in 2006/07, and almost half of this money came from the voluntary sector. The cost of generalist care is unclear but it is a significant part of the work of many staff in health and social care.

Audit Scotland

What improvements would you like to see in end-of-life care? Your comments: (Terms and conditions apply)

"My father is at this moment in the last stages of his life and is receiving care in a residential home for Dementia in Yorkshire. They are giving him the best care they can but there are not nurses in this home and I have had to fight for even basic pain relief. The GPs do not appear to care enough to support these care homes and I feel my father is the bottom of the pile when it comes to him even having a decent pressure mattress as he has dementia. I have been a nurse for over 20 yrs and I am very saddened by this. I am not hopeful of the future unless more finance goes into palliative care." - Diane Clarke