‘Too many patients’ receiving palliative care in hospitals instead of hospices

Too many patients are spending their last days in hospitals rather than at home or in hospice care amid financial pressures that are forcing hospices to reduce services and make staffing cuts, a parliamentary committee has warned.

The Public Accounts Committee (PAC) has published a new report setting out serious concerns around a ‘growing financial crisis’ among adult hospices in England, warning of a ‘funding cliff-edge’ from April.

The committee, which has been running an inquiry focused on hospice finances, has accused the government and NHS England of failing to respond to the situation with ‘the seriousness and urgency’ needed.

The committee’s inquiry revealed how some hospices have recently reduced ‘essential services’ despite demand for palliative and end-of-life care rising.

Quoting statistics from Professor Fliss Murtagh, of Palliative Care at Hull York Medical School, the report said the situation had resulted in ‘around a quarter’ of adults spending their last days receiving ‘costly’ palliative care in hospitals.

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Meanwhile a third of people receiving acute care in hospital are in the last year of life, accounting for around 10 million bed days each year, the committee also quoted from Professor Murtagh.

The PAC report, titled: Financial sustainability of adult hospices in England, suggested that hospices could be ‘forced to reduce services further’ if no new funding is received in the new financial year, after already making staff redundancies and cutting back services.

Several recommendations to address hospice pressures have been set out in the report, including a call on NHS England to explain how it will move more palliative and end-of-life care out of acute settings and into the community, and the savings it expects this will deliver.

‘Too many patients spend their last days receiving palliative care in acute hospitals, which does not always achieve the best outcomes for patients nor represent value for money,’ the report said.

‘Patients are frequently receiving palliative care and reaching the end of their lives in settings they would prefer not to be – in hospitals rather than at home or in a hospice – and which are more expensive.’

The PAC’s analysis suggests hospices ‘annually support around 20,000 people to die in community settings rather than in hospital, saving the NHS approximately 1.5 million bed days and around £800m’.

And it flagged that a dashboard had been set up by NHS England to track patients at the end of their lives across integrated care boards (ICBs), ‘which highlights the significant number of people who need not be in hospitals and would rather be at home’.

Sir Geoffrey Clifton-Brown, chair of the PAC, said: ‘All of us, whoever we are, deserve access to care and in an environment that gives us the best possible quality of life as we approach the end.

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‘The institutions whose job it is to help ease our final days deserve to have recognition of the central role they play in our health system.

‘And yet government’s actions, despite all reassurances to the contrary, are communicating a certain blithe certainty that the sector’s challenges will be resolved at the local level.’

It was announced in January that hospices across England will receive an extra £25m in capital funding to support building and IT upgrades, bringing the total investment in the sector up to £125m over the past two financial years.

However, hospice sector leaders warned that capital investment alone would not resolve ongoing financial pressures as, for example, capital funding is not used to cover staffing costs.

The PAC has recommended that NHS England works with ICBs to establish which hospices are ‘forecasting imminent service reductions’ and confirm that for each of these, the ICB has undertaken a quality impact assessment.

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It then suggests that NHS England helps ‘develop an individual plan for each such hospice, setting out how the ICB will support the hospice to maintain its services, or how the ICB will otherwise compensate for the service reductions’.

Concerns have previously been raised around hospice funding constraints causing ‘stretched caseloads’ for district nurses. Speaking to Nursing in Practice in December, district nurses warned that cuts to hospice services, coupled with staffing issues, mean district nurses are managing larger caseloads and, in some cases, feel they are unable to deliver care at a standard they would like to.

Last week, Royal College of Nursing (RCN) chief executive and general secretary Professor Nicola Ranger told MPs that the government must put greater ‘energy and focus’ into care delivered outside of hospital settings to help eliminate corridor care.