Case for change
The need to improve end of life care has been recognised nationally and in 2008, the Department of Health published the End of Life Care Strategy – promoting high quality care for all adults at the end of life. London lags behind other regions of the country in this area of healthcare.
While in some areas 90% of GP surgeries conform with accepted good practice for end of life care described by the National Gold Standards Framework, less than a quarter of London surgeries use these techniques.
In one poll, 77% of people who had experienced the death of a loved one in the last five years were fairly or very happy with the care given, but this does not tell the whole story. Some 54% of all complaints about hospitals received by the Care Quality Commission (formerly the Healthcare Commission) are about end of life care, indicating that there is considerable room for improvement.
While in polls 57% of people say they would prefer to die in their own homes, in London just 20% do die at home.
Overall there is a need to develop an information base and ensure all patients’ wishes are registered and services coordinated, as currently very few patients are on the end of life care register held by their GPs.
Changing services to provide more support for people at home would involve moving skills and resources and would appear costly, but the National Audit Office has identified that there is scope to reduce expenditure by preventing unnecessary admissions to hospital. The Good Practice Guide provides more detailed information on the costs of end of life care and the opportunity to improve the service whilst spending less by using the skills and resources of the NHS more efficiently.
