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31.03.16

Care for the dying has improved but is still inadequate – RCP report

End of life care in NHS hospitals has improved but still suffers from problems such as a lack of round-the-clock trained staff, a new report warns.

The Royal College of Physicians (RCP) audit of end of life care found that although 96% of NHS trusts had in-house training on the issue and 97% had their own specialist palliative care service, only 37% had a face-to-face palliative care service from 9am to 5pm in the week and only 11% had face-to-face care 24/7.

It also found that only 25% of patients who were likely to die had documented evidence of a discussion with a healthcare professional about their death, although in 84% of cases their loved ones were notified. There was a holistic assessment of the patient’s needs in 73% of cases, but only 15% of patients who were capable had a discussion of their cultural, religious or practical needs. The patient’s ability to eat and drink was assessed in 61% and 66% of cases.

Dr Adrian Tookman, clinical director at Marie Curie, said: “It’s clear from the report that there has been a real effort to improve care of the dying in hospitals over recent years.  Despite this, we can’t ignore the fact that the vast majority of dying people and those close to them, still have limited or no access to specialist palliative care support when they need it in hospital.  This is not right, nor good enough.

“Round-the-clock availability of specialist palliative care in hospitals should be the norm. When this care is missing, people suffer, and this suffering can live long in the memory of those they leave behind.”

Dr Tookman called for funding for recruiting and training specialist doctors and nurses as part of the introduction of the seven-day NHS, warning that the problem would get worse otherwise.

Emeritus Professor Sam Ahmedzai, chair of the RCP group which produced the research, said the report reflected ‘momentous’ changes since the Liverpool Care Pathway was phased out.

NHS England said: “There are clear variations in the support and services received across hospitals and areas where improvements must continue to be made.”

A similar report from the Economist Intelligence Unit last year found that the UK was ranked best in the world for palliative care, but that it was still inadequate for some patients.

The BMA warned recently that doctors need better training on treating dying patients.

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