University report explores efficacy of palliative care in England

A new report by Sheffield Hallam University has revealed that, despite an abundance of government recommendations on end of life care in England, there is uncertainty as to whether they have led to improvements in patient care (2).     

On the day the Government will respond to the Review into Choice at the End of Life(1), the report by Sheffield Hallam's Centre for Health and Social Care Research, says the reason behind the uncertainty is that not enough attention has been given to how policies are implemented.

The University's State of the Nations report, funded by Marie Curie, reveals that since 2004 there have been 76 government publications impacting on terminal illness. It argues that this excess of information has diluted focus among commissioners and providers and this has made it difficult to ensure the consistency and quality of local end of life care services.

The report’s authors say that, while there has been progress in some areas, national policy needs to be clearer and there should be a greater emphasis on evidence-based practice. They also note that there is a lack of clarity over the resources and budgets that should be provided to terminal illness care.

The report recommends that those commissioning services should be responsible for ensuring that services are delivered as intended and that there are appropriate frameworks in place to monitor and evaluate efficacy and quality.

Today’s publication and Government response also coincides with new data (3)that shows more work is needed to ensure that services can meet the current level of need.  The data shows that the estimated numbers of, and proportion of deaths from conditions requiring palliative care, including Alzheimer’s disease, dementia and senility, are increasing rapidly.

The analysis of national mortality data from 2012 to 2014 reveals that - at the very minimum - more than seven out of every ten people die from a condition that needs palliative care. When conditions that contributed to a person’s deaths are considered, as well as those that were the underlying cause, this rises to nine in every ten deaths.

Dr Fliss Murtagh, reader and consultant in palliative medicine, Cicely Saunders Institute, King’s College London, said: “The new data analysis shows quite clearly that the number of people requiring palliative care is increasing rapidly. Palliative care therefore needs to be seen as a priority – it needs to be properly planned and resourced, otherwise those approaching the end of life will miss out on the care they need. I am pleased to see my work has been updated, and hope that these robust estimates of need will be used to underpin palliative care strategies going forward.”

Dr Jane Collins, chief executive for Marie Curie, said: “This new data shows us that the need for palliative care is continuing to increase as people die with more complex needs and conditions.  However, the Sheffield Hallam University report highlights that there has been little action to drive quality or choice from the Government despite a wealth of announcements and documents aimed at tackling this crucial issue.

“If we are going to help people demand better palliative care, the Government and NHS England must take account of the growing need for these services and deliver solutions which can be easily understood and accessed by those who need them.  

“Without this more people will go without the care they desperately need, more will die where they don’t want to and more families and friends will have their lives devastated by the negative experiences of their dying loved ones.”

Dr Julie Skilbeck, from Sheffield Hallam's Centre for Health and Social Care Research, said: “England’s palliative and end of life care policies are key drivers for commissioning, planning and delivering services for people living with terminal illness. However, there are a large number of strategy and guidance documents in circulation.

"The profusion is making it extremely difficult for commissioners and practitioners to develop and implement services for people requiring end of life care. It is important that commissioners and practitioners in England have an overarching piece of guidance that is specific, and lasts long enough to be applicable to all palliative care services.”

References:

1. Government’s response to the Review into Choice at the End of Life, July 2016
2. State of the Nations Report: Terminal Illness Care in England, Northern Ireland, Scotland and Wales, Centre for Health and Social Care Research, Sheffield Hallam University, July 2016
3. Palliative care and the UK nations. An updated assessment on need, policy and strategy – Implications for England, Marie Curie, July 2016

About Sheffield Hallam University

Sheffield Hallam University is one of the largest universities in the UK, with more than 31,500 students. It is one of the country's largest providers of health and social care courses, teacher training, and sport and physical activity courses.
Its courses are designed and delivered in close partnership with employers, professional associations and practice specialists to ensure that the skills our students develop are relevant. As a result, 93 per cent of its students are in employment or further training within six months of graduation.

As one of the UK's most progressive universities, providing opportunity through widening participation is at the heart of the University. 96 per cent of its young full-time undergraduate UK students are from state schools/colleges and 41 per cent are from low income backgrounds. Sheffield Hallam’s research is characterised by a focus on real world impact - addressing the cultural, economic and social challenges facing society today. 65 per cent of its research was rated world-leading or internationally excellent in the Research Excellence Framework.

About Marie Curie

Marie Curie is the UK’s leading charity for people with any terminal illness. The charity helps people living with a terminal illness and their families make the most of the time they have together by delivering expert hands-on care, emotional support, research and guidance. Marie Curie employs more than 2,700 nurses, doctors and other healthcare professionals, and with its nine hospices around the UK, is the largest provider of hospice beds outside the NHS.

For more information visit www.mariecurie.org.uk