Source · Select Committees · Public Accounts Committee
Recommendation 4
4
Too many patients spend their last days receiving palliative care in acute hospitals, which does...
Conclusion
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. 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. Around one in four adults cared for in acute 4 hospitals are in the last year of their life, accounting for about 10 million bed days each year, when many could be in other settings that are better suited to supporting their needs. 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 £800 million. NHS England use a dashboard to track patients at the end of their lives across all ICBs, which highlights the significant number of people who need not be in hospitals and would rather be at home. recommendation NHS England should explain, in detail, 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.
Government Response
Response Pending
HM Government
Response Pending
The government agrees with the Committee’s recommendation. community, to ensure patients and their families receive personalised care in the most appropriate setting, and palliative care and end-of-life care services, including hospices, will have a big role to play in that shift. The government is developing a Palliative Care and End‑of‑Life Care MSF which will support the shift to strategic commissioning based on integrated needs assessments. The MSF will outline evidenced based interventions and will include metrics that will focus on reduction of clinically avoidable non‑elective admissions and unnecessary bed days for people at the end of life. The MSF will build on Medium Term Planning Framework, which made clear that ICBs and relevant NHS providers should ensure an understanding of current and projected total service utilisation and costs, including for those with palliative care and end-of-life care needs, and create an overall plan to more effectively manage the needs of these high-priority cohorts and significantly reduce avoidable unplanned admissions. It will also build on the recently published Neighbourhood Health Framework, which sets clear expectations for the improvement of care of palliative care and end-of-life care patients through Neighbourhood Health. This set the ambition is to systems to increase in the number of people identified as approaching end of life by 10%, alongside a reducing the number of non-elective admissions and bed days of one day or over for people in the end of the life cohort by 10%.