In England, at least £4.5 billion a year is spent caring for people who are at the end-of-life, and while some individuals, particularly those accessing hospice or specialist community and hospital palliative services, receive high standards of care many others do not. Our report, Transforming care at the end-of-life, argues that while there has been a great deal of positive activity following the Department of Health's 2008 End-of-life Care Strategy, there are still too many inequalities in access to support and availability of good quality care.
Our report, which is based on a synthesis of key national reviews and audits published over the past 18 months, supplemented by interviews and discussions, highlights shortcomings and concerns about the large degree of variation in services across the country.
For example, Public Health England's 2013 National Survey of Bereaved Relatives, published in July 2014, found that while 43 per cent of respondents thought care was excellent or outstanding, 24 per cent said it was only fair or poor.1Indeed, co-ordination of care for those who died at home was rated significantly lower in 2013 than the previous year's survey with responses from the three annual surveys suggesting that the overall quality of care has remained relatively static.
Other reviews and audits; such as the 2013 review of the Liverpool Care Pathway chaired by Baroness Neuberger, the 2013-14 National Care of the Dying Audit for Hospitals and the recent House of Lords debate on assisted suicide; all identified examples of good practice but also shortcomings and concerns.2 3 4
The facts on end-of-life care in 2014 are that:
around 500,000 die each year in England, of whom 75, per cent have some form of palliative end-of-life care needs but for at least a quarter these needs go unmet and for others the services provided are only fair or poor at least £4.5 billion a year is spent caring for people in the last year, days and months of life (excluding self-funders and care provided by families and carers) but a third of this is spent on the more expensive hospital care for people who, for the most part, would prefer to die at home care requirements are becoming increasingly complex as people live longer but die following chronic, multiple, ill-health conditions the provision of care involves a continuum of people and support structures from hospitals to primary care, hospices to social care, volunteers, families and unpaid carers...