In December 2015 the Scottish Government published The Strategic Framework for Action on Palliative and End of Life Care 2016 – 2021. Within the Strategic Framework for Action, the Scottish Government has made ten commitments, (appendix 1). Healthcare Improvement Scotland (HIS) has been asked to deliver commitment 1:
“Support Healthcare Improvement Scotland in providing Health and Social Care Partnerships with expertise on testing and implementing improvements in the identification and care co-ordination of those who can benefit from palliative and end of life care.”
About 1% of general practice patients will die each year. It is important to find ways of identifying these patients so that their needs and preferences can be assessed in order to plan for them and to provide the right services at the appropriate time. About one-quarter will die from cancer; these are the patients that have generally been thought of when initially discussing palliative care. In addition about one-third will die from organ failure, e.g. heart failure and COPD, and about one-third will die from multiple organ failure, frailty or dementia.
There are variations in access to palliative care by condition (particularly cancer vs. non-cancer), age, location, ethnicity and the identification challenges posed by multiple medical conditions. Longer periods spent living with life-limiting illness can make it difficult to know when the time is right for professionals to introduce a palliative care approach.
The Palliative and End of Life Care workstream supports Health and Social Care Partnerships to test new approaches to identify people who would benefit from palliative and end of life care and new approaches to co-ordinate care that enable people to spend more time living well in the community in the last six months of life that would otherwise be spent in hospital.
We are recruiting a team to support the palliative and end of life care work nationally and in several Health and Social Care Partnerships, including East Ayrshire, Fife, Glasgow, Perth and Kinross and the Western Isles. We have mapped the whole system for palliative and end of life care in Glasgow City and carried out a service self-assessment with staff.
NHS boards and Health and Social Care Partnerships.
Benefits of programme
The use of home-based palliative care found that it can more than double the chance of a patient dying at home and leads to symptoms being better managed.
Investment in community-based palliative care services reduces time spent in hospital at the end of life and is likely to be cost effective. Supporting patients to live well during their final months has the potential to release resources that can be reinvested elsewhere. £104 million could be released for investment elsewhere if emergency admissions were reduced by 10 per cent and the average length of stay following admission was reduced by three days.