Caring for those approaching the end of life in Scottish Hospitals

Over half a million Scots will die in acute hospitals in the next twenty years, and millions of people with palliative care needs and approaching the end of life will be cared for in a hospital in the years and months before their death.

Public policy approaches in recent years emphasising care in community settings have led to a mistaken perception by some that any palliative and end of life care provided in a hospital setting represents a failure of the system or a ‘problem’ (Robinson et al, 2016). Good care for people needing palliative and end of life services takes place in hospitals daily, where people need and often choose to be. The problem with much palliative and end of life care in hospitals is not that it is taking place, but that it needs to be better supported and resourced.

Marie Curie and the University of Glasgow brought together (before COVID 19) a range of interested stakeholders from across Scotland to discuss and consider over three seminars how palliative care in acute settings can be improved, what changes need to be made, and how we can share good practice.

We published a report Past, present and future: Caring for those approaching the end of life in Scottish Hospitals highlighting the findings from these seminars including the challenges facing acute hospitals in ensuring good palliative care and recommendations to address them including:

• The need for a much greater commitment at national and local policy level for supporting palliative care in acute settings.
• Identifying patients with palliative needs following their admission or when approaching end of life is a challenge that could be improved with better support for practitioners.
• Support to make change in acute services to help those with palliative care needs. There are lots of examples of successful change and innovation that could be shared and replicated.
• IT challenges need to be addressed, including the sharing of current clinical information and electronic anticipatory care plans. Lack of information can lead to unwanted and inappropriate treatments been given to patients.
• Scotland is failing to meet the staffing levels for palliative care recommended by the Association of Palliative Medicine. This can mean many acute settings not having sufficient staff to support patient needs. There needs to be a palliative care workforce plan developed to support Scotland to meet these recommendations.
• Many of those working in acute hospitals do not have the training and education they need to support people with palliative care needs, including communication training.
• Many hospitals do not have the environment to support people coming to the end of life, with some spending the final hours on busy and noisy wards with little space for family and friends.
• The evidence base to show the true value of palliative care in acute settings needs to be strengthened. There is emerging evidence that there is value to be gained through focused approaches to acute based palliative and end of life care, as well as the impact that it has on the wider health and social care system including financial efficiencies.
• For many hospitals there is still a culture of ‘treat and cure’, which can mean patients with palliative care needs do not always get the care and support they would prefer or need. This can lead to a greater risk of over and unnecessary treatments being used at cost to both individuals and the system. The Realistic Medicine approach introduced by the Chief Medical Officers must be adopted and embraced in all settings and by all professionals including all those that work in acute settings.

Richard Meade is the Head of Policy and Public Affairs of Marie Curie Scotland.

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References

Robinson et  al,. The ‘Problematisation’ of palliative care in hospital: an exploratory review  of international palliative care policy in five countries, BMC Palliative Care (2016).