To state an obvious truth, everybody dies. Dying patients are seen in every part of healthcare, and the vast majority will have some level of palliative care need.
There is an opportunity in the Health and Care Bill for specialist multi professional palliative care to be recognised as a core service like cardiology or gastroenterology, and at committee stage of the Bill, I tabled an amendment which would require clinical specialist palliative care services to be commissioned by integrated care boards in every part of England against specific criteria.
It is hugely encouraging that the government has taken this on and made a commitment to require ICBs to commission specialist palliative care as appropriate in local areas. It is a step in the right direction.
Specialist palliative care is a relatively new specialty, which is why it was not included in the early NHS legislation. The hospice movement grew up outside the NHS, spearheaded by Cicely Saunders, who realised that bringing about change within the NHS was painfully slow. This has meant that a patchwork of services has developed in the wealthier parts of Britain. In some areas great, innovative integration with community social care is happening. But other areas of enormous need are left with almost no service, or no service at all.
Until now, we have depended on fundraising events for people to get expert support for pain and other symptoms, and for psychosocial distress. No one would advocate having a cake sale so that a woman in obstructed labour can have a caesarean section. Maternity service provision across the UK is mandatory. Specialist multi-professional palliative care provision needs equivalent recognition in statute.
Commissioning specialist palliative care as a core service will raise standards, ensure better use of current resources to avoid unnecessary admission and inappropriate delays in Emergency Departments, improve symptom control and speed up hospital discharge. Importantly, such a core specialty will better improve communications with patients by equipping professionals to start the difficult but needed conversations around the progression of disease, and what matters to them in care plans.
Timely palliative care intervention can avoid situations escalating into serious complaints, again avoiding unnecessary cost to the NHS. Indeed, moving the nature of commissioning to ensure all areas have integrated specialist palliative care should not require new funding. This was demonstrated in Wales in 2008, when, with just over £2 per head of population investment, seven-day services and 24/7 advice to any health or social care professional was made available, covering hospitals, hospices and community, with increasing integration reaching areas where no services existed.
This Bill arrives at a critical moment for improving care. In 20 years’ time, 100,000 more people will die each year in the UK. Demand is set to increase rapidly as our population ages and more people live for longer with multiple and complex conditions.
The number of people dying with a need for palliative care is projected to increase by up to 42 per cent by 2040. The solution is at hand, and I am glad that the government is responding to this need. Recognising specialist multi-professional palliative care as a core NHS service will improve care without increasing overall cost.
The NHS promised to support people from the cradle to the grave, and it can now realise that promise and properly address deficits in care.
Key Points:
• Specialist multi-professional palliative care must be a core service of the NHS.
• It is encouraging that the government has made a commitment on the face of the Bill.
• Currently there are wide variations because services depend on charitable funds.
• Services must be commissioned 7/7 with advice available 24/7.
• Good specialist palliative care raises standards, reduces delays and avoids unnecessary costs to the NHS.
• Wales has shown the cost-efficacy of ensuring fair access to palliative care
• Increasing demand for care makes commissioning services as core an urgent need.
Ilora Finlay FMedSci, Baroness Finlay of Llandaff, is a Welsh doctor, professor of palliative medicine, an Independent Crossbench member of the House of Lords, and Co-Chair of the All-Party Parliamentary Health Group.
This article originally appeared in The Leaders Council’s special report on ‘The Impact of the Health & Care Bill’, published on March 4, 2022. Read the full special report here.
