Hospitals warned end-of-life care crisis threatening treatment
Rising numbers of end-of-life patients in hospitals could impact the level of care carried out this winter, a group of regional NHS leaders have been told.
A consultant working in palliative care highlighted the looming “crisis” at an online internal meeting of health leaders in Sussex, heard by the BBC.
The consultant at University Hospitals Sussex NHS Trust described the dilemmas hospital managers face when some patients need to be cared for at the end of life in A&E corridors.
This gloomy assessment is likely to be repeated in other NHS areas as increasing winter pressures increase the difficulty of finding hospital beds for sick patients needing care.
Sussex Trust University Hospitals include Worthing Hospital, the Royal Sussex County Hospital, St Richard’s Hospital in Chichester and the Princess Royal Hospital in Haywards Heath.
As well as community health representatives, doctors and officials from East Sussex Healthcare NHS Trust, including Conquest Hospital in Hastings and Eastbourne District General Hospital, also attended the meeting.
The consultant gave a slide presentation titled “Palliative and End of Life Care in Sussex” at the meeting held on 4 November.
He told the audience that local hospices were struggling and finding places for patients needing end-of-life care was difficult, but sometimes it wasn’t clear how much support was available from the local community when people were sent home.
He said: “I really worry that patients with treatable conditions may not be able to go to hospital and get treated because there are so many end-of-life patients in hospital beds.”
“We no longer directly put dying patients on the waiting list for transfer,” he continued, focusing only on those with complex needs.
Regarding the delivery of advanced palliative care in A&E, the consultant said it was “a really tough choice – do you admit them to corridor care, or do you turn them away and put them in the back of the ambulance where they could die on the way home”.
He argued that there were “too many patients in the hospital who didn’t need to be there, too many patients with complex needs whose needs were not being met.”
“We all knew this crisis was coming; it’s getting worse and worse,” he concluded.
A spokesman for the NHS in Sussex said they were committed to ensuring patients had access to the “best possible, high-quality palliative and end-of-life care”.
They said: “This includes providing a range of places for compassionate, person-centred care and, importantly, where possible, in non-hospital settings such as community settings and our care homes.
“Urgent care services across Sussex continue to be under significant pressure, but staff continue to work incredibly hard to ensure patients can get the care they need in our hospitals and across all our health and care services.
“Strong partnership work is being carried out over the winter to support individual care plans and ensure people receive the right NHS service to suit their needs.”
But the Royal College of Emergency Medicine said delayed discharges were a major problem across the NHS and a lack of social or community care could mean some patients needing end-of-life care and support were unable to leave hospitals.
President Dr. Ian Higginson said the college was “concerned about the number of patients needing end-of-life care who are admitted first to emergency departments and then to hospitals because the specialist services they need are not available”.
“Patients who choose to be at home may end up in our corridors, which is not the right place for anyone, let alone those at the end of life.”
Meanwhile, community services are being stretched and care homes are warning of a funding crisis.
Toby Porter, chief executive of Hospice UK, said: “We know how hard staff in the NHS and care system work to provide people at the end of their lives with the care they deserve.
“But while a hospital may be the right place for some, a busy ward is not the right place for most people who die.
“Hospitals up and down the country want to provide more care to the community, but this year we have seen that cut back due to funding pressures, which is having a knock-on effect on hospitals.”
