DEATH is one thing we are certain of in life, and yet, in this
country, death appears to take us by surprise. Three recent
occurrences have led me to this conclusion: the proposed closure of
in-patient care at the hospice in Canterbury; a report by Marie
Curie and the Royal College of Physicians criticising the lack of
end-of-life care in hospitals; and the recent indictment by the
chief executive of NHS England, Simon Stevens, who suggested that
the strategy of closing cottage hospitals should be reversed, as
older patients were not being treated with "dignity and compassion"
in our centralised system.
The wider community of east Kent was shocked when the charity
Pilgrims Hospices announced last month that it might close the
hospice in Canterbury, one of three that it runs. The charity,
under pressure to provide services, must close beds in the hospice
to enable it to provide more care in people's homes. The hospice
relies on volunteer fund-raising for 75 per cent of its income, and
it is currently running at a £1-million deficit.
On average, hospices in this country receive only one third of
their funding from the Government. They struggle to operate when
they face uncertain, flat, or reduced levels of statutory funding.
Volunteers raise amazing sums for the hospices in their locality,
but there are additional fund-raising challenges in today's tough
economic environment. The number of people aged 85 or over is
expected to double in the next 20 years, and, given a rise in
complex terminal illness, demand is set only to increase.
THE Commission into the Future of Hospice Care recommended last
year that hospices explore new models of community care so that
they can meet these challenges of demand and funding. The proposed
closure of the in-bed service at the Pilgrims Hospice in Canterbury
is a working out of the charity's trying to provide as much care as
possible within the ridiculous constraints of funding that our
Government (and previous governments) impose on them.
Although I support the vision of providing better end-of-life
care for people in their own homes (if they choose this), I do not
believe that this should be at the expense of valuable, much-needed
in-patient beds. It is difficult to see how the local health
economy would care for people with the most complex of needs, if
itdid not have easy access to hospice beds where expert palliative
care is available around the clock from a highly skilled and
I also question how people's spiritual needs (a quality standard
outlined by NICE in 2011) can be adequately met outside a hospice
or hospital environment. The problem how the faith community
adequately meets the needs of terminally ill individuals who are
not networked into their local church, but who are being cared for
at home by a series of nurses and carers, must be considered.
In answer to the question whether our hospitals are providing
quality end-of-life care that our hospices are not funded to meet,
a joint report, published in May, by the charity Marie Curie and
the Royal College of Physicians suggests that this is not the case.
The report shows that four-fifths of hospital trusts were
criticised for not providing specialist end-of-life care seven days
THE report also found that, during the past 12 months, nearly a
half of all hospital trust boards failed to discuss strategies for
care of the dying, and only 19 per cent of trusts provided
mandatory training for their doctors in end-of-life care. These are
shocking statistics when you consider that 58 per cent of the
500,000 deaths that happen annually in England occur in
And then, at the end of May, Mr Stevens suggested that the
erstwhile strategy of closing cottage hospitals in favour of large
specialist hospitals should be reversed, because care that was too
centralised led to a failure to treat older people with "dignity
I believe that most nurses and doctors provide the very best
care they can, every day, in difficult circumstances. But this
report, and the indictment by Mr Stevens, suggests that they are
not being resourced sufficiently to provide the levels of care that
dying people require in hospitals.
TEN years ago, NICE recommended that hospitals offer specialist
palliative care 24 hours a day, seven days a week. Four-fifths of
hospitals do not do so. In 2010, the government White Paper
Equity and Excellence: Liberating the NHS made a
commitment to reviewing funding for end-of-life care, so that
people have a choice about how and where they may have a good
death; but little progress has been made.
In 2011, the Palliative Care Funding Review found that
a fifth of people dying in England had a need for palliative care
that was unmet.
There appears to be a lack of strategy, a lack of impetus, and a
lack of sustainable funding for high-quality end-of-life care in
England. The debate about how we ensure that people have good
end-of-life care drags on interminably, and evidence of progress is
To this end, I have written to the Minister for Care and Support
at the Department of Health, Norman Lamb, asking him urgently to
adopt and implement a strategy that makes high-quality end-of-life
care a national priority.
It is simply not acceptable to be surprised that people
The Rt Revd Trevor Willmott is the Bishop of Dover.