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But what about terminal care?

11 July 2014

Assisted dying: Poor treatment of the dying is skewing the argument, warns Trevor Willmott

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 multi-professional team.

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 a week.

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 hospital.

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 and compassion".

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 depressingly meagre.

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 die.

The Rt Revd Trevor Willmott is the Bishop of Dover.

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