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Palliative pain relief suffers in community settings

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Community palliative services pain relief Community palliative services have the poorest rating for pain relief

Community palliative care services are not as effective in relieving pain at the end of life compared to other settings, a report by PHE's National End of Life Care Intelligence Network.

The report, What we know 2014, found that only 18% of relatives thought terminally ill patients had received adequate pain relief when being provided with palliative care during the last three months of their lives. This is compared to 62% in hospices, and 45% in care homes.

Simon Chapman, director of intelligence, policy and public affairs for the National Council for Palliative Care, suggested that the disparity could be due to access to pain relief. He said: "In hospices, patients in need of palliative care are likely to be surrounded by specialist practitioners around the clock, who can provide pain relief at any time. In the community and at home, patients may be unable to access pain relief at weekends and after hours.'

However, the report also found that district and community nurses were regarded as treating patients with the most dignity while providing palliative care, with 78% of respondents saying that their relatives had always been treated well by community and district nurses at the end of life, compared with 51% of hospital nurses.

Professor Julia Verne, a consultant in public health, said: 'There is still work to be done to ensure we keep focus, not just on the numbers but on people's experience of dying. However we are now a step closer to balancing out the number of people using hospital and community care.'

Care homes and community settings achieved similar figures for overall quality of care. The report found that 45% of community and district nurses providing palliative care were considered excellent, compared to 46% in care homes. General practices were the least likely setting to provide optimum palliative care, with 33% of general practice services rated as excellent.

Claire Henry, chief executive of the National Council for Palliative Care, said: 'With the number of people dying each year on the rise there's never been a more important time to understand how and where people die, the range of services and support available and the inequalities in end of life care that continue to exist.'

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