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Poor integration between community and hospitals leading to poor palliative care

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Palliative care in the community is underresourced Palliative care in the community is underresourced

Communication between secondary and community care settings is leading to a decrease in the quality of end-of-life care, a report by the Parliamentary and Health Service Ombudsmen has found.

The report, Dying without dignity, looked at the conditions of palliative care in general practice, community, hospital and mental health settings. It concluded that there are major failings in the provision of palliative care across sectors. The report identified failings of communication between secondary and community care as a major barrier to patient's being able to access high quality end-of-life care, as well as being able to die with dignity in their own homes.

Peter Carter, chief executive of the RCN, said: 'Communication, particularly the shared recognition that someone is approaching the end of their life, is key and requires all staff to be trained in delivering end-of-life care, whether it is something they will do rarely or every day.'

A lack of resources and staff for community palliative care is also cited as a barrier to patients' being provided with the best possible end-of-life care. The report said that this often led to poor care planning for patient's recently discharged from hospital, which led to a high risk of exacerbations to the patient's condition.

Dr Carter added: 'There must be enough staff available either in hospital or in the community to properly listen to the needs and concerns of dying people and their loved ones. Had this support been available for the families in the report, the ombudsman's intervention would not have been needed.'

Another area in need of improvement identified by the report was the time of diagnosis, particularly in general practice. It cites several cases where the diagnosis of a terminal illness was made too late for the appropriate plans and conversations to be had with the patient.

The chief executive of cancer charity Marie Curie, Dr Jane Collins, said that the report provided 'a stark reminder of what happens to people with a terminal illness when they are failed by staff without adequate training and let-down by a system that struggles to provide effective support outside normal working hours. The experiences highlighted show the devastating impact that poor care can have, not just on patients but also their families, long after their loved one has died.'

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