Deloitte report: £4.5 billion spent annually on end-of-life care, but delivery could be improved
6 October 2014
- More than 50% of deaths occur in hospital, while at least 70% would have preferred to die at home
- Numbers dying each year are increasing and expected to rise to 590,000 by 2030
- Care requirements becoming increasingly complex as people live longer but often suffer multiple, chronic, ill-health conditions
At least £4.5 billion is spent each year in England caring for those at the end of their lives, according to a report by the Deloitte Centre for Health Solutions, an independent research arm of the business advisory firm. Yet the report finds that while some individuals, particularly those accessing hospice or specialist community and hospital palliative services, receive high standards of care, many others do not. The report’s analysis of national reviews and audits over the past 18 months, highlights shortcomings and concerns about the large degree of variation in services across the country.
Karen Taylor, Director of Deloitte’s Centre for Health Solutions, said: “End-of-life care is a difficult but necessary subject to broach, yet it has the potential to prevent unnecessary suffering if delivered appropriately. It is an area to unite rather than divide service providers and, if done well, could be an exemplar of cost-effective, co-ordinated and integrated care. However, the primary barrier to the delivery of good quality care is the lack of access to effective services that support people to die at home or in their care home. In 2013, 50 per cent of people died in hospital, despite the fact that opinion polls consistently show that, on average, 70 per cent of people would prefer to die in their usual place of residence.”
Transforming care at the end-of-life, argues that while there has been a great deal of positive activity following the Department of Health’s End-of-life Care Strategy, published in 2008, significant inequalities remain. This was highlighted by Public Health England’s 2013 National Survey of Bereaved Relatives, which found that while 43 per cent of respondents thought care was excellent or outstanding, 24 per cent said it was only fair or poor.
Likewise the 2013 review of the Liverpool Care Pathway; the 2013-14 National Care of the Dying Audit for Hospitals; and the recent House of Lords debate on assisted suicide all identified examples of good practice but also serious shortcomings and concerns.
The response to these concerns was the establishment of the Leadership Alliance for the Care of Dying People and its identification of five Priorities for Care. Initiatives such as this will take time to come into effect but the issue is again firmly on the government’s agenda. As such, Deloitte’s report analyses the current challenges to improving care, and shares examples of best practice* where improvements are already being seen and where wider adoption could help kick-start the urgently needed transformation.
Taylor added: “The emphasis now should be on transforming support in the community to reduce unwarranted variation in the quality of care and unwanted hospital admissions. High spend does not equate to a ‘good death’ and the reallocation of resources from the more expensive hospital setting should lead to better quality care that is cost neutral if not cost saving.
“We are now seeing an increase in the number of deaths per year, which is expected to reach 590,000 by 2030. This coupled with an aging population and a massively over-stretched health service, means that improving end-of-life care is an imperative. High quality care in the lead up to death is a human right that should be tackled immediately.”
Notes to editors
* Themes covered by examples of good practice, which have led to improved care in some parts of the country, include:
- improving understanding of the needs and wishes of people at end-of-life
- education and training in care of the dying, including skills in communicating with and supporting families, carers and their advocates
- access to advice and support from specialist palliative care service, including making effective use of technology such as telehealth
- new incentives that encourage closer partnerships between care providers, including alternative funding models
- end-of-life care audits, incorporating the views of bereaved relatives
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