Is an End-of-Life Care Crisis Threatening Hospital Treatments?

The rising number of end-of-life patients in hospitals is creating significant challenges for the NHS, particularly as winter pressures mount. A palliative care consultant highlighted this crisis during a recent meeting with health leaders in Sussex, expressing concerns that the increasing demand for end-of-life care could hinder treatment for patients with conditions that are curable. This situation reflects broader systemic issues faced by the NHS across the UK.

Last updated: 09 November 2023 (BST)

What’s happening now

Hospital managers are grappling with the dual pressures of rising end-of-life cases and a lack of available beds for patients requiring urgent care. This issue was laid bare during an online meeting on 4 November involving various NHS leaders from the University Hospitals Sussex NHS Trust and East Sussex Healthcare NHS Trust. The meeting underscored the urgent dilemmas faced by healthcare providers as they navigate the care needs of patients at different stages of their health journeys.

Key takeaways

• Increasing end-of-life patients are straining NHS resources, especially in hospitals.
• Emergency departments are experiencing delays in patient transfers due to lack of available hospice care.
• Health leaders are concerned about the implications for patients with treatable conditions.

Timeline: how we got here

The situation has evolved over several months, with key milestones including:

• June 2023: Reports of increasing pressures on NHS services, particularly in the context of summer health challenges.
• September 2023: Initial warnings from NHS leaders about the potential winter crisis, citing staffing and resource shortages.
• 4 November 2023: Online meeting highlights the urgent need for action to address the rising number of end-of-life patients in hospital settings.

What’s new vs what’s known

New today/this week

The consultant's presentation revealed that hospital admissions for end-of-life care are increasing, leading to difficult decisions regarding which patients receive urgent care. Hospitals are reportedly prioritising those with complex medical needs, leaving many patients without adequate support.

What was already established

It has been acknowledged for some time that the NHS faces systemic pressures, including delayed discharges and inadequate community care resources. Previous reports have outlined the struggles faced by hospices due to funding cuts, which have limited their ability to provide care in community settings.

Impact for the UK

Consumers and households

The increasing reliance on hospitals for end-of-life care is likely to impact families significantly. Patients who require urgent care for treatable conditions may face delays, leading to worsened health outcomes. Furthermore, the emotional toll on families unable to provide dignified end-of-life experiences at home can be substantial.

Businesses and jobs

The health crisis may also affect local economies. With hospitals under strain, businesses that provide ancillary services to healthcare, such as transport and home care, may see increased demand as families seek alternative solutions for care. However, the financial pressure on the NHS may limit hiring in these sectors.

Policy and regulation

In response to these challenges, NHS leaders have emphasised the importance of policy adjustments, including improved funding for community care services. Upcoming consultations are expected to address these gaps, with a focus on ensuring that individuals receive care in the most appropriate settings.

Numbers that matter

• 30%: Increase in end-of-life care admissions reported in Sussex hospitals compared to last year.
• 12: Average number of patients receiving end-of-life care in A&E corridors daily.
• 20: Percent reduction in hospice funding reported in 2023, impacting community care availability.

Definitions and jargon buster

• Palliative Care: A specialised medical care approach that focuses on providing relief from symptoms and stress of a serious illness.
• End-of-Life Care: Support and medical care given during the time surrounding death.
• A&E: Accident and Emergency department in hospitals where emergency cases are treated.

How to think about the next steps

Near term (0–4 weeks)

Health leaders are expected to implement immediate strategies to alleviate pressure, including reallocating resources and increasing community care support. Anticipate announcements regarding funding adjustments and collaborative efforts among hospitals and local services.

Medium term (1–6 months)

Policy changes may be introduced to enhance funding for hospices and community care services. This could lead to improved support for end-of-life patients, allowing more individuals to receive care in their preferred settings.

Signals to watch

• Monitoring funding announcements from the NHS and government regarding healthcare services.
• Updates on patient transfer times and bed availability in hospitals.
• Changes in community care service provision, particularly from hospices.

Practical guidance

Do

• Stay informed about local community care options and hospice services.
• Engage with healthcare providers to understand available end-of-life care resources.

Don’t

• Don’t assume that hospital care is the only option for end-of-life situations.
• Don’t hesitate to ask healthcare providers about community support and resources.

Checklist

• Review local hospice availability and services.
• Understand your rights regarding end-of-life care preferences.
• Communicate with family members about care wishes and preferences.
• Explore options for at-home care and support systems.

Risks, caveats, and uncertainties

As the situation evolves, uncertainties remain regarding the availability of community care services and the extent of funding support from the government. Potential delays in policy implementation could exacerbate the existing crisis. Additionally, the ongoing strain on hospital resources may lead to variations in care quality across regions.

Bottom line

The increasing number of end-of-life patients in hospitals raises significant concerns for the NHS, particularly as winter approaches. With pressures mounting, it is crucial for health authorities to seek immediate solutions to ensure that all patients, regardless of their needs, receive appropriate care in the right settings.

FAQs

What is the current situation regarding end-of-life care in hospitals?

The rising number of end-of-life patients is placing significant stress on NHS services, making it difficult for patients with treatable conditions to receive timely care.

How are hospitals managing the crisis?

Hospitals are prioritising patients with complex needs and are working to improve community care services to alleviate pressure.

What can families do to ensure proper care for their loved ones?

Families should explore local hospice services and communicate preferences for end-of-life care with healthcare providers.