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End of life care at home: the Cinderella service of the pandemic

Hospice and community-based nursing care deserves more recognition and funding – Marie Curie 
glove hands of a healthcare worker placed on hand of a patient

Deaths at home increased dramatically during COVID-19, but end of life and palliative care services faced staffing and PPE shortages as a result

End of life care at home and in hospices was not viewed as an essential service and was compromised by staffing and equipment shortages in the pandemic, a report found.

Marie Curies Better End of Life report said 91,000 more people died at home in 2020 than the five-year average of 604,000. The charity attributes this partly to patients choosing to stay at home because of hospital visitor restrictions, and to closure of hospice beds for infection-control reasons.

Staffing shortages among providers of care at home

In addition, community end of life services

Deaths at home increased dramatically during COVID-19, but end of life and palliative care services faced staffing and PPE shortages as a result

glove hands of a healthcare worker placed on hand of a patient
Picture: iStock

End of life care at home and in hospices was not viewed as an essential service and was compromised by staffing and equipment shortages in the pandemic, a report found.

Marie Curie’s Better End of Life report said 91,000 more people died at home in 2020 than the five-year average of 604,000. The charity attributes this partly to patients choosing to stay at home because of hospital visitor restrictions, and to closure of hospice beds for infection-control reasons.

Staffing shortages among providers of care at home

In addition, community end of life services faced staff shortages, according to the charity’s survey of 277 UK hospice and other providers between April and July 2020.

Inadequate staffing was reported across the UK, but were most common in Wales and London, where 60% of providers reported staff shortages. This was attributed to nurses being redeployed, or needing to shield or self-isolate.

Supplies of personal protective equipment for hospices and palliative care providers were also affected, with up to 61% of services in some parts of the UK experiencing shortages.

A common theme among those reporting trouble procuring PPE at the beginning of the pandemic was not having parity of esteem with other, front-line services.

‘As we are not classed “front-line NHS” we were unable to access masks and gowns from our local NHS board. This was less than satisfactory for seven weeks, however this has now been resolved,’ a provider in Scotland said.

Funding for end of life care in the community

Julie Pearce, chief nurse at the charity Marie Curie
Julie Pearce, chief nurse at Marie Curie

Marie Curie is calling for the UK’s palliative and end of life care services, whether in the NHS or not, to be properly resourced, insisting these services be seen as an ‘essential’ part of the COVID-19 response.

The charity’s chief nurse and executive director of quality and caring services Julie Pearce said: ‘The hidden story of the pandemic was the sheer number of people who died at home.

‘The challenge now is to ensure home and community-based care is properly recognised and funded. Everyone has a right to end their lives well, with the people they love and the support they need.’

RCN community and end of life care lead Carolyn Doyle said the government must prioritise community services.

A Department of Health and Social Care spokesperson said funding had been put in place to support end of life care during the COVID-19 pandemic including providing free PPE to hospices and social care providers until March 2022.


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