Shortage of district nurses prevents dying people from remaining at home

Lack of community palliative care resources means too many patients have to spend their final days in hospital, say MPs

A shortage of district nurses is preventing many patients from fulfilling their wish to die at home, a report by MPs has revealed.

The Commons health committee, which has been examining end of life care following the withdrawal of the Liverpool Care Pathway, found ‘great variation in quality and practice across both acute and community settings’.

It has called on Health Education England to set out how it will address the shortfall of community nurses to ensure more people are able to die at home in the future.

The inquiry found that just 21% of people die at home, despite 63% expressing a preference to do so. Fifty-three per cent of people die in hospital even though a study by the Cicely Saunders Institute found hospitals to be the least-commonly preferred place of death.

Committee chair Sarah Wollaston said: ‘The care people receive at the end of their lives has a profound impact not only on them but also on their families and carers. At the most difficult times, their experience will be made worse if they encounter poor communication and planning or inadequate professional expertise.’

The committee said too many staff lacked the confidence, skills and training to communicate positively with people about palliative and end of life care, and more training was needed.

RCN survey findings, submitted to the inquiry, found just 10.5% of nurses felt they were able to deliver the right level of care to individuals, while almost 70% had witnessed people being admitted to hospital at the end of life, against their wishes, because of a lack of resources in the community.

The report states that all clinicians and providers of end of life care should be aware of the government’s new Five Priorities of Care approach to end of life care and that a senior named person in each NHS trust should take responsibility for monitoring how end of life care is given.

Further details: read the Commons health committee report

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