End of life care delays are stopping inpatients from dying at home

Fast-track Continuing Healthcare framework is not fast enough.

Fast-track Continuing Healthcare framework is not fast enough

Marie Curie director of nursing Dee Sissons says nurses are in the best position to identify patients who are deteriorating rapidly​. Picture: Marie Curie

Charity Marie Curie is urging nurses to be advocates for terminally ill patients who may benefit from a fast-track service that helps them receive care at home.

The charity found that people who are terminally ill are dying in hospital because of delays in availability of the Continuing Healthcare package.

48-hour time frame

Continuing Healthcare enables adults in England to recieve care outside hospital. Some individuals are placed on a fast-track route – recommended to take place within 48 hours – to enable people who are terminally ill to return to their own home or care home.

But a Marie Curie report has raised concern that the service is not operating quickly enough. In some cases, people are being delayed in hospital, and potentially dying there, while they wait for the care package to be put in place.

Waiting for days

The charity estimates that in 2015-16 as many as 57,000 people waited longer than two days for a package of care, of which 25,000 were waiting longer than a week.

Marie Curie director of nursing Dee Sissons said: 'While nurses may be involved in the multidisciplinary team assessment of dying patients who could be cared-for in the community, their most important role often lies in being in the best position to identify when patients are rapidly deteriorating in the first place and are therefore eligible for fast-track Continuing Healthcare.

'The sooner this assessment is made, the sooner the process of getting patients out of hospital can begin.

'This can be a major challenge for nurses who are subject to the pressures of a busy ward. They might need to balance monitoring a seriously ill patient with making sure the patient in the next bed gets their drugs or is ready for theatre. Identifying when someone is rapidly deteriorating can be further complicated where the disease trajectory is less predictable. More training is needed to ensure all nurses are able to recognise these signs and act on them.'

Unanswered questions

Marie Curie sent Freedom of Information requests to NHS organisations to ascertain how many people received fast-track care within the recommended time. No NHS trust responded in full to the charity's questions and only 28% provided partial responses.

Only 22% of clinical commissioning groups (CCGs), responded in full to the data request, with a further 27% giving partial responses. Of the respondents, just 28% were able to provide Continuing Healthcare within an average of 48 hours and almost one third had average waiting times of more than a week. Some CCGs said patients waited more than two weeks to leave hospital.

Julie Wood, chief executive of NHS Clinical Commissioners, which represents CCGs, said she recognised the Continuing Healthcare framework was 'too complex'.

She added: 'This is why we are working with NHS England to simplify the framework and make sure it is consistent.'

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