Independent review calls for universal end-of-life care standards

In collaboration with the Press Association

A government-commissioned review has called for a new funding system to be introduced to improve the standard of end-of-life care and reduce regional inequalities in access to services.

The Palliative Care Funding Review, chaired by Thomas Hughes-Hallett, found that many people are unable to die at home because of a lack of 24-hour nursing care in their area.

At present, some primary care trusts (PCTs) spend in excess of £6,000 per patient on end of life care, while others spend as little as £186 per patient.

The review estimated that, as a result, more than 90,000 people do not have their palliative care needs met.

It concluded that a fairer funding system should be brought in to enable more people to die in the place of their choosing.

In addition, a national payment structure would help to address existing inequalities and could save the state millions of pounds.

The review proposes a "fair and transparent" funding system, where the level of funding would be based on an individual's needs, age and capabilities.

This means that a patient's funding would no longer be influenced by the area in which they live.

Mr Hughes-Hallett said: "No other country in the world has introduced such a system for both adults and children, so the step is both a bold and necessary one."

He explained that reforming the system would enable funding to be based on the needs of individuals, provide better outcomes for patients, and provide better value for the NHS.

"Basing the funding model on a needs classification system would ensure that the funding follows the patient in a fair and transparent way, as the level of funding provided to a service would be determined by the complexity and level of need of the patients," he added.

Professor Sir Alan Craft, advisor to the review, urged the government to act on the recommendations.

He revealed: "Evidence shows us that incentivising the provision of palliative care leads to better outcomes for patients, supports choice and is the most cost-effective way of using NHS resources.

"We need to remove the barriers within the current system to enable this to happen."

Care services minister Paul Burstow told BBC Radio 4's Today programme that the system needs to be "much better".

He noted: "There may well be a number of costs to managing a transition from where we are now, which is a model that does not deliver good experiences and good quality care.

"We have some excellent palliative care in this country but not everyone gets it. This report does give us a very good road map to transform the service."

Martin Ledwick, head of Cancer Research UK's Information Nurse service, said: "The Department of Health introduced an 'End of Life Care Strategy' in 2008. Worryingly, this independent review shows that many of the strategy's recommendations have yet to be implemented. We now need to find out whether this is due to organisational problems, or regional variation in palliative care resources.

"It is vital that patients can choose where and how they are looked after at the end of their lives. If they want to be cared for at home, there need to be adequate specialist services to allow them to end their days comfortably, safely and without feeling abandoned and alone."