Palliative care postcode lottery and wide variations in budget per patient

3rd April 2017

No one wants to live with the uncertainty that the care received by a loved one as they approach the end of life is dependent upon the postcode lottery of where they happen to live. However, considering the fact that end of life care is an inevitability for many people living in the UK, recent research has found a worrying lack of consistency in the provision of palliative care services across England.

Palliative care often involves the management of complex terminal conditions, and this requires the involvement of staff with specialist knowledge. The conditions of people approaching the end of life do not adhere to normal working hours, and often their needs and requirements differ considerably according to the wishes of the individual. Therefore it is critical that patients have access to palliative care teams with the requisite training who are available on a 24/7 basis and who will have the resources to ensure that patients experience responsive and personalised end of life care.

A new study1 published in BMJ Supportive and Palliative Care has found a large degree of variation in the palliative care services provided by Clinical Commissioning Groups (CCGs), resulting in inadequate services and notable differences in provision for people with palliative care needs in their areas. The data also reveals that many CCGs do not consider palliative care provision to be a core service in some parts of England, despite the evident and long-lasting distress caused to patients and carers by poor palliative care received at the end of life.

After receiving freedom of information requests in 2015, all 209 CCGs in England were asked to submit responses to a questionnaire covering population size, allocated palliative care budgets, number of specialist palliative care beds, provision of specialist out-of-hours services, provision of specialist support teams, education and training and future plans for palliative care services.

The findings of the research paper, after early analysis from the National Council for Palliative Care (NCPC), reveal the discrepancy of the palliative care services available for patients according to where they live:

Budgets for palliative care ranged from £51.83 to £2,329.19 per patient per year according to individual CCGs;

83% commission 7-day specialist palliative care services in patients’ own homes, although out-of-hours support relies heavily on hospice services.

31% commission 7-day pain control teams, but it is still unclear whether these operate outside regular working hours.

68% reported commissioning palliative care education for healthcare professionals, but there is a huge amount of variation in the type and amount of educational support.

Only 16% of CCGs consider end of life care a priority and 45% of CCGs do not have plans to update or review their palliative care services.

As a result of this research, a team led by Baroness Ilora Finlay is calling on the government to prioritise the National Commitment on End of Life Care, which was launched in July 2016.

The paper can be accessed here: http://spcare.bmj.com/content/early/2017/02/28/bmjspcare-2016-001119

  1. Lancaster H, Finlay I, Downman M, et al, Commissioning of specialist palliative care services in England, BMJ Supportive & Palliative Care. Published Online First: 28 February 2017. doi: 10.1136/bmjspcare-2016-001119