Palliative care: fourth report of session 2003-04; volume 1; report together with formal minutes

Currently, around 56% of people die in hospital, 20% at home, 20% in nursing or residential homes and 4% in hospices. Yet surveys suggest that the majority of people would prefer to be supported to die in their own homes. We note the recent economic analysis which Marie Curie has produced of the potential cost benefits arising from a shift towards more patients dying at home and recommend that the Department assesses this carefully. We welcome the fact that the Government is considering legislation to grant extra rights to carers and recommend that it provides for a period of paid leave for them. We recommend that the Department reviews the place of domestic support within the spectrum of social care services and ensures that people’s needs for domestic help are adequately met. We were concerned to note the variation in the criteria for continuing healthcare between Strategic Health Authorities and recommend that national criteria for continuing care should be developed. Many of our witnesses drew our attention to disputes between health services and those providing personal social care for the terminally ill. Unseemly arguments about who should pay for different elements of a care package are especially abhorrent in palliative care, and we call for an integrated structure in the delivery of care. We also seek the inclusion of hospices or specialist care units in the ambit of the Community Care (Delayed Discharges etc.) Act to ensure that higher priority is not attached to other patients in dealing with delayed discharges.