Hospitals warned end-of-life care crisis threatening treatment

A growing number of end-of-life patients in hospitals could affect the level of treatment carried out this winter, a group of regional NHS leaders have said.

A palliative care consultant highlighted the looming “crisis” during an internal online meeting of health leaders in Sussex, a recording of which was heard by the BBC.

The University Hospitals Sussex NHS Trust consultant has described the dilemmas hospital managers face when some patients have to receive end-of-life care in A&E corridors.

This grim assessment is likely to be echoed in other parts of the NHS as increasing winter pressures increase the challenge of finding hospital beds for sick patients in need of care.

Sussex Trust University Hospitals include Worthing Hospital, Royal Sussex County Hospital, St Richard’s Hospital in Chichester and Princess Royal Hospital in Haywards Heath.

Doctors and managers from East Sussex Healthcare NHS Trust, which includes Conquest Hospital in Hastings and Eastbourne District General Hospital, also attended the meeting along with representatives from community health.

The consultant gave a slide presentation titled “Palliative and End of Life Care in Sussex” at the meeting which took place on November 4.

She told the audience that local hospices were struggling and it was difficult to find places for patients who needed end-of-life care, and that it was sometimes unclear what support there might be in the local community when people were sent home.

She said: “I’m really concerned that patients with treatable illnesses won’t be able to get into hospital and be treated because there are so many end-of-life patients in hospital beds. »

She added that “we are no longer putting patients on the transfer waiting list who are simply dying”, focusing only on those with complex needs.

On improving palliative care in emergency departments, the consultant said it was a “really difficult choice: admit them for treatment in the corridors or turn them around, put them in the back of the ambulance where they risk dying on the way home”.

She argued there were “a lot of patients in hospital who don’t need to be there, a lot of patients with complex needs and their needs aren’t being met.”

She concluded: “We all knew this crisis was coming – it’s getting worse and worse.”

A Sussex NHS spokesperson said it was committed to ensuring patients had access to the “best possible, high quality palliative and end-of-life care”.

They said: “This includes providing a range of settings for compassionate, person-centred care – and importantly, where possible, outside of hospitals, such as community settings and our hospices.

“Sussex’s urgent care services remain under significant pressure, but staff continue to work incredibly hard to ensure patients can receive the care they need in our hospitals and across all our health and care services.

“Strong partnership work is in place over the winter period to support individual care plans and to ensure people receive the right NHS service to suit their needs. »

But the Royal College of Emergency Medicine said late discharges were a huge challenge in the NHS, and a lack of social or community care could mean some patients needing end-of-life care and support would not be able to leave hospitals.

Its president, Dr Ian Higginson, said the university was “concerned about the number of patients requiring end-of-life care who end up in emergency departments and then hospitals because the dedicated services they need are not available”.

He said: “Patients who would prefer to stay at home risk ending up in our corridors, which are not appropriate places for anyone, least of all those who are at the end of their lives. »

Meanwhile, community services are also under strain and hospices are warning of a funding crisis.

Toby Porter, chief executive of Hospice UK, said: “We know how hard staff across the NHS and care system work to give people at the end of their lives the care they deserve.

“But while hospital may be the right place for some, a busy ward is simply not the right place for most people who die.

“Hospice centers across the country want to provide more care to the community, but this year we’ve seen their budgets cut due to financial constraints. And that’s having a ripple effect on hospitals.”