A million NHS bed days

People
ViewsDecember 1st, 2014

Most of us don’t like to think about death or dying, whether our own death or that of our friends and relatives.  But every year in Wales about 32,000 people do pass away, many of them from conditions that cannot be ‘cured’ but which do need some sort of specialist care to manage symptoms such as pain or dehydration.

Our research with Marie Curie Wales looked at the data collected by the NHS itself, on the health care received by all people in their last 12 months of life.  Although we recognise the very real progress made in the provision of palliative care and the additional recent investment, the findings are nevertheless a wake-up call to the NHS in Wales.

The first important point is that people in the last 12 months of life account for nearly a quarter of all usage of NHS hospital beds – 1 million bed days to be precise.  On average, someone spends more than a month (33.9 days) of their precious final days in hospital, and is admitted on average 2.13 times.  People with cancer have more admissions but shorter stays than people with other conditions.

At first sight this might not seem to be a problem – surely that’s what hospitals are there for? Well yes and no. Hospitals are not necessarily the best place for people to be in their final months of life – their condition may not be treatable, their symptoms may be equally or even better managed outside hospital, and hospital environments bring their own risks of loss of independence, infection and so on. When asked, the majority of people would rather die at home than in a hospital.

Palliative care provides the practical and emotional help people need in their last few days and months of life.  It is estimated that about three-quarters (69 – 82%) of all people who die would benefit from palliative care, with people with complex needs requiring specialist care.  In Wales (as in England) we are  a long way from reaching this gold standard.  Despite improvements, only 17% of people receive specialist palliative care in their last year of life, with it being highly unlikely that general palliative care (e.g. that provided by GPs or ordinary medical and nursing staff) make up the shortfall in provision.

Even more striking is that access to specialist palliative care is highly uneven – it depends on what condition you have, how old you are and which health board you live in.  So:

  • people with cancer are nine times more likely to receive specialist palliative care than people with non-cancerous conditions, even though they might benefit from such care;
  • people with some cancers are much more likely to receive specialist palliative care than others – 60% of women with genital cancers receive specialist palliative care compared with 40% of males with genital cancers for example.
  • the older you are the less likely you are to receive specialist palliative care – whether you have cancer or another condition.
  • which health board provides care makes a huge difference – for example of people with cancer 58% in Cwm Taf received specialist palliative care compared with 38% in Betsi Cadwaladr.

Surprisingly, the deprivation of the area people lived in doesn’t seem to make a difference. If this is the case, then Wales has bucked an international pattern of which it should be proud. It also suggests that the difference between health boards is not because of differences in the deprivation of their population but for other reasons e.g. different policies and practices.

This work raises some interesting questions for the Welsh NHS. First, it is clear that a considerable reduction in the emergency use of hospital beds by people in their last year of life ought to be achievable and we recommend that this is a priority. Second, action is needed to improve access of older people and people with non-cancer diagnoses to specialist palliative care. And third, there needs to be an investigation into why there is such variation between health boards.

The report is available here.

Victoria Winckler is Director of the Bevan Foundation and co-wrote the report.  

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