NHS Reset: Why we can no longer neglect the palliative care sector

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic.

In this blog Heidi Travis, Chief Executive of Sue Ryder, discusses the impact of delays in medical diagnoses and treatments on the numbers of people needing palliative care over the next 24 months, and makes the case for sustainable statutory funding for hospices. The blog is part of a series of comment pieces from NHS Confederation members and partners.

Adapting quickly so we can be there when it matters

Sue Ryder supports people through the most difficult times of their lives. Whether that’s a terminal illness, the loss of a loved one or a neurological condition, we’re there when it matters. Our doctors, nurses and carers give people the compassion and expert care they need to help them live the best life they possibly can. The expert palliative care we provide has proven crucial in the country’s response to COVID-19. We have supported the NHS by increasing our Hospice at Home community service provision, freeing up much-needed hospital beds and relieving pressures on the wider system. 

The long road ahead

However, the battle against COVID-19 is far from over for palliative care providers. With thousands of NHS treatments for life-threatening conditions postponed or cancelled during the pandemic, we are anticipating a surge in the need for palliative care services. Before the pandemic struck, there was already a growing preference among the public to receive end-of-life care in a hospice setting or at home, rather than in a hospital. This has prompted Sue Ryder to begin planning for an increase in need for palliative care over the coming months and years.

Our most recent research has revealed concerning findings regarding potentially serious symptoms going unchecked during lockdown. One third (34 per cent) of the public said that they, or somebody they know, have delayed seeking medical advice or treatment because they do not want to put pressure on the NHS or risk catching COVID-19. Such delays in diagnosis and accessing treatment are worrying because they further reduce chances of survival. Coupled with the fact that over three quarters (76 per cent) of people now want to receive end-of-life care in either a hospice or at home, it is clear that we should expect an increase in the number of people needing our care.

Reset is long overdue

The COVID-19 pandemic has shown that the government recognises that specialist palliative care providers are a vital part of the integrated health and care system. Yet, without a sustainable funding agreement for hospice services, the predicted increase in need could quickly become overwhelming for the palliative care sector as a whole. 

We cannot resume business as usual when the system of commissioning specialist palliative care was already unsustainable. Adult hospices in the UK receive, on average, just one third of their costs from the NHS; the remaining gap between statutory funding and expenditure is fundraised. Commissioning of hospice care lacks a coherent national funding model and local models of provision are not often updated to reflect changing local population needs. Despite the introduction of end-of-life care currencies in 2017, uptake by CCGs is very limited.

The lack of an agreed model has resulted in different levels of funding across the UK and from provider to provider. The government acknowledged this in 2016, committing in the Choice Review to end the variation in end-of-life care across the health system by 2020. Even before COVID-19, hospice providers overwhelmingly indicated that levels of funding were not fair or sustainable. What’s more, the increasing rate of multi-morbidities at the end of life as a result of the ageing population is placing further pressure on the palliative care system. 

Match ambition with funding

As we work in collaboration with national stakeholders, including the Ambitions Partnership and NHS England and NHS Improvement, to improve specialist palliative care provision, we will continue to argue for a long-term sustainable funding agreement, and for reform of the commissioning model for specialised palliative care. 

The review of the Ambitions for Palliative and End-of-Life Care later this year, is a welcome opportunity for the government to review progress against its commitment to prioritise and improve end-of-life care. The government must start planning now to increase statutory funding and transform the model of commissioning in order to relieve the pressures facing palliative care services across the country. This is vital to ensure Sue Ryder and the entire palliative care sector can continue to be there for people at the end of their lives.

This blog was first published by NHS Confederation as part of their NHS Reset campaign. For more information, visit their website.

Photo of Heidi Travis

Chief Executive - Sue Ryder

Heidi Travis