Senior medics have called for dying patients to have 24/7 access to specialist end of life care after it emerged that most hospitals only provide telephone contact after hours and others have no specialists at all.
The call follows a report into NHS care of people dying in hospital, which found that patients who die overnight or at the weekend may not have access to the right care because only 11% of hospital trusts in England provide specialist palliative services round the clock.
Amanda Cheesley, the Royal College of Nursing’s professional lead on end of life care, said hospitals should be providing end of life care at all times. “Absolutely [there should be a palliative care specialist on hand all the time],” she told BBC Radio 4’s Today programme.
“With the best will in the world, general training does not give you the additional skills you need if someone has complex needs or the medication or treatment is no longer working and you have done everything you possibly [could] have done.”
The audit of end of life care by the Royal College of Physicians (RCP) and Marie Curie, which analysed the care of more than 9,300 patients, found that there had been “a broad front of improvements in nearly all aspects of care of the dying in hospitals” after the controversial Liverpool Care Pathway was abolished.
However, it also found that less than a third of patients were reviewed by a member of a specialist palliative care team within 24 hours of admission to hospital.
Cheesley said specialists did not necessarily require highly technical skills. “They need to be providing people who are dying and their families with the assurance and the confidence that people looking after them are well trained, are confident in what they are doing and are competent and are kind, nice people.
“An awful lot of this is about people keeping an eye on someone, hearing what they want and making sure that they get it.”
Prof Sam Ahmedzai, clinical lead for the end of life audit report on behalf of the RCP, said help was usually available, but it may not be face to face. “The vast majority of hospital trusts do provide telephone service[s] around the clock. People on the wards can get hold of advice on the telephone.”
It would be a significant investment to provide 24/7 palliative care, he said. “It costs money to have a rotation of five or six junior doctors, five or six consultants, on call for a population of half a million.
“Put that across the country, to go from the position we are in now to having 24/7 services does require a lot of new investment or reinvestment.”
Ahmedzai said specialists were needed not just for medical reasons, but also as emotional support for patients and families. “When it comes to sitting down, putting a hand on someone and talking face to face, soul to soul, that requires a special kind of person and that requires them to be available round the clock,” he told the BBC.
“And also for family members as well, often the patients are too ill for communication but family members are needing that.”
Another key concern in the report was the access patients had to basic things to give them comfort, including drinking water. Only 10% of dying patients in some hospitals were assessed as to whether they needed help consuming fluids, the audit found.
Cheesley said giving patients access to drinking water was often a highly emotive issue, which families found particularly distressing. “I know that sounds counterintuitive when people express that they are thirsty, but there is a fear that if you do give them something to drink, they are going to choke, and people who are dying quite often do choke,” she said.
“And also people who are dying, or some people, really don’t want to have anything to drink. I cared for my sister when she was dying with her family. And her family were absolutely distraught when she no longer wanted anything to drink and it’s very difficult to persuade people that this is [what happens in] the end of dying phase sometimes.”
