Families will be expected to provide end-of-life care to relatives dying at home during the crisis, according to NHS England guidelines that have raised safeguarding concerns among experts.
According to the new standard operating procedure for community health services, families will be asked if they can provide care that until now has been provided by GPs, community services and specialist palliative care teams.
“During the coronavirus pandemic, there will be more people dying of coronavirus at home who will also require care and support at the end of their lives,” says the guidelines.
“The anticipated increase in demand and stretch in workforce availability means that there will have to be a greater reliance on family members, unpaid carers and those who are with these patients, to help provide the care,” it adds. “They may have to administer medication more than they are used to.”
To help manage the health needs of people at the end of life, specialist palliative care advice usually available only to GPs will be made accessible to those caring for loved ones dying at home.
Additional information to support family carers is being developed, the guidance says. In the meantime, it provide links to two documents, including a toolkit, which give step-by-step instructions to help those caring for someone dying at home.
The documents instruct family members how to insert and use cannulas to inject medication under the skin if the dying person is experiencing pain and other symptoms not controlled by their regular medication.
Strong pain medications such as opioids, often used to manage pain, will be issued to families. But concern has also been raised about relatives of vulnerable people having to administer high doses of drugs such as morphine without sufficient oversight.
There is also concern that enough checks will be made to ensure the opiates are not used by those other than the patient.
“The guidance talks about delivering palliative care remotely, but how is that possible?” said Caroline Abrahams of Age UK. “In a valiant and right attempt to protect NHS staff from contracting the virus, people are being left on their own when they need support.
“Where are the safeguarding measures to stop people being bumped off?” she asked. “Helping someone die well is a specialist skill set. Unfortunately, it feels is thought people have been left to get on with it when a reasonable expectation of our society is that we get skilled palliative care.”
Dr Richard Vautrey, the GP committee chair at the British Medical Association, said families had not previously been asked to take on end-of-life care. “But as we have seen across the health and care system, processes are having to change and adapt in the face of what is an unprecedented situation,” he said.
“Of course, it would only be done when individuals had the ability to do it safely and with supervision – albeit remotely in most cases. Only family members who are willing and able would be asked to do this – no one should be compelled to do so.”
Prof Martin Marshall, the chair of the Royal College of GPs, said: “We understand it is a distressing time for people whose loved ones are sick and if appropriate, we will support families and unpaid carers to safely take on elements of an individual’s care, such as administering medicines.
“Covid-19 is more than an NHS issue – it will take a nationwide effort to get through this crisis and so far, we’ve seen a tremendous effort from our patient’s families and friends. Where families are not comfortable taking on elements of their loved one’s care, this will be respected.”
An NHS spokesperson said: “It is already common practice for people who are willing and able to help care for family members receiving end-of-life care, supported by expert clinicians and with the right training, and just as is already the case no one will be asked to do things they cannot, or do not wish to, do.”
