MPs: Let more patients die at home

Hundreds of thousands die in hospital every year despite the fact they would rather die at home, according to a report out today.

Patients suffering from devastating conditions such as cancer cannot always die at home surrounded by friends and family because they are hindered by the NHS and social care system, it said.

The report, from the Commons Public Accounts Committee, said there was often no clinical need for them to be in hospital, but sometimes there is no other choice.

It also found that co-ordination between health and social care services in relation to end of life care is "generally poor".

One example is care homes, where staff may feel ill-equipped to care for dying people and send them to hospital, or refuse to take residents back after a hospital stay.

Figures show that around half a million people in England die each year, with three-quarters dying after time spent with a chronic illness such as cancer or heart disease.

In 2006, only 35% of people died at home or in a care home, while around 60% of deaths occurred in an acute hospital.

The report said: "Most people express a preference to die at home but 60% die in an acute hospital, even when there is no clinical need for them to be there.

"People should have the right to die in the place of their choice."

The group of MPs noted that people who die in hospital are not always treated with dignity and respect, and called for NHS trusts to employ specialist palliative care teams.

They said common problems in hospitals "include poor support for basic comfort; a lack of privacy for the patient and their family; poor communication by staff; and staff recognising too late that somebody is at the end of their life."

The report said NHS trusts should agree plans, as set down in the Department of Health's end of life strategy last year, to increase the number of community teams that can help people die at home or in nursing homes.

The Government wants to see access to 24-hour district nursing as well as advice and medication out of hours to help reduce the number of hospital admissions.

Today's study also found a lack of education and training in basic end of life care among NHS staff.

"Improving the skills of health and social care staff should be a priority," the report said.

"In particular, the department should work with the relevant professional bodies to put in place appropriate training."

It also raised concerns that an extra £286 million pledged by the Government to improve end of life care was not ring-fenced and may not be used as intended by hospital trusts.

"The department should require primary care trusts to account for how the additional funding is spent," the study said.

Tory MP, Edward Leigh, chairman of the committee, said: "Most people die in hospital, even when there is no medical need for them to be there.

"Many would prefer to die at home. But because of the poor co-ordination of health and social care services for the dying, the wishes of people approaching death are often not known.

"And, even where the wish to die at home is clearly communicated, it often cannot be satisfied because of the lack of services for caring for people dying at home."

He added: "It is appalling that people dying in hospital are not always being given the end of life care they deserve, including effective pain management and being treated with dignity and respect.

"People approaching the end of life have as much right to quality of life as anyone else."

The report comes as it emerged nurses are to be sent advice by the Royal College of Nursing (RCN) on what to do if patients ask for advice on helping them die.

The union says more and more nurses are being asked for advice on how to end a life.

The guidance, which will be formulated this summer following a consultation with nurses, will state that it is illegal to give patients advice on assisted suicide.

It will also suggest the types of counselling that patients can undergo if they feel like ending their life.

The union is currently opposed to assisted suicide.

RCN head of policy, Howard Catton, said the advice was needed because of the publicity over clinics like Dignitas in Switzerland, which help people commit suicide.

Phil Hope, Minister for Care Services said: "People coming to the end of their lives deserve high-quality, compassionate and dignified care, on their own terms.

"Many people receive excellent care at the end of their lives and we are investing a total of £286 million between now and 2011 to make sure we improve end of life care for all adults, regardless of where they live.

"End of life care is a priority in the operating framework for the NHS and guidance issued to Primary Care Trusts has made it clear that we expect the extra funding to be used for end of life care services.

"The NHS locally should have proper monitoring in place to make sure this happens."