When thinking about the end of life, many people would prefer to die at home. However, half of deaths occur in hospital. This is often due to a lack of in-home and community-based support. The provision of palliative care to provide comfort and improve quality of life frequently happens at a late stage in the process because the mechanisms to ensure timely access are not in place.
There has been a significant rise in demand for end-of-life care due to a variety of factors, including a rapidly ageing population and an increase in the number of people living with multiple, complex, long-term conditions. The UK's population is ageing and it is estimated that, by 2050, one in four people will be aged 65 years or over (Morgan, 2019).
In order to meet this demand, the total cost of hospice provision of palliative care services in England will average £947 million per year over the next 10 years (Sue Ryder, 2021). If current trends continue, then hospital-based palliative care costs may reach £4.8 billion by 2043 (Thomas, 2021). Care homes are likely to become an increasingly important setting for palliative care.
A collective response is needed to address the demand for palliative and end-of-life care. The will, determination and innovation of organisations working in a collective way to identify new ways of delivering better end-of-life care can and will make a difference. A key challenge for nurses and others is to work together, collectively, co-operatively and in partnership to achieve high-quality palliative and end-of-life care. Organisations that represent health and social care, statutory and voluntary bodies, and people with personal and professional experience, must come together and speak with one voice.
The ageing process, death and dying are inevitable. Palliative and end-of-life care must be seen as a priority by those who are commissioning services, as well as those who have influence over the provision of care for people as they approach the end of their lives. The needs of people who are living with dying, death and bereavement, families, carers and communities have to be addressed, with their priorities and preferences taken into account.
In England, integrated care boards have a duty to commission, monitor and oversee health services, including palliative and end-of-life care. The Care Quality Commission has a duty to monitor, inspect and regulate palliative and end-of-life services provided by community health services.
A key challenge is related to funding. Around a third of funding for palliative care services is provided by the NHS, the rest is funded through fundraising and donations. The COVID-19 pandemic interrupted fundraising activities, this put the provision of care at risk. The financial sustainability of the provision of palliative and end-of-life care is clearly precarious, and this must be a concern.
Patient demand continues to outstrip the recruitment and retention of NHS staff. District nurses provide generalist palliative care in the community, but the number of NHS district nurses continues to reduce. Nurses and other health professionals need support and education to help them develop further their competence and confidence in caring for people who require palliative and end-of-life care and their families. The provision of education and training has the potential to improve knowledge, confidence, competence and openness, as well as reducing work-related stress.
Bespoke, supportive palliative and end-of-life care is essential. A collective approach can help to drive down health inequalities. Service providers must include fair access to care provision as well as maximising comfort and wellbeing (NHS England, 2022). Nobody who needs palliative and end-of-life care is to be left behind.