Despite many people expressing a preference to die at home, half of deaths occur in hospital. Often this is 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 owing to a variety of factors, including a rapidly ageing population and an increase in the number of people 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 care will, and can, make a difference. A key challenge for nurses and others is to work together, collectively and co-operatively, to achieve high-quality palliative and end-of-life care. This will require organisations and individuals to work differently. 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.
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 living with dying, death and bereavement have to be addressed, with their priorities, preferences and wishes taken into account.
In England, Integrated Care Boards have a duty to commission, monitor and oversee health services, and this includes palliative and end-of-life care. The Care Quality Commission has a duty to monitor, inspect and regulate health and adult social care. This incorporates the inspection of palliative and end-of-life services provided by community health services.
A key challenge is related to funding. Around one 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, which put the provision of care at risk. The financial sustainability of the provision of palliative and end-of-life care is clearly precarious with much variation across the UK 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 their numbers continue to reduce.
Nurses need support and education to help them further develop their competence and confidence in caring for and communicating with people who require palliative and end-of-life care and their families. Education and training have the potential to improve knowledge, confidence, competence and openness, as well as reducing work-related stress.
Bespoke palliative care, which has the potential to improve support for people, including those who are bereaved, is essential. A collective approach can help 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.