Critically ill ‘should not be made to die away from home’

This article was taken from: Toby Helm Political editor

By

Better funded end-of-life care would be fairer and cost less, says IPPR report

One in three people who die in hospital could spend their final days at home if the government introduces and adequately funds a modern community-based health and social care system, a new report says.

The Institute for Public Policy Research (IPPR) says that, while most people would prefer to die at home or in a good care home, they are often unable to do so because of inadequate and underfunded local care.

The researchers analysed investment in long-term care in several European countries, and concluded that there appears to be a correlation between funding levels, modern systems and the proportion of people dying in hospitals. Citing 2017 data from the Survey of Health, Ageing and Retirement in Europe, covering 28 countries, IPPR found the proportion of people dying in hospital in England (47%) was higher than in many EU states, with people dying at home (23%) the second lowest after Sweden and the Czech Republic (22%).

If funding were increased to match that in countries with the lowest rates of deaths in hospitals and the most up-to-date systems – such as the Netherlands – IPPR argues, up to a third of those who currently die in hospital could be at home or in a care setting. Data for England cited in the report also shows marked regional variations, with more people dying in hospital in poorer areas. While 49% died in hospital in the north-west and West Midlands, the proportion was 43% in the south-east.

“Taken together,” the report says, “the variation in hospital deaths between European countries and within England suggests there is significant scope for policy to reduce the proportion of people who spend their final days in hospital, and in doing so potentially develop a model for end-of-life care that is of higher quality and lower net cost to the taxpayer.”

Around 60% of those who reported poor care experienced it in a hospital, and most say they would prefer to be at home, given adequate services.

IPPR research fellow Jack Hunter said: “For too many, the end of life is an even more difficult experience than it needs to be. The fact that those in the most deprived areas are more likely to die in hospital is wholly unjust. Where you live should not affect whether you experience good-quality care at the end of your life.

“Enabling more people to spend their last days outside hospitals, in more appropriate settings, with properly funded support, will improve their experience of care. It will also be more cost-effective for the taxpayer.”

A green paper on care and support for older people is due to be published this summer. In last January’s cabinet reshuffle, Jeremy Hunt kept his health portfolio, but his responsibilities and title were expanded to include social care. This was a signal of long-promised reform, merging the health and care budgets and systems.

The report calls for more power to be devolved to local authorities and for a big cash injection. But it concludes: “It is far from clear that the government’s vision will include the size and scale of investment for care that would be commensurate with a radical shift in funding, nor whether it will also consider long-term options (including devolved fiscal measures) to ensure the long-term sustainability of local authorities.”

47%

Proportion of people in England who died in hospital .

23%

Proportion of people in England who died at home.

£487

Estimated public saving, per person, of shifting care, in final three months of life, from hospital to community.