Palliative Care requires extensive reform and greater transparency

With the care sector and now Parliament likely to be locked in ongoing debate regarding the proposals of the Andrew Dilnot Independent Commission for some time, it would be a pity if the conclusions of a second review team, looking into the specific issue of Palliative Care Funding, has slipped under the media radar.

The Palliative Care Funding Review was chaired by Thomas Hughes-Hallett, the chief executive of Marie Curie Cancer Care, with the aim of developing a ‘per-patient funding mechanism for palliative care’ in England. Seen as a significant absentee from current healthcare capabilities, campaigners have long supported moves towards a system that would help more people receive end-of-life care in their own homes, rather than being forced to spend their final days in hospitals where, as well as being unhappy, they become one of the chief causes of bed blocking in the NHS.

The three key outcomes highlighted by the review are: ‘to create a fair and transparent funding system’, ‘to deliver better outcomes for patients’ and ‘to provide better value for the NHS’. The lack of transparency behind how the state currently funds what we can consider to be a ‘good death’ is seen by the review as the main obstacle to overcome in terms of achieving an effective reform.

Although Britain is actually seen as a world leader in palliative care, the reality of an ageing population means that healthcare experts do not see this as a position of comfort. Figures compiled by the review would strongly support this conclusion, estimating 92,000 of over 400,000 people a year are not being reached by current end-of-life care services.

The core recommendations of the Funding Review are targeted towards achieving a more thorough but cost effective use of NHS resources, suggesting a new ‘care tariff’ be introduced for greater clarity of the expenses faced. Accompanying the tariff, we can also expect a ‘needs classification’ system, together with the setting up of new integrated care packages that are designed to give communities the means of developing and adapting to their particular requirements.

The care community can also expect a significant shift of responsibility from NHS services to social care. Although the NHS will still be involved in the assessment of individual needs, the pressure will be on social care providers to take the burden of palliative care away from hospitals, with services collaborating to achieve smoother discharges after a diagnosis of terminal illness.

The full review can be found at www.palliativecarefunding.org.uk, which includes suggestions for the establishment of five ‘pilot sites’ where the new measures can be tried and tested. The review team are keen to stress that full reform will not be achieved overnight, having no comparisons worldwide against which to judge the pitfalls involved, with the possible exception being that of Australia, who do have a tariff for palliative care, though not one as all-encompassing as that the review is hoping to achieve.