The National Audit Office today revealed that primary care trust spending on specialist palliative care varies by a factor of 11 across England.
The finding came in a highly critical report on the state of end of life care services, which said that too many people were dying in hospital due to a lack of community-based services, joint working between health and social care was “generally poor” and training needed to improve.
The NAO’s first study on the issue found that estimated expenditure by PCTs on specialist palliative care ranged from £154 per person who died to £1,684 in 2006-7, a difference that could not be accounted for by variations in need.
The NAO criticised the quality of PCT commissioning of end of life care, saying trusts lacked information about population needs and contracts with hospices were often only for one year, leaving them unable to plan for the future.
Despite up to three-quarters of people wanting to die at home, or in a care home, 58% of people died in hospital in 2006.
A lack of community services, including 24-hour response services, lead to people being unnecessarily admitted to hospitals, the report said. There were also wide variations in the number of care home residents who died in hospital, ranging from none to all.
Care home training
The NAO said training needed to improve in residential. While three-quarters of homes surveyed by the NAO provided training in end of life care, this was mandatory in just half of these cases.
It said coordination between health and social care was poor in relation to planning, delivery and monitoring of end of life care, and was hampered by difficulty in determining the distribution of the cost of patients’ care between the two sectors.
The NAO welcomed the Department of Health’s end of life care strategy, published in July, which pledged to invest £286m from 2009-11 to give people greater choice over where they died and improve care planning, through 24-hour access to community-based care.
DH must ensure delivery
However, Karen Taylor, director of health studies at the NAO, said: “The DH has recommendations about how it would like things to be but there’s no indication of how they will be delivered. It needs more direction and support.”
The NAO said the DH should provide more information and, as appropriate, guidance to PCTs to meet end of life care needs and allocate resources more efficiently.
It also urged the DH to strengthen training requirements on care homes – through the regulatory system – to ensure staff are trained in communication skills, adequate pain management, avoiding unplanned emergency admissions and treating residents with dignity.
It said PCTs should should use joint strategic needs assessments, carried out with local authorities, to address the gaps between end of life care needs and services. It also called on trusts to aim for three-year contracts with hospices to enable them to plan for the future.
Research realities on end of life care