Recently in End-of-life care Category

A report this week revealed that people in more deprived areas are more likely to die in hospital than those from more affluent places.

In this guest blog, National End of Life Care Programme social care lead Tes Smith argues that social workers have a key role to play in narrowing these inequalities in death.

Fairness is much in the news at present, not least in the shape of the stubborn gap between rich and poor. As in life, so in death it seems. This week, the National End of Life Care Intelligence Network identified that people living in deprived areas are 7% more likely to die in hospital than those residing in the most affluent areas.

Surveys consistently show that most of us would prefer to die at home or in another community setting, such as a hospice, rather than hospital.  Reducing the percentage of deaths that take place in hospital is a key objective of the Department of Health's national end-of-life care strategy.

A small fraction of the gap identified in this week's report - one seventh - can be accounted for by differences in factors such as the cause of death and life expectancy. Individuals affected by some conditions that affect more people in deprived areas, for example chronic obstructive pulmonary disorder, sometimes prefer to be cared for in their final days and hours in hospital.

However the report does raise issues around equity of access to housing and care services that allow people to exercise choice over where they are cared for and, ultimately, where they die. Social care professionals can do something about that.

Social worker role

Yes, death might come after months or even years of high tech medical interventions - whether pharmacological, surgical or technological. However, social care services often have regular contact over a long period with an individual as they become more frail - and with their family or informal carers.

We can liaise with services such as housing and occupational therapy to ensure the individual's home is both decent and equipped with any aides and adaptations needed to support them in their final days, weeks or months.

More powerfully however, we can support individuals nearing the end of life and their carers so they can access the services that will allow them to die at home or in a hospice if that is their wish. This can involve putting in place a package ranging from transport services to specialist pain relief services and community nursing.

With our assessment, communication, co-ordination and care planning skills we should be working with health colleagues in hospitals and the community. We can advocate on behalf of clients who might lack either the verbal skills or self-confidence to effectively pursue such care packages themselves and co-ordinate the delivery of services. With ethnic minorities over-represented amongst the most deprived in our community, there might be language barriers that we can help overcome.

Sharp elbows

The broader social care profession should be working with specialist palliative care social workers in hospices and hospitals to champion the interests of those whose voice might otherwise be lost.

When asked why he thought his new National Health Service would survive, Nye Bevan is said to have replied that the 'sharp elbows of the middle classes' would make quite sure they and their families had access to high quality free healthcare.

Perhaps it is part of the social care professional's role to play the sharp elbows of those less able to voice their wishes and preferences for care in this age of choice. Care provision at the end of life might be a good place to start.

• That people approaching the end of life are offered a comprehensive, holistic assessment and a personalised care plan.
• That they are offered timely, personalised support for their social, practical and emotional needs.
• People in their last days of life are identified in a timely way and receive co-ordinated care in accordance with their personalised care plan.

Worth a read when you have a moment.