Terminally Ill 'Unable To Die At Home For Lack Of Nursing Cover'

Terminally ill 'unable to die at home for lack of nursing cover', Mar. 1, 2010.

A lack of 24-hour nursing cover and poor planning by doctors is threatening government plans to give the terminally ill a right to die at home, campaigners say.

More than a third of family doctors are not reviewing the needs and wishes of dying patients, while round-the-clock nursing care is not available to give patients support and pain relief at weekends and at night in many areas.

The shortfalls mean that thousands of patients suffering from conditions such as cancer are taken into hospital or hospices to die when they would rather stay at home, according to the charity Macmillan Cancer Support.

Ministers opened a consultation in November on whether a legal right to die at home — where possible — should be enshrined in the NHS constitution, after the publication of an End of Life Care Strategy in 2008.

But up to 40 per cent of GP surgeries in England are still not participating in a “gold standards framework” to keep registers of patients who are close to death, and respect their needs accordingly, The Times has learnt.

Only one in five deaths occurs in a person’s home, despite two thirds of people saying that that is where they would prefer to die. By contrast, about 60 per cent of people die in hospital.

Professor Jane Maher, Macmillan’s chief medical officer, said that many doctors were still too reluctant to prepare or discuss plans for death with patients nearing the end of their lives.

“Many doctors are still uncomfortable reviewing terminally ill patients or bringing it up in consultations, but patients need to be asked about their plans and wishes for dying in the same way as they might plan for a pregnancy or any other medical condition,” Professor Maher said.

But even if GPs do discuss plans with patients, community nurses or health visitors are often not available at night.

Gordon Brown recently pledged that all cancer patients would have access to specialist nurses trained in their condition. Macmillan says that these services would typically be available only during the day, however, leaving 24-hour care to be provided by nurses with more general skills.

The National Audit Office (NAO) and the National Institute for Health and Clinical Excellence advise that all patients should have access to 24-hour nursing services. But a report by the NAO in 2008 found that only just over half (53.2 per cent) of local health authorities provided such a service to all patients seven days a week.

The variation has created a postcode lottery in areas such as Dorset, where round-the-clock nursing care is funded in the east of the county but not in the west. Charles Campion-Smith, a GP in Dorchester and Macmillan adviser, said that there was no cover in his area from 10pm to 6am the next morning.

“Patients have lost control of a lot of things by the end of life, and wanting to maintain control about where they die is one of the most fundamental things they value,” he said. The National Council for Palliative Care and the Royal College of Nursing (RCN) supported the call for round-the-clock nursing for dying patients.

Peter Carter, the general secretary of the RCN, said: “Sadly it is often the case that patients at the end of their lives are admitted to hospital in the middle of the night simply due to the unavailability of district nursing services.”

Anna Dixon, the acting chief executive of the King’s Fund, a healthcare charity, said that such cases should have access to basic medical care within an hour, “in whatever setting and whatever time of day or night”.

By David Rose, in TimesOnline