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Lack of nursing cover means terminally ill ‘unable to die at home' PDF Print Email

Government plans to allow the terminally ill to die at home is being threatened by A lack of 24-hour nursing cover and poor planning by doctors, say campaigners.
More than a third of family GP's are not reviewing the needs and wishes of dying patients, while there is also a lack of round-the-clock nursing care to give patients care at weekends and at night in many areas.

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

Ministers started a consultation in November on whether a legal right to die at home — wherever 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 doctor surgeries in England are still not participating in a “gold standards framework” to keep registers of patients who are close to death, and make efforts to respond to their needs accordingly.

Although two thirds of people say that they would prefer to die at home only one in five deaths occur there, compared with about 60 per cent of people who die in hospital.

Macmillan’s chief medical officer, Professor Jane Maher, 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.

However, community nurses or health visitors are often not available at night even if GP's do discuss plans with patients.

It was recently pledged by Gordon Brown 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 (NICE) 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.

In areas such as Dorset, the variation has created a postcode lottery, where round-the-clock nursing care is funded in the east of the county but not in the west. According to Charles Campion-Smith, a GP in Dorchester and Macmillan adviser, 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.”