Next year will mark 50 years since the hospice movement pioneer Cicely Saunders established St Christopher’s Hospice in south London, spearheading a transformation in care across the country. Today, more than 200 hospices deliver the highest quality of care to people with terminal conditions – over 90 per cent rated as “good” or “outstanding” by the Care Quality Commission in England.
This quiet revolution did not have its origins in the NHS, or in local government, but among communities who came together to respond to the distressing deficit in care for the dying by the NHS of the 1960s. Hospices continue to depend on the support of local people for their vital work, collectively raising nearly £2 million a day from local charitable sources.
It is a testament to the success of the NHS that we can all expect to live longer than ever before, and that conditions that once signalled the end of life can increasingly be treated, managed or even cured.
While more of us are living longer, however, we are likely to do so with increasingly complex health and care needs. If trends continue, in just 15 years the number of older people with a long-term illness could rise by 44 per cent. Dementia could affect well over 1 million people by 2030 in England alone. The number of Britons aged over 85 is anticipated to reach 3.5 million by 2035. What was previously a small minority with exceptional longevity is rapidly becoming a whole new generation.
Currently a third of all deaths are of people aged 85 and over, but they will soon represent almost half of all deaths in the UK. Too many will die in a hospital bed, often with no clinical need or wish to be there.
Soon deaths of the over-85s will represent almost half of all deaths in the UK. Too many will die in a hospital bed, often with no clinical need or wish to be there.
Demand for care is rising at precisely the moment that resources are increasingly stretched. A report from Age UK found that squeezed council budgets are increasing the pressure on care homes, which in turn are raising fees for the growing number of residents who must fund their own care. These pressures have seen around 1,500 care homes close in the past six years. A recent report by the Care Quality Commission also concluded that our social-care system is reaching crisis point.
Most people with complex needs would prefer to remain at home, with support to help them retain their independence and quality of life. Too often, the care and support available is in short supply, is expensive, and is offered in such small doses that vulnerable people can face isolation.
What is to be done?
First, we need to rebalance our health and care system so that it can respond to the way society is changing, and tackle our over-reliance on acute care. That means placing greater emphasis on community-based services. We could support more people to die at home rather than in expensive hospital beds and train and support district and community nurses to provide end-of-life care at home, which many hospices already do. New homes could be designed to reflect the fact that their occupants may well have long-term care needs.
Second, we need to do more to support families and carers. Organising and coordinating care at a distance, which is the reality for most families, is difficult and stressful. We need to go further to help carers, for instance by encouraging workplace flexibility; Hospice UK is exploring this with leading employers.
Charities, like hospices, have a great deal to offer and with more support from the NHS and councils could do so much more.
Third, we should go further in integrating care services so that people no longer fall between the gaps in care. Too often, the debate focuses on how to bring NHS and local government services together, overlooking the role of the charitable sector. Around the country, hospices are working increasingly closely with hospitals, care homes and home care services, many providing training to care-home staff to equip them better to care for people approaching the end of life. Charities, like hospices, have a great deal to offer and with more support from the NHS and councils could do so much more.
Almost 50 years since Dame Cicely’s determination began a revolution in how we care for dying people, we need to renew that remarkable spirit.
Lord Howard of Lympne is chairman of Hospice UK2 December 2016