Correspondence
When the saints go marching on
H
Anthony Waite is a GP and former specialty doctor in palliative care Email: [email protected] Or: ijpn@ markallengroup.com
46
aving worked as a specialty doctor in palliative care for the past 6 years and now returning to general practice, I have become increasingly uncertain as to the future role of in-patient hospices. Perhaps the time has come for a realistic look at where exactly they fit in to the bigger picture of end-oflife care. Of particular concern is whether their existence inhibits the development of other services and fuels the myth that palliative care is different from simply good care. Hospices are often jointly funded by charity and the NHS and offer end-of-life care to people with incurable illness where treatment options have been exhausted. The specific criteria for admission appear to be near impossible to define. Basically they provide support for those who are unable to be at home whether due to difficult-to-control symptoms or unsustainable social circumstances. The funds raised contribute to sustaining a high staff-to-patient ratio with an extensive multidisciplinary team focusing on a small number of patients. Meanwhile patients in similar situations, who for whatever reason do not find themselves admitted to these institutions, enter the less well staffed and costly world of care homes or NHS facilities. Hospices have certainly enabled the principles of palliative care to be practised with great effectiveness on their select group. Their patients are beautifully cared for by dedicated teams who have time and resources on their side. They have also had a wider influence in the community through home visits, out-patient appointments, day-hospice activities and the availability of 24-hour medical advice. Education for community teams in symptom control has also been provided, increasing skills and enabling patients to be well cared for at home. Patients are also well supported by Macmillan and Marie Curie nurse teams. Patients with difficult-to-control symptoms are often appropriately admitted to district
general hospitals. From there if possible they may be transferred to community hospitals for further support or return directly home. If they are ultimately unable to return home then care home placement may be required. The existence of hospices complicates the picture and risks undermining the care provided by these other organisations. It is possible that the creation of a palliative medicine specialty and the concentration of care within hospices have hindered the development of good care elsewhere. Palliative care teams in general hospitals are an excellent resource battling to promote good care. However, it is disturbing to hear of reports suggesting misunderstandings of the Liverpool Care Pathway, lack of compassion in nursing, and seemingly increasing public interest in assisted dying. It is therefore not clear that, on a national level, the hospice movement has influenced care in general hospitals, which was the main reason Dame Cicely Saunders set the whole process going in the first place. Twenty one years ago Colin Douglas (1992), in his article ‘For all the saints’, raised the suggestion that ‘the hospice movement is too good to be true and too small to be useful’. Surely the time has come to address these apparent inequalities in health care and acknowledge that most end-oflife care occurs outside of hospices. Greater public awareness of the reality of where most end-of-life care occurs might lead to donations and resources being directed more appropriately to care settings more greatly in need of support. The emphasis should now turn to how best to support the facilities already providing the vast majority of end-of-life care and enable them to realistically aspire to the level of care at the flagship hospices. I● JPN Declaration of interest The author has no conflicts of interest to declare. Douglas C (1992) For all the saints. BMJ 304: 579
© 2014 MA Healthcare Ltd
Anthony Waite
International Journal of Palliative Nursing 2014, Vol 20, No 1
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 15, 2015. For personal use only. No other uses without permission. . All rights r
When the saints go marching on
H
Anthony Waite is a GP and former specialty doctor in palliative care Email: [email protected] Or: ijpn@ markallengroup.com
46
aving worked as a specialty doctor in palliative care for the past 6 years and now returning to general practice, I have become increasingly uncertain as to the future role of in-patient hospices. Perhaps the time has come for a realistic look at where exactly they fit in to the bigger picture of end-oflife care. Of particular concern is whether their existence inhibits the development of other services and fuels the myth that palliative care is different from simply good care. Hospices are often jointly funded by charity and the NHS and offer end-of-life care to people with incurable illness where treatment options have been exhausted. The specific criteria for admission appear to be near impossible to define. Basically they provide support for those who are unable to be at home whether due to difficult-to-control symptoms or unsustainable social circumstances. The funds raised contribute to sustaining a high staff-to-patient ratio with an extensive multidisciplinary team focusing on a small number of patients. Meanwhile patients in similar situations, who for whatever reason do not find themselves admitted to these institutions, enter the less well staffed and costly world of care homes or NHS facilities. Hospices have certainly enabled the principles of palliative care to be practised with great effectiveness on their select group. Their patients are beautifully cared for by dedicated teams who have time and resources on their side. They have also had a wider influence in the community through home visits, out-patient appointments, day-hospice activities and the availability of 24-hour medical advice. Education for community teams in symptom control has also been provided, increasing skills and enabling patients to be well cared for at home. Patients are also well supported by Macmillan and Marie Curie nurse teams. Patients with difficult-to-control symptoms are often appropriately admitted to district
general hospitals. From there if possible they may be transferred to community hospitals for further support or return directly home. If they are ultimately unable to return home then care home placement may be required. The existence of hospices complicates the picture and risks undermining the care provided by these other organisations. It is possible that the creation of a palliative medicine specialty and the concentration of care within hospices have hindered the development of good care elsewhere. Palliative care teams in general hospitals are an excellent resource battling to promote good care. However, it is disturbing to hear of reports suggesting misunderstandings of the Liverpool Care Pathway, lack of compassion in nursing, and seemingly increasing public interest in assisted dying. It is therefore not clear that, on a national level, the hospice movement has influenced care in general hospitals, which was the main reason Dame Cicely Saunders set the whole process going in the first place. Twenty one years ago Colin Douglas (1992), in his article ‘For all the saints’, raised the suggestion that ‘the hospice movement is too good to be true and too small to be useful’. Surely the time has come to address these apparent inequalities in health care and acknowledge that most end-oflife care occurs outside of hospices. Greater public awareness of the reality of where most end-of-life care occurs might lead to donations and resources being directed more appropriately to care settings more greatly in need of support. The emphasis should now turn to how best to support the facilities already providing the vast majority of end-of-life care and enable them to realistically aspire to the level of care at the flagship hospices. I● JPN Declaration of interest The author has no conflicts of interest to declare. Douglas C (1992) For all the saints. BMJ 304: 579
© 2014 MA Healthcare Ltd
Anthony Waite
International Journal of Palliative Nursing 2014, Vol 20, No 1
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 15, 2015. For personal use only. No other uses without permission. . All rights r
