There are currently serious shortcomings in the arrangements, facilities, services and communication needed for all dying patients to receive the best possible care. The RCP believes that amongst other shortcomings there is a need for equitable access to palliative care, and for core NHS funding to increase palliative care services.
We believe that all patients should experience the best possible care at the end of life, with equitable access to palliative care services and appropriate management of the dying process, including excellent communication between the patient, family, carers and clinical team.
Certain shortcomings in palliative care in the UK have been identified, due to:
- patchy provision and fragile funding mechanisms
- practical and ethical difficulties in diagnosing and managing the clinical symptoms of patients at the end of life
- problems of communication between patients, relatives, carers and the clinical team.
The RCP has contributed greatly to keeping end-of-life issues on the public agenda with policies on assisted dying, advance care planning, and consent to organ donation.
Equitable and adequate access to palliative care services for all patients who are suffering or dying - There are currently unacceptable variations in care across:
- different geographic regions
- different demographic groups
- for patients with different illnesses and needs.
There is a wide range in the standard of care, from excellent to non-existent.
Core NHS funding to increase palliative care services - the NHS currently only provides about 30% of funding for these services. This requires the voluntary sector and charity funding to support about 70% of the costs of specialist care, which is entirely unsatisfactory and has led to poor integration of services.
Sustainable and adequate core funding is essential to allow cohesive development of services across the country.
'Nil by mouth' as a last resort rather than the first option for patients with feeding difficulties at the end of life - Feeding patients by mouth should always be the main aim of a nutrition strategy - patients with feeding difficulties should not be fed by tube when neither necessary nor clinically indicated.
Such decisions should never be based on the convenience of staff or carers, but on offering the patient the best quality of life.
An opportunity for patients to discuss their future care in the event of losing mental capacity - In February 2009 the RCP, with a wide variety of other relevant organisations, produced guidelines for healthcare professionals on how, when and where to discuss issues surrounding death with patients, in the event of the patient losing mental capacity.
