Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Mr Peter Tebbit, National Council for Hospice and Specialist Palliative Care Services (DD 17)

  I set out below on behalf of the National Council for Hospice and Specialist Palliative Care Services a response to the Committee's inquiry.

  The National Council is the national umbrella body for all the principal organisations involved in palliative care. It includes in its membership all the national charities and professional associations in the field as well as representatives of both NHS and voluntary services.


  1.  In 2000-01 there were around 59,000 admissions to NHS and voluntary hospice and specialist palliative care in-patient services. Around half of these admissions ended in the patient's death. Of the remainder 26,000 patients were discharged home, 1,500 to hospital and 2,000 to nursing or residential homes.

  2.  If delayed discharges to home or care homes were to occur in a significant number of cases, it could be expected to show up in average length of stay, total admissions and bed occupancy in one year compared with another. The data for the year 2000-01 compared with 1999-2000 reveals no significant change in respect of these data items. This would suggest that there were no significant problems occurring up to the beginning of 2001.

  3.  As far as the current year is concerned there is some evidence that the number of delayed discharges has increased. These delays are occurring to both discharges home and to care homes.

  4.  The major concern is the effect of delayed discharges to home since potentially that could affect several thousand discharges per year.

  5.  95 per cent of all admissions to hospice and specialist palliative care are of patients with advanced cancer. Most of those will require bespoke packages of care and support from both health and social services. Reports from individual providers indicate that there are increasing problems in some parts of the country in arranging the home support expeditiously.

  6.  The problems arise mainly with local social services. In some cases it is a lack of funding and in others, where funding is not an issue, it is a lack of insufficient home carers.

  7.  Because discharge home can be a problem for primary care and for acute hospital services there is often pressure on hospice and specialist palliative care services to admit patients who would be more suitably placed in a care home than in a specialist palliative care unit.

  8.  Delayed discharge to care homes is also an increasing problem in some areas particularly where there have been closures of nursing homes.

  9.  The overall effect of delayed discharges on hospice and specialist palliative care services cannot be comprehensively assessed until the patient activity data is available later this year for the year 2001-02. What however is clear is that delayed discharges are occurring in some measure. When they do occur they have the following unwelcome effects:

    (a)  They prevent the patient from having access to the most appropriate care and support when they need it. For patients in the last phase of their lives for whom time is of the essence, this is plainly unacceptable.

    (b)  By bed blocking they prevent other patients from being admitted for pain and other symptom control that would enable them to return home and resume independent living for whatever time they may have left.


  1.  Urgent action is required by the Government to ensure that the financial contribution made by Social Services to the costs of care of individual patients in Nursing Homes reflects the actual cost of providing such care to the standards set out in the Regulations and Standards of the Care Standards Commission.

  2.  All local providers of supportive and palliative care, NHS, voluntary, social services and independent, should be encouraged to work together in the new Supportive and Palliative Care Networks (established in consequence of the NHS Cancer Plan) with the following aims:

    (a)  To develop and ensure agreed procedures for rapid joint assessment of palliative care patients and older people

    (b)  To plan and develop flexible out of hours services

    (c )  Through more creative planning to develop care solutions that integrate services across institutional and sector boundaries.

21 January 2002

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