Memorandum by Mr Peter Tebbit, National
Council for Hospice and Specialist Palliative Care Services (DD
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
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
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
(b) To plan and develop flexible out of hours
(c ) Through more creative planning to develop
care solutions that integrate services across institutional and
21 January 2002