North Yorkshire’s health watchdog is calling for the establishment of a multi-agency task force in the county to improve the provision of end-of-life care.
Following a 6 month investigation into end-of-life care in North Yorkshire, the County Council’s Scrutiny of Health Committee has drawn up a report which highlights the need for investment in multi-agency, community-based provision. This could help to reduce the numbers who die in hospital.
The report, which sets out a number of recommendations, has involved engagement with a broad range of commissioners, service providers, patients and the public. Its findings will be presented to North Yorkshire’s Health and Wellbeing Board at their meeting this Friday to inform future strategies.
The report highlighted that the majority of people, about 75%, experience good quality end of life care, whether that is at home, in a care home or in a hospital. However, 25% do not. It also found that while most people would prefer to die in their own home, nearly half (43%) die in hospital, with all the associated, significant costs.
County Councillor Jim Clark, the Scrutiny of health Committee chairman said: “People do not like to think about death and their own mortality. As a consequence, opportunities to make early plans and exercise choice are missed and often people end their days in a hospital bed when they would have preferred to be with family and friends in a familiar and comforting environment like their home, a care home or a hospice”.
He said the quality and availability of end of life care across the county was variable and that people were not always able to access the support and services they needed or able to exercise choice over what plans they want put in place for the final months, weeks and days of their lives.
“This is not the fault of any one agency or organisation”, he said, “but a symptom of a health and social care system that is disjointed and under considerable financial stress. The report has found that there are a great many examples of good planning, good services and good joint working. However, much of what is currently done is dependent upon good will and strong local, operational relationships, rather than a coherent and planned approach across agencies and organisations in North Yorkshire”.
Key findings include:
- There is a strong financial case to support increased funding for multi-agency community-based end of life care packages on the basis of an ‘invest to save’ argument as this could lead to a reduction in numbers of people ending their life in hospital.
- The provision of 7 day services and/or out of hours care remains a challenge in health and social care in general and it is also the case for end of life care.
- The support that is given to people in the last 12 months of their life is overwhelmingly provided by carers and close family members
- Bereavement counselling and psychological therapies are not widely available or accessible to people in need
- There is no shared strategy or system for end of life care commissioning and provision
- Councillor Jim Clark stated that service improvement did not necessarily involve significant investment or service restructures. “A starting point”, he said, “would be greater co-ordination of existing health, social care and voluntary and community services in the county”.
A multi-agency forum for commissioners and providers of end of life care would provide this coordination, lead to the development and sharing of good and best practice.