Credit: Marie Curie

Room for improvement for palliative care in Scottish hospitals

By Matilda Handley and Karolina Omenzetter

Marie Curie and University of Glasgow call for improved care of terminally ill patients.

Marie Curie and the University of Glasgow have criticised the care and experience of people dying in hospitals, calling for improved action. A report into Scottish hospitals made by the two organisations has determined that the palliative care offered in hospitals needs to be better supported and resourced.

Marie Curie, a charitable organisation that cares for and supports people through terminal illness, alongside the University of Glasgow, brought together interested stakeholders from around Scotland. These individuals and organisations discussed the issues and challenges within hospitals and worked to create recommendations to address these.

The report is about the shortcomings of palliative and end of life care in Scotland’s hospitals. It outlines twelve aspects of the system that they believe need to be addressed. These problems include insufficient identification of patients that would benefit from palliative care, and current hospital culture focusing on the preservation of life rather than the quality of life. 

Another pressing issue cited was the insufficient numbers of staff available to provide adequate palliative care. Volunteers were deemed as important for being able to provide more emotional support to patients during their end of life care. This was said to ease stress for staff members and improve the patient’s experience. Praise was given to Musgrove Park Hospital, which was able to recruit 30 volunteers to emotionally support 350 patients during their end of life care. 

A further problem outlined was the lack of training, particularly in communication skills for staff members when handling difficult conversations surrounding death and dignity. It is hoped that delivering more training through e-learning and increased public education to deal with the stigma surrounding death would be helpful. 

As 47% of the people who died in Scotland in 2016/17 died in hospital, the access and quality of palliative care likely impacts a huge portion of the population. It is hoped that the changes proposed in the report will allow people to die with more dignity in the hospital environment.

The report issued by the University and charity states that the specialty would also benefit if there were more audits and research funding to study outcomes and patient’s experiences to improve the quality of care. The environment provided for patients in hospitals was also put under scrutiny, as many hospitals have patients approaching the end of their lives in busy wards with little space to be surrounded by their loved ones in their final days and hours. 

Marie Curie and the University of Glasgow have also called on the Scottish government to set aside £15m for a nationwide Change and Innovation Fund, which would help improve the efficiency of care across hospitals.

Marie Curie’s head of Policy and Public Affairs Scotland, Richard Meade, stated: “Hospitals are absolutely the right place for some dying people to be, but we need definitive action to ensure people get the care they need when in hospital… It’s particularly concerning that knowledge of palliative care among healthcare professionals was patchy, with some not understanding that it can be provided alongside curative treatments.”

Professor David Clark, Wellcome Trust Investigator and associate of the University of Glasgow Institute of Health and Wellbeing, stated: “Over the last 10 years, our research has consistently shown that, on any given day, almost one third of patients in Scottish hospitals are in the last year of life, and 10% will die on their current admission. We are not grasping the opportunity to identify these people and to have conversations about their end of life preferences. Covid-19 has revealed the shocking absence of advance care plans in many cases, making it even more difficult to give the right kind of care in pandemic conditions.”

The 12 recommendations from Marie Curie and the University of Glasgow listed on their websites are:

  1. Scottish policy must actively support palliative care in acute settings and appoint clinical and executive leads in each NHS Board for palliative and end of life care.
  2. Hospitals are supported to provide consistently high-quality care that improves patient outcomes and experience.
  3. Everyone with a palliative care need should be identified if admitted to hospital or attending an outpatient appointment.
  4. Hospitals should ensure they have joined-up working across multi-disciplinary teams and specialities to provide palliative and end of life care.
  5. IT and technology must support patient-centred care and enable those working with patients to have the most up-to-date information about that care and be able to provide appropriate input.
  6. An increase in the number of palliative care consultants, doctors and specialist nurses.
  7. Scotland should draw upon the power of volunteers to respond to the needs of communities and empower volunteers to support those with palliative needs and approaching the end of life in acute settings.
  8. All acute staff should be given training to provide care and support for those living with a terminal condition coming to the end of life and dying in hospitals, as well as their families, friends and carers.
  9. All hospital staff should have training and support in communication skills to support them in speaking with people with palliative care needs, and their families.
  10. A review of the number of available specialist palliative care beds across Scotland is required.
  11. Hospitals should also review the physical environment to ensure it is appropriate for dying people and their families.
  12. There is a need for robust data and evidence on patient and carer experience to allow greater scrutiny of care standards.

To find out more information, read the full report here.


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