Palliative care under ‘significant strain’ says report criticising ICB commissioning

Patients needing palliative care services face a ‘postcode lottery’ due to variability in commissioning services by ICBs who do not understand the needs of their populations well enough, an independent report has concluded.

An Independent Expert Panel, commissioned by the Health and Social Care Committee, also found that ‘insufficient funds’ had been allocated to end of life care because of ‘competing financial pressures’.

It has left services under ‘significant strain’ and people are struggling to navigate ‘a complex and fragmented’ palliative care system that lacks a single point of access and communication, the expert panel found.

In addition, those needing end of life care and their families are too rarely given the opportunity to plan in advance, the report noted.

Patients were too often not identified early enough and offered advice, and when conversations did take place they were not sufficiently meaningful, they added.

Government plans to shift care from hospital to the community is ‘highly relevant’ to palliative care with increasing numbers of people dying at home, the panel said.

Yet funding challenges are making this shift to the community difficult alongside ‘inadequate provision of social care and widespread workforce and skill shortages’, the report concluded.

Overall, the health and social care workforce is ill equipped to meet the needs of people at the end of life and better education and training is needed.

But shortages in specialist palliative care are ‘critical’ and are particularly stark in children and young people’s end of life care, the panel said.

The panel found some examples of good practice, such as effective partnerships between hospices and GPs. 

Bereavement services were found to be valuable but frequently inaccessible due to ‘patchy levels of provision’ across the country and a high dependence on voluntary organisations. 

Since the Covid pandemic there has been an increase in the number of people dying at home, in care homes and in hospices, with fewer are dying in hospital.

Currently just over one quarter of patients die at home. 

But spending on primary and community health care accounts for 11% of health expenditure for people in their last year of life, while hospitals receive 81% of the spending.

Following the report’s publication, the health select committee will question primary care minister Stephen Kinnock and senior NHS England officials on ways to improve services this week.