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End-of-life care across England not prioritized, despite aging population

July 17, 2018

Research by King's College London has found that local authorities across England have failed to prioritise palliative and end of life care, despite the health care challenges posed by a rapidly ageing population.

The research, published today in the journal Palliative Medicine, is based on an analysis of the Health and Wellbeing Strategies of 150 local authorities across England, which found that only 4 per cent cited end of life care as a priority.

Palliative care is defined as the active total care of patients whose disease is not responsive to curative treatment, with the control of pain, of other symptoms, and of psychological, social and spiritual problems paramount.

The goal of palliative care is to achieve the best possible quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness.

As the population ages, the need for effective palliative care strategies that are fit for purpose has never been greater - research suggests that the demand for palliative care will increase by 42%* by 2040.

To understand how England's 152 local authorities - whose regional Health and Wellbeing Boards are responsible for improving health and care - prioritise end of life care, researchers systematically analysed their Health and Wellbeing Strategies published from 2012 onwards. In two areas neighbouring Health and Wellbeing Boards developed a joint strategy, making the total number of strategies analysed 150.

Specific measures linked to end of life care were assessed, including; the level of prioritisation of end of life care; whether end of life care was referenced within a specific clinical context - such as in relation to cancer or dementia; whether a target for improvement was identified; and whether a specific intervention for improving end of life care was present.

Researchers found that of the 150 strategies identified, end of life care was mentioned in just over half 78 (52 per cent) and prioritised in only six (4 per cent).

In 43 of the 78 strategies, end of life care was mentioned in connection with specific medical conditions, with ageing and dementia the most cited.

The King's team also found that there was a sparse use of evidence in relation to end of life care, particularly with respect to the effectiveness of interventions. With budgets for specialist palliative care services ranging from £51.83 to £2,329 per patient per annum across England, being able to provide robust evidence about the effectiveness of treatments could have a bearing both on provision and budgets.

Lead author Dr Katherine Sleeman, from King's College London's Cicely Saunders Institute for Palliative Care, Policy & Rehabilitation said: 'This is the first study to systematically analyse content relating to end of life care within local health care strategies and provides a comprehensive national picture of priorities and plans.

"What we found is that while half of Health and Wellbeing Strategies mention end of life care, few prioritise it, and none cite evidence for effective interventions This is concerning, especially as end of life care has been highlighted as a priority for policy makers nationally and internationally.

'This research highlights the large variations in the prioritisation of palliative and end of life care across England and underscores the need for greater scrutiny of local health and care strategies to avoid the unintended creation of a palliative care post code lottery.'
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Notes to editors:

For further information please contact Garfield Myrie in the King's College London press office at: garfield.myrie@kcl.ac.uk / 0207 848 4334

The research: 'Is End of Life Care a Priority for Policy Makers? Qualitative Documentary analysis of Health care Strategies' is published in Palliative Medicine.

The report is independent research arising from a Clinician Scientist Fellowship to Dr Katherine Sleeman supported by the National Institute of Health Research (NIHR). The views expressed in the report are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

*https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0860-2

King's College London

King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2018/19) and among the oldest in England. King's has more than 29,600 students (of whom nearly 11,700 are graduate students) from some 150 countries worldwide, and some 8,000 staff.

King's has an outstanding reputation for world-class teaching and cutting-edge research. In the 2014 Research Excellence Framework (REF), eighty-four per cent of research at King's was deemed 'world-leading' or 'internationally excellent' (3* and 4*).

Since our foundation, King's students and staff have dedicated themselves in the service of society. King's will continue to focus on world-leading education, research and service, and will have an increasingly proactive role to play in a more interconnected, complex world. Visit our website to find out more about Vision 2029, King's strategic vision for the next 12 years to 2029, which will be the 200th anniversary of the founding of the university.

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King's College London

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