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The report

• Focuses on differences in provision, spending, identification and experiences

• Identifies variations across different parts of the country and a range of services

• Draws together & analyses data from the Marie Curie End of Life Care Atlas & other sources

Our ambition

• To shift the debate about care for terminally ill and dying people

• To use what we have learnt about end of life care over the last year to improve care in all settings. Now is the time to act

Why now?

• NHS reforms offer opportunity to re-prioritise and re-focus services to emphasise development of better end of life care

• Ageing population and budgetary constraints mean increasing pressures on already stretched NHS resources

• Stronger evidence base around end of life care. We have an opportunity to use this increased knowledge to push forward with improvements

• Francis report brings a renewed focus on patient needs

Changing demographics

• Total number of deaths per year to increase by 17%

• Particularly rapid increase in over 85s; Number of deaths in those aged 85 years+ to increase by 48%

• People accumulate long term conditions as they age; by 65, most people have multiple conditions

• The more conditions people have, the more hospital care they consume in the last 12 months of life

Growing evidence base

• Marie Curie End of Life Care Atlas

• VOICES survey of bereaved relatives

• Nuffield Trust study of the impact of the Marie Curie Nursing Service on hospital use

• Nuffield Trust study of health and social care at the end of life

• Whole system Delivering Choice evaluations (Lincolnshire & Somerset)

• Recent polling by Marie Curie

Marie Curie End of Life Care Atlas

• Web-based mapping tool brings together range of data on end of life care across the UK

• Range of indicators, include population characteristics, need and identification, patient and carer experience, costs, and place of death

Death and dying – experiences (VOICES)

Death and dying – experiences (VOICES)

Death and dying - spending

Declared PCT spend on specialist palliative care per death varies from £193 to £7,445

Death and dying - identification

Average of 26% of deaths with palliative care needs on Palliative Care Register; ranging from 14% to 70%

Death and dying – deaths in hospital

Greater proportionof people die in hospital in urban areas than rural ones

Recommendations

• Better targeting of end of life care

• Improved training for doctors and nurses

• A standardised approach to reporting spending on end of life care

• Outcomes based KPIs

• Free social care for those in the last six months of life

Challenges & Opportunities

• Ageing population• On-going constraints on public spending• NHS reforms• Francis

Moving the debate forward

• Over-reliance on hospital based care• Evidence shows that people do not want to die in

hospital, do not need to be there & experience poorer care if they end up there

• Evidence should give us confidence to shift away from our current reliance on hospitals.

Moving the debate forward

• We must seize opportunity afforded us and ensure that people at the end of life get the services they require; in the place of their choice, being pain free and surrounded by the people they love

• We have the evidence, what we need now is the determination and the will to affect fundamental changes which will ensure better quality care for dying people

•We are keen to work with you to improve end of life care services in all settings and to move the debate on.

Follow us on Twitter: @mariecuriepa

#DeathandDying