Report calls for more care for people wanting to die at home
http://www.100md.com
《英国医生杂志》
More needs to be done to allow people who wish to die at home to be able to do so, says a report from the House of Commons Health Committee.
Although 56% of people who are terminally ill say they would prefer to die at home, currently only 20% do, says the report on palliative care. Most terminally ill people (56%) die in hospital under the care of generalists.
"The right to a good death should be fundamental," said David Hinchliffe, chairman of the committee. "We hear much about the `choice' agenda in the NHS at present. But for those who are terminally ill, choices are not being realised."
The report calls for the government to consider a new model of palliative care being introduced in Canada, where carers are entitled to six weeks of paid leave and patients have access to a "virtual hospice" online with direct access to specialist nurses and doctors.
The charity Marie Curie Cancer Care has calculated that 14 days of palliative care in the home costs around ￡2500 ($4600; 3800), compared with ￡4200 for the equivalent care in hospital. An investment of slightly less than ￡100m to cover the annual cost of dying at home would release ￡200m of hospital resources for other acute services, said Tom Hughes-Hallet, the charity's chief executive.
The report also points out the disparity of end of life services around the country and the bias towards cancer, with little provision for children or for patients with neurological diseases or cardiac or renal failure.
"Around a quarter of us die from cancer, but over 95% of hospice places are taken by those suffering from that disease. Those who are terminally ill with, say, motor neurone disease or heart disease are most unlikely to use specialist services," said Mr Hinchliffe.
The Newcastle and Northumbria region, which has a palliative care need 30% above the national average, has only half the average number of beds. By comparison the county of Surrey has a need 20% below the average but has one of the highest bed to population provisions in the country, says the report.
The report also calls on the government to examine the current policy of excluding hospice patients from legislation that expedites the discharge of patients from acute hospital beds. "Any delays in discharge arrangements can be catastrophic, meaning the difference between someone ending their days in the place of their choice, or having that wish denied," says the report.(Zosia Kmietowicz)
Although 56% of people who are terminally ill say they would prefer to die at home, currently only 20% do, says the report on palliative care. Most terminally ill people (56%) die in hospital under the care of generalists.
"The right to a good death should be fundamental," said David Hinchliffe, chairman of the committee. "We hear much about the `choice' agenda in the NHS at present. But for those who are terminally ill, choices are not being realised."
The report calls for the government to consider a new model of palliative care being introduced in Canada, where carers are entitled to six weeks of paid leave and patients have access to a "virtual hospice" online with direct access to specialist nurses and doctors.
The charity Marie Curie Cancer Care has calculated that 14 days of palliative care in the home costs around ￡2500 ($4600; 3800), compared with ￡4200 for the equivalent care in hospital. An investment of slightly less than ￡100m to cover the annual cost of dying at home would release ￡200m of hospital resources for other acute services, said Tom Hughes-Hallet, the charity's chief executive.
The report also points out the disparity of end of life services around the country and the bias towards cancer, with little provision for children or for patients with neurological diseases or cardiac or renal failure.
"Around a quarter of us die from cancer, but over 95% of hospice places are taken by those suffering from that disease. Those who are terminally ill with, say, motor neurone disease or heart disease are most unlikely to use specialist services," said Mr Hinchliffe.
The Newcastle and Northumbria region, which has a palliative care need 30% above the national average, has only half the average number of beds. By comparison the county of Surrey has a need 20% below the average but has one of the highest bed to population provisions in the country, says the report.
The report also calls on the government to examine the current policy of excluding hospice patients from legislation that expedites the discharge of patients from acute hospital beds. "Any delays in discharge arrangements can be catastrophic, meaning the difference between someone ending their days in the place of their choice, or having that wish denied," says the report.(Zosia Kmietowicz)