No one should die in hospital when they don’t want or need to be there. The state of end of life care needs to change.

9 January 2025, 17:49 | Updated: 9 January 2025, 17:50

Wes Streeting is right. No one should die in hospital when they don’t want or need to be there. The state of end of life care needs to change.

In an interview on LBC Radio this week, The Secretary of State for Health and Social Care, Wes Streeting said he was ‘ashamed’ of the experiences of some patients in the NHS.

He described ‘heart-breaking’ conditions in A&E, including people being driven in ambulances to emergency departments to die because the right end of life care isn’t available to them.  

He’s right, it is shameful.

No one should be dying in hospital under these circumstances.  

As a palliative care consultant and Chief Medical Officer for Marie Curie, the UK’s leading end of life charity, I know it doesn’t have to be this way.  

Across the UK, initiatives set up by Marie Curie are working to stop this happening.  

In Bradford, responding to data suggesting there are around 1,000 people with palliative care needs not accessing services, the Responsive Emergency Assessment and Community Team (REACT) has been set up to support patients in the last year of their life, particularly those who often end up in A&E in crisis.

The service is a partnership between Marie Curie, Bradford Teaching Hospitals NHS Foundation Trust and Social Finance with social investment from Macmillan Cancer Support and Big Society Capital and grant funding from The National Lottery Community Fund. 

In its first year, REACT supported more than 400 patients, drastically reducing the average number of days patients in the last year of their life would normally spend in hospital from 38 days to 17 days.  

In Plymouth, currently only 20% of people are dying at home, compared with 29% in Devon as a whole and 28.4% in England.

To help stop people dying in hospital when they don’t necessarily need or want to be there, last year Marie Curie launched a new partnership with University Hospitals Plymouth NHS Trust.   

This has included providing Marie Curie Healthcare Assistants to support the Emergency Department at Derriford Hospital.

These staff are working in partnership with an end of life care practitioner to help get patients home if this is where they want to be.   

Marie Curie Nurses also support the identification of people who are approaching the end of their lives across the wider hospital, assess their needs and, in line with their wishes, support their transfer or discharge to their preferred place of care in a timely manner.  

The team talk with patients and families about their preferences for where they would like to receive their care at end of life.  

University Hospitals Plymouth has also expanded the number of dedicated beds available at Mount Gould Hospital, a local community hospital, for people nearing the end of their lives, with Marie Curie Nurses and Healthcare Assistants providing additional hands on-care and expertise.  

These initiatives are making an enormous difference. But it isn’t enough. Currently 90% of people who die need palliative care but an estimated one in four people miss out.  

This equates to around 150,000 people. 

What’s even more shocking is that there is currently no national palliative care strategy in place to create the real change that is so urgently needed.   

After the assisted dying debate gripped the nation, it’s clear that how we die is incredibly important and affects us all.

And, as we see A&E departments buckling under winter pressures this week and ambulance handover delays hitting record highs, we must not underestimate the importance of end of life care in this discussion.

Ensuring robust, effective and compassionate palliative care is in place is key if we want to reduce the amount of people being taken to A&E and give dying people the peaceful and dignified deaths they deserve.  

If the government is to realise its ambition for more healthcare to be provided in the community rather than in hospital, so that patients and their families receive personalised care in the most appropriate setting, then palliative and end of life care needs to be at the heart of its plans to build an NHS fit for the future.  

As the government prepares the NHS 10 Year Health Plan, palliative and end of life care must be prioritised.  

We need a national palliative care strategy, we need long term transformational funding and we need to close the gap in end of life care.

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Dr Sarah Holmes, Palliative Care Consultant and Chief Medical Officer at Marie Curie.

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