UK has ‘palliative care problem’ as more nurses needed to fill gaps

A palliative nurse has said more people must take on the specialism to meet a huge forecasted growth in end-of-life care needs.

Jenny Evans, a Marie Curie clinical nurse manager based in Devon, said having enough nurses to meet all palliative care needs seemed like “blue sky thinking” at present, and encouraged anyone interested to take on what she called an “amazing” specialism.

Marie Curie, the UK’s largest end-of-life care charity, this week estimated that around one in four people in the UK die without the palliative care support they need, and that by 2048, palliative care needs will climb by around 25% nationally.

Amid this rising demand, the charity is drawing up plans to try and help close current and future gaps in service provision.

Part of this plan is to scale up its rapid response nursing service for people needing end-of-life care over the next five years, to take the pressure off the NHS and prevent hospital admissions for those better suited to home care.

Ms Evans, who has worked in palliative care for around a decade, said increasing the offer of a service like this was crucial to improving the quality of the end of people’s lives.

“It’s about ensuring people get the right care where they want it, and the pressure that’ll take off the NHS,” said Ms Evans.

“I think obviously, in a blue sky world, we’d have more nurses for this. Unfortunately, that’s really difficult at the moment.

“Also, rapid response is not currently possible everywhere; but, it’s a reactive service, and it means that if someone is in trouble, suddenly got very poorly and entered the dying phase, support is just a case of picking up the phone, contacting the service which will then come out.”

Ms Evans said nursing shortages more widely were having a “massive effect” on palliative care, and that it “absolutely” needed to be addressed.

Asked if she would recommend the specialism, Ms Evans said: “It’s becoming a much more exciting career than it used to be; it used to be seen as just sitting and holding someone’s hand.

“And we do those nice things, we do, but there’s so much more to it, so much career progression with a lot of specialist areas.

“I do overnight service where you’re in someone’s house, and being able to focus on one patient all night, the patients are so much more complex and you really use your clinical skills.

“It’s a special area, there’s something amazing about doing good palliative end-of-life care.

"You only get one chance to get it right, but when you do it has benefits for the patient, family, their long-term grief, and the whole NHS system. It’s so important.”

Ms Evans said she hoped more people join the specialism. With a rapidly ageing population, end-of-life care is set to become more important each year.

Marie Curie’s most recent predictions put the number of over-85-year-olds as increasing by 92% over the next 25 years.

As well as more nurses, Ms Evans said the main things which needed improving were ease of access to services and equity.

Regarding access, one of Marie Curie’s five-year goals is to implement a single point of contact for carers and patients.

Ms Evans said that, at present, many people find that their only option is calling 111 or 999 for help and then ending up in hospital.

“A 24/7 single point of access hub is a definite must, and essential,” she continued.

“It’s really hard for people, there are so many different services to know about, and know which ones are the right one.

“Having one number that someone can call when they are caring for a loved one who is dying, rather than being passed around and missing support – it means they can get the right support in a timely manner and won’t slip through the cracks.

“In hospital, they’re dealing with people who are acute and have other needs, not equipped to deal with end of life. It’s not nice for staff, it’s not nice for the patient, and it’s not nice for their loved ones.”

Marie Curie, over the next five years, is also looking to improve the equity of palliative care.

Chief executive Matthew Reed pointed to an even wider gap in end-of-life care for certain demographics: “We're troubled that there's a gap around people who are not getting the end-of-life care they need, and that gap is getting bigger, particularly for the poorest communities.

“Every year, more and more people will be dependent on end-of-life care – we are going to spend longer in the last chapter of life, with more complex health needs.”

To address the current equity issues, the charity is looking at more targeted support for those in areas which are underserved by the current system.

Mr Reed added that the UK had an “end of life problem”, and said without intervention it would overwhelm the health service.

“To put it bluntly, you only die once – and the last chapter of life has not been right for many, many people,” said Mr Reed.

“It is bad for the patient, and it can have a devastating impact on their loved ones too.

“The system we have at the minute does not reflect who we are as human beings, and it is also the most expensive way we could possibly think of doing things – distressed families call 111 and the ambulance service, who are often not best placed to be able to deal with end-of-life care, so they take people to hospital, which is rarely the best place for dying people to be.

“What is needed is more – much more – support for people in their own homes. That care is often better, and cheaper, than what is available in hospital."

Marie Curie is turning 75 this year alongisde the NHS, and Mr Reed said the charity was marking the milestone by shining a light on the "urgent need for more palliative care and support services to deliver a better end of life for all".

"This problem is solvable, and we intend to solve it," he added.