Yesterday, the House of Commons Health and Social Care Committee published a report on palliative care, which outlines recommendations for the Government’s Palliative and End of Life Care Modern Service Framework (MSF). The BGS is deeply concerned that the report does not reference the specific needs of older people, despite them accounting for most deaths each year. It is therefore a missed opportunity to highlight how end of life care can be improved for the majority.
Most people who die each year are older people over the age of 75, accounting for 70% of deaths. Older people will typically have multiple health conditions, including frailty and dementia, and will have specific needs at the end of life which are different to those of people dying at a younger age with one terminal illness. They may also experience fluctuating health, making it difficult to predict when they will die. This means that traditional palliative care does not always serve them well.
The report’s recommendations include multiple targets for children and young people’s palliative care. We recognise that this group, who account for 2% of deaths each year, will have distinct unmet needs at the end of life which the MSF should address. However, we are alarmed that the report does not make similar recommendations for older people, the majority dying each year, who are the group least likely to have access to palliative, end of life, or hospice care.
We welcome the report’s recommendations to strengthen training for the generalist and social care workforce. However, its proposals to expand the specialist palliative and end of life care workforce are not realistic, given the scale of need. There will never be enough palliative care specialists to support everyone at the end of life, and currently, such specialists only care for a small proportion of those who die each year. In practice, most end of life care is delivered by GPs, district nurses, allied health professionals, and clinicians from other specialties, including geriatricians. Those with expertise in older people’s healthcare should be recognised as specialists in end of life care for this population, but this is not reflected in the report’s recommendations. The BGS therefore calls for the MSF to acknowledge palliative and end of life care expertise beyond the formal specialty of palliative care. This includes a call for the development of a national accreditation framework for professionals with the training and skills to manage the complex needs of older people living with multiple conditions.
The Palliative and End of Life Care MSF is a pivotal opportunity to improve care for the majority of people who die each year, namely those who die in later life. To achieve this, it must prioritise the needs of older adults living with multiple conditions, including frailty and dementia, who account for the majority of deaths each year. Older people should be clearly recognised as a distinct group within the MSF, including in its overarching moonshot goal and interventions. Without this focus, the MSF risks being perceived as irrelevant for most deaths and even as ageist. We strongly recommend greater involvement of experts in older people’s healthcare, such as geriatricians, in the development of the MSF. The BGS will continue to push for the needs of older people to be represented in the MSF and stands ready to work more closely with Government to make this a reality.
We have written a letter to the committee, outlining our concerns.