Choice at the End of Life

Aimed at those responsible for commissioning and organising end-of-life care services at a local level, the final report, Implementing the End of Life Care Strategy: lessons for good practice, has now been published.

The research that The King's Fund undertook with Marie Curie Cancer Care and the Delivering Choice Programme focused on:

• the impact of shifting end-of-life care into the community
  access to end-of-life care services for non-cancer patients
• discharging patients from the hospital setting at the end of life
• the role of care homes in the delivery of end of life care

The findings from this research demonstrated the importance of partnership working across health and social care providers, to ensure that patients who are nearing the end of life can be cared for holistically in the community setting. Support for patients at the end of life is frequently provided by district nurses, GPs and other community providers. It is essential that these health care professionals work together with specialist palliative care services to ensure that they feel skilled and confident in delivering this care

Findings from previous publications and research

The King's Fund research has produced an additional report on the Delivering Choice project in Lincolnshire that evaluates the impact of the programme in reducing admissions and length of stay in the acute setting, as well as its impact on the proportion of deaths at home. The project focused specifically on patients using two new services:

• a community-based rapid response team (RRT) that makes emergency and planned visits to patients in their homes at twilight (3pm-10.30pm) and out-of-hours (10pm-7am)
• two discharge community link nurses (DCLNs): acute-based, dedicated discharge nurses who co-ordinate packages of home care and provide support and advice to patients and their carers, including other medical teams.

The analysis found that the programme has been associated with an increase in the percentage of patients across Lincolnshire who die at home and cut the percentage who die in hospital; home deaths rose from 19 per cent to 23 per cent. Findings from a small sample of patients further demonstrate that this shift to community care for patients at the end of life does not incur any additional costs to the NHS.