This report suggests that hospices can help improve capacity in generalist health settings by sharing their expertise in end of life care with other care providers. It highlights the substantial contribution made by Scottish hospices, especially in providing community-based support.
In 2016-17 hospices in Scotland directly supported 19,000 people, from new born babies to centenarians. A further 2,400 people accessed bereavement services provided by hospices, and many more were supported as carers and families.
This does not mean that everyone who could benefit from expert end of life care receives it. In his 2015 report to the Health and Sport Committee, Professor David Clark noted that, using a per capita model from England to establish an estimate of those who might benefit from but are currently not receiving palliative care, there are potentially 10,600 people per year in Scotland who are missing out on the right care at end of life.
To address this we need a system-wide response; improved awareness of the services available through hospices and who they could benefit, increasing referral rates for some diagnoses, specific programmes to identify and reach underrepresented groups, and greater collaboration across health and social care where people with palliative and end of life needs come into contact with services.
The Scottish Government has committed to ensuring that, by 2021, everyone in need of palliative and end of life care can access it; and to the doubling of such care in the community. Hospices are integral to meeting these ambitions, and recognise that community based care is key to expanding reach.
Almost 80 per cent (by volume of patients) of the care provided by hospice services in Scotland allows people to remain in their own homes. This includes attending day hospice and outpatient care to use medical and wellbeing therapies; and being cared for by home care and hospice at home, where professionals attend to people in their home to provide services from advice and support, to hands-on nursing care around the clock.
While care that allows people to remain in their usual place of residence can be more cost efficient than unplanned admission to hospital or attendance at accident and emergency, it is not free to provide. If the Scottish Government is to meet its commitments for 2021 it will need to work with hospice services and invest in expanding hospice led community care.
As the provider of a significant proportion of Scotland’s expert palliative and end of life care, which is around 60 per cent funded by the generosity of local communities, hospice services are integral to end of life care now, and should be a key voice in planning for the future.
Acknowledgements
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We are grateful to member hospices in Scotland for their support and the provision of data on which this report is based.
We thank Sue Hogg, Director of Children and Families at Children’s Hospices Across Scotland (CHAS) for contributing the chapter on children’s hospice care.
Finally, thank you to Clydesdale Bank for supporting the printing of this report.
Other relevant Hospice UK reports are available on our website:
