NHS leaders in some regions have been told that an increase in the number of end-of-life patients in hospitals could affect treatment levels this winter.
A palliative care adviser highlighted the looming “crisis” at an online internal meeting of health leaders in Sussex, a recording of which was heard by the BBC.
Consultants at University Hospitals Sussex NHS Trust described the dilemma faced by hospital managers as some patients had to receive end-of-life care in A&E.
This pessimistic assessment is likely to be echoed in other NHS areas, as increased winter pressure increases the challenge of finding hospital beds for patients in need of care.
Sussex University Hospitals Trust includes Worthing Hospital, Royal Sussex County Hospital, St Richard’s Hospital in Chichester and the Princess Royal Hospital in Haywards Heath.
Doctors and officials from East Sussex Healthcare NHS Trust, which includes Conquest Hospital in Hastings and Eastbourne District General Hospital, also attended, as well as community health representatives.
The consultant gave a slide presentation titled ‘Palliative and end-of-life care in Sussex’ at the meeting on 4 November.
She told the audience that local hospices were struggling to find places for patients who needed hospice care, and it was sometimes unclear how much support the local community could provide when people were sent home.
“I’m really concerned that patients with treatable conditions are not being admitted to the hospital because there are so many end-of-life patients in hospital beds,” she said.
She continued, “We are no longer putting patients on the waiting list for transfer who have died immediately” and are only focusing on those with complex needs.
Speaking about increasing palliative care in A&E, the consultant said it was a “very difficult choice – do you put them in corridor care or do you turn them over and put them in the back of an ambulance and they could die on the way home”.
She believes that “there are many patients in the hospital who do not need to be hospitalized, and many patients with complex needs are not being met.”
“We all knew this crisis was coming – and it’s getting worse,” she concluded.
‘Under great pressure’
A spokesman for NHS Sussex said the organization was committed to ensuring patients had access to “the best possible, high-quality palliative and end-of-life care”.
They said: “This includes providing a range of compassionate, person-centred care settings and, importantly, where possible, in settings outside the hospital, such as community settings and our hospices.
“Urgent care services across Sussex remain under huge pressure, but staff continue to work extremely hard to ensure patients can get the care they need in our hospitals and across all our health and care services.
“There are strong partnerships in place over the winter period to support individual care plans and ensure people receive the appropriate NHS services to meet their needs.”
But the Royal College of Emergency Medicine said delays in discharge were a huge challenge across the NHS and a lack of social or community care could mean some patients who need end-of-life care and support are unable to leave hospital.
Dr. Ian Higginson, the college’s president, said the college was “concerned that a significant number of patients who require hospice care are ending up in emergency departments and then hospitals because they are unable to access the specialized services they need.”
“Patients who prefer to stay at home may end up in our hallways and that’s not appropriate for anyone, let alone those who are nearing the end of their lives,” he said.
Meanwhile, community services are being stretched thin, with hospices warning of a funding crisis.
Toby Porter, chief executive of Hospices UK, said: “We know how hard NHS and care system staff are working to give dying people the care they deserve.
“But while a hospital may be a suitable place for some people, for the majority of people who die, a busy ward is not a suitable place.
“Hospices across the country want to provide more care in the community, but this year we’ve seen cuts due to funding pressures. This has had a knock-on effect on hospitals.”
