Improving end of life care
The grants

The role of hospital emergency departments
Most people die in hospital, although the majority of the elderly say they would prefer to die at home. With a grant of £60,000 a new project is auditing hospital admissions to A&E at Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital of people aged over 65 with palliative care needs. Data collected includes the reasons why these patients are admitted and how many ended up dying in hospital. Analyses will show the extent of preventable local admissions and potential reductions in the length of hospital stays, and thus how to increase the number of elderly deaths occurring at home.

Dignity for the elderly in care homes…
Almost one in five people die in a care home in the UK. Nationally, the standard of end-of-life care in care homes is variable, and it appears that residents are often inappropriately admitted to hospital at the very end of their lives, instead of dying in familiar surroundings with known carers. This second project, funded by a grant of £100,000 aims to explore whether this is a problem in Lambeth and Southwark and, if so, to find ways of overcoming barriers to providing residents with good end-of-life care and so ensure that good practice − embodied in the Gold Standards Framework − meets residents’ needs. The views of staff in 50-plus care homes and 25 residents are being sought.

Susan Longhurst, a research associate in the Department of Palliative Care at King’s College London, interviews a resident at the Westwood Care Homes as part of the study.

… and hospital wards
Hospices have a reputation of caring for the dying with greater sensitivity and compassion than the average hospital ward. Dying patients, however, have a right to expect a uniformly high standard of care irrespective of their location or medical condition.

A £386,000 grant is introducing a protocol for care throughout the Trust. The Liverpool Care Pathway (LCP) for the Dying has been recognised as a model of excellence. The guidance covers both best practice in controlling symptoms and communication, identification of spiritual and cultural wishes as well as supporting the family after death. The LCP also advocates coordination of existing policies such as “not for resuscitation” and “care of the body after death”.

Trinity Hospice, Clapham, was established in 1891 and is the UK’s oldest hospice. It is the sole provider of specialist end of life services – inpatient services, home care services and day therapy services - to 750,000 people living within its catchment area.

Most patients cared for at Trinity have cancer, but they also care for people with advanced heart, lung or kidney disease as well as those with neurological diseases such as motor neurone disease. Trinity’s care includes specialist nursing and medical care, emotional and spiritual support, physiotherapy, occupational therapy, practical social work support as well as complementary therapy, art therapy and hypnotherapy. Trinity’s care is free for everyone.

The Charity awarded Trinity Hospice a grant of £300,000 in February 2006 towards its £6 million appeal. The funding will enable Trinity Hospice to:

• Provide an enhanced facility that will increase the capacity for inpatient and day therapy services ensuring that those at the end of life and their families and carers have access to flexible, responsive and high quality specialist palliative care services able to meet their needs and expectations.
• Use the improved environment to support a new model of integrated, flexible and high quality inpatient and day therapy care.
• Maximise service and resourcing efficiency and effectiveness.

The world’s first Palliative Care Institute was launched by Prime Minister Gordon Brown on 5th February 2008 at King’s College London. The Cicely Saunders Institute will be the first international academic institute in the world to focus on palliative care research, dissemination and teaching, linked to clinical care. Geoff Shepherd, Chief Executive of the Charity said: “The Prime Minster’s attendance at the Institute demonstrates the government’s commitment to the End of Life Care agenda and I am sure that the new Institute will provide vital research and understanding in plannig future care for people at the end of their lives.”