Warning over ‘unacceptable’ lottery in care of the dying


Relatives of cancer sufferers were more likely to feel their loved ones had
received good quality care, the right pain relief, and died in the place of
their choosing, the studies have found.

Prof Richards said he was also concerned by significant geographical
variations in the care received by patients, regardless of their disease.

“There are big geographic variations, but it is not as simple as a north/south
divide or London versus the rest,” he said. “The south west comes out well
but so does the north east… we need to understand these variations so we
can improve the quality of care.”

Prof Richards, who was national clinical director for cancer and end-of-life
care before he was appointed to CQC last year, said: “The level of variation
is unacceptable; we need to understand why this is, in order to help the
areas doing badly to do better.”

Research suggests that those who spent their dying weeks in their own homes or
in hospices and in care homes, tended to have better experiences of care
than those who spent much of their time in hospital.

“There was a big difference in the quality of care,” said Prof Richards. “In
general, we see those in hospices getting the best care, when it comes to
those who died in care homes, or in their own home, its about neck and neck,
but hospitals, I regret, are some way behind.”

Plans for the national review cite recent studies which have found poor
end-of-life care among dementia sufferers living in care homes.

Last year, a report by the thinktank Demos found that those with dementia, or
other complex conditions, suffered worse care than those with a diagnosis of
cancer.

Prof Richards said that cancer care tended to be better at providing
“hospice-style” help because charities and pioneers in the field had founded
such efforts decades ago.

He said future changes to improve the care of all dying patients were likely
to require better use of patient records, with more sharing of information,
so that the right help could be provided at all times.

He said ambulance crews should be given notice if patients had said they did
not want to be sent to hospital in their dying hours.

Prof Richards said the national review, which is due to report by next March,
will try to identify any “barriers to care” affecting those suffering from
particular diseases, as well as those from different ethnic backgrounds, and
those with mental health conditions or learning disabilities.

“This is not just about geographical variation,” he said, “It’s about
examining what the barriers to good care are for all types of patients with
all sorts of backgrounds or diagnoses.”

A national survey of 50,000 bereaved relatives found that those in the south
west rated the care provided most highly, with those in Cornwall, Somerset,
Devon and Dorset among the most positive about the way their loved ones were
treated. High scores were also found in the north east, with the lowest
scores found in London, and the east of England, the 2012 research found.