The health secretary, John Reid, has promised further funds to help double the number of cancer patients allowed to die at home—if NHS pilots prove claims, as they are expected to, that such a move would save money and comply with patients’ wishes.
Speaking at the launch of Marie Curie Cancer Care’s campaign, “Supporting the choice to die at home,” Mr Reid said the charity”s research confirms his prejudices that most people would prefer to die in familiar surroundings but that he needs hard evidence before he can confirm extra funding.
“We’re committed to ensuring that palliative care is available to all who want it,” he said.
Marie Curie Cancer Care says that giving a further 37 000 cancer patients the necessary support to die at home would reap net savings of £100m ($187m; €150m) every year by freeing up hospital beds.
The figures come from an opinion paper written by health economist Professor David Taylor, who has calculated that every £1 spent on home palliative cancer care releases a further £2 from hospital funds.
As part of his paper, Professor Taylor, from the University of London”s School of Pharmacy, calls for primary care trusts to audit quality of death as a method of reducing health inequalities. Primary care trusts should win extra funding if they improve “end of life” services and manage to show more respect for the care preferences of terminally ill patients.
Marie Curie Cancer Care is concerned that many terminally ill people don”t get to die at home because their carers—including family and health professionals—feel ill equipped to cope with the stresses involved. Its survey of 2000 adults published earlier this week shows that 64% of people would prefer to die at home if they had a terminal illness. But official figures show that only 22% of those with terminal cancer—and less than one in five of the population as a whole—die at home (Office for National Statistics, England and Wales, 2001).
“GPs and district nurses have less experience of people dying in their homes than they would have done a generation ago. They feel deskilled,” explained Dr Teresa Tate, the charity”s medical director and a palliative care consultant at Barts and the London NHS Trust.
Under a £6m pilot programme, the NHS will test various models of at-home care for terminally ill people, evaluating any cost savings. The government is currently seeking bidders to manage the pilots, which will include social services staff and voluntary sector partners.
• In an online survey on bmj.com last year, 74% of 1533 respondents said they would prefer to die at home (19% expressed no preference; 5% would choose a hospice and 2% a hospital). http://bmj.com/misc/good_death.shtml