A coalition of leading health and social care organisations is
calling on the government to tackle failings in the way older
people are cared for in their final years of life. The new
Coalition of Frontline Care for People Nearing the End of Life,
which includes Care England, the British Geriatrics Society (BGS)
and The Gold Standards Framework Centre (GSF), is calling for
enhanced core training in end of life care (EOLC) for the UK’s
three million generalist frontline...Request free trial
A coalition of leading health and social care organisations is
calling on the government to tackle failings in the way older
people are cared for in their final years of life.
The new Coalition of Frontline Care for People Nearing the End of
Life, which includes Care England, the British Geriatrics Society
(BGS) and The Gold Standards Framework Centre (GSF), is calling
for enhanced core training in end of life care (EOLC) for the
UK’s three million generalist frontline health and social care
workers. They also want to see a step-change in health and care
integration from the new Integrated Care Boards (ICBs) and
heightened recognition of end of life care by the regulator
CQC.
In an open letter to Secretary of State for Health and Social
Care, Rt Hon MP, and Social Care Minister,
, they say that existing
NHS resources could be better used to transform a vital system of
care that is failing those most in need.
Professor Keri Thomas OBE, founder and Chair of
GSF, the leading training provider in end of life care
for frontline health and care staff, said:
“Everyone deserves gold standard care at the end of their
life. Most hands-on care for people in their final year of life
is given by the frontline generalist workforce, in both health
and social care. Therefore, it makes sense to ensure that those
giving most care to most people in their final years, in any
setting, are well trained in end of life care.”
“The current system, however, is particularly failing
vulnerable older people in their final years and the situation
will only worsen as the population ages. Patterns of dying are
changing too. Healthcare systems must adapt to the age-related
conditions causing deaths and long-term illnesses, such as the
UK’s biggest killer - dementia, by equipping frontline teams to
provide proactive, personalised, coordinated and system-focused
care for people in their final years.”
“Research shows that given the choice, most people would prefer
to die at home or in a care home yet almost half die in hospital.
Unless more frontline health and care professionals receive
specific end of life training and support, we will see further
increases in emergency admissions and hospital deaths, which is
not what we or the public want.”
The open letter has been signed by the leaders of seven health
and care organisations which represent the health and social care
workforce providing frontline care to those in the last years of
life. These include: the Gold Standards Framework Centre (GSF),
Care England, the British Geriatrics Society, the National Care
Forum, the Homecare Association, the Association of Retirement
Communities Operators (ARCO) and the Community Hospitals
Association.
Highlighting the fact that about a third of the NHS budget is
currently spent caring for people in the last year of their
lives, the coalition say minimal investment would reap
considerable rewards and cost-savings, reducing avoidable
hospitalisation, cutting waiting times and fulfilling people’s
preference to die at home.
Driven by the ageing population, the number of UK deaths is
projected to rise by 25% in the next 20 years, with numbers aged
over 85 set to double (i).
About 1% of the population (650,000) dies each year, mainly older
people (85% over 65). We know that at any one time 30% of
hospital patients and about 80% of care home residents are in
their final year of life.
Most of these people will require substantial levels of hands-on
care, largely provided by an under-recognised frontline health
and social care workforce. For many, their decline can be
anticipated, and their care proactively planned, yet there is
currently little investment in preventative, system-based
training for the workforce caring for these people.
About 40% of emergency hospital admissions of care homes
residents are considered preventable, and EOLC training such as
GSF can dramatically decrease these (ii).
Many more could be enabled to live well and die well at home with
better staff training and stronger support. This would also
reduce over-hospitalisation and increasing bed access for others,
making economic and practical sense. In particular, this would
help with the government’s target of reducing waiting times.
Professor Martin Green OBE, Chief Executive of Care
England, said:
“Care for people nearing the end of their life is a major
part of delivering good health and care services, and all parts
of the system need to make changes in order to deliver good end
of life care.”
“The NHS Long Term Workforce Plan (iii) suggests improved
recruitment, retention and reform are needed to address the
workforce crisis, but it does not adequately address the need for
good quality end of life care, and currently excludes the social
care workforce.
This obvious omission could be remedied in part by a focus on
training in this vital area of end of life care for the social
care workforce.”
“Implementing a policy of enhanced core training in end of life
care for all frontline generalist staff in health and social care
is essential if we want to reduce suffering for older people in
their final years. “
“In each individual case there is only one opportunity to get end
of life care right. If the government is willing to grasp the
nettle on this issue, we can bring about a step-change in
care.”
A recent survey commissioned by GSF suggests there is widespread
public support for proposals outlined in the open letter with two
thirds of people (67%) agreeing that the Government should
provide more resources and training for end of life care as a
national priority (iv).
The full text of the letter is copied below and is available
to download here.
**Ends**
Coalition of Frontline Care for People Nearing the
End of Life
Dear Secretary of State and Minister,
Ensuring high quality care for people in the final years of life,
across health and social care.
We call on the Government to make a radical transformational
shift in the care for older people nearing the end of their
lives, through support and investment at service, system and
national levels. This includes (1) enhanced core training in
proactive, personalised end of life care (EOLC) for the three
million generalist frontline workforce in health and social care,
(2) system changes for Integrated Care Boards (ICBs) enhancing
inter-sector collaboration, community care and preventing
over-hospitalisation, and (3) nationally, a shift in policy and
CQC regulation. EOLC is everyone’s business. Care for people
nearing the end of their life is a major part of delivering good
health and care services and all parts of the system are
involved. Funding should be prioritised from new or existing
resources. With the ageing population, acting on this
unrecognised opportunity could reap benefits at multiple levels,
leading to a step-change in care to meet the needs of older
people in their final years of life.
We write to you as a coalition of leading organisations from
across health and social care, united by a desire to promote best
practice in care for older people in their final years of life,
by enabling the frontline workforce. Together we represent most
of the health and social care workforce who care for most people
in their last years of life (in hospitals, community, care homes,
domiciliary care, retirement villages, etc.), and the leading
provider of EOLC training, the Gold Standards Framework (GSF)
charity.
We believe everyone deserves top quality care as they near the
end of life. Most hands-on care for older people in their final
years is given by the frontline health and care workforce. It
makes sense, therefore, to ensure that those giving most care to
most people in their final years, in any setting, are well
trained in proactive, personalised EOLC, and supported by wider
Integrated Care Systems (ICSs), policies, and CQC
regulation.
The case for change is strong. The current system is not working
and is failing those most in need, notably older people in their
final years. As the population ages, with death rates predicted
to increase by 25% by 2040 and numbers aged over 85 set to double
, the issue of the fractured interdependence of health and care
is likely to escalate. Health and care systems must shift towards
care for people with age-related conditions such as dementia, now
the UK’s leading cause of death. Many more could be cared for and
die at home with better staff training and stronger support
in accordance with the wishes of the voting public . In a
recent survey, two thirds of UK adults backed a call for the
government to provide more resources and training for EOLC as a
national priority . We believe there is a strong case to shift
resources to something that is central to the delivery of
high-quality integrated care, for the benefit of the most
vulnerable people in our society.
Improvements in this area would lead to four key areas of
benefit: (1) humanitarian; (2) economic and practical; (3)
workforce; and (4) helping attain national strategic policy
aspirations - as outlined below.
1. Humanitarian - more could live well and die well at home with
better staff training and support.
One of the few certainties in life is that we will all die.
Despite this, many people in their final years have a poor
experience of care. Repeated surveys confirm that most would
prefer to die at home or in their care home supported by
their familiar care providers. Yet almost half die in hospital,
with repeated emergency hospital admissions in their final year .
Sadly, many do not have their EOLC needs recognised or met. Too
often we hear of older people enduring poor quality care and the
distress of families navigating a system not fit for purpose. We
believe things could be different and that we must strive to
ensure quality care at the end of life for all.
2. Economic and practical - minimal investment results in major
rewards through preventative care.
About one third of the NHS budget is spent caring for people in
the last year of their lives, much of which could be better spent
with proactive, personalised planning and crisis prevention.
People in their last year of life constitute about 1% of
the population, 30% of hospital patients at any time and
about 80% of care home residents. They also represent 25%
hospital bed days and almost a tenth of hospital admissions .
About 40% of emergency hospital admissions of care home residents
are considered preventable . These avoidable admissions both
distress patients and families and further stretch NHS capacity,
reducing access for acutely ill patients and increasing waiting
times. Without intervention, we risk a rise in
over-hospitalisation and inadequate home care . However, a small
investment reaps considerable reward, taking a proactive,
preventative approach. For example, for the cost of 2 nights in
hospital or 1-2 weeks in a care home, a whole team could be GSF
trained and accredited, fulfilling peoples’ choices, reducing
hospitalisation and freeing capacity.
3. Workforce - a better trained workforce delivers more and
boosts recruitment and retention.
Our workforce is our strength. The vast majority of care for
people in their final years is given by the three million
frontline generalist staff across the NHS and social care.
Hospices and palliative are specialists (workforce about 10,000)
and are highly valued colleagues, though in practice account for
only a fraction of the care provided to people in the last years
of life, with about 5% of deaths taking place in hospices. We
need both enabled, well-trained, up-skilled generalists and
support from specialists working together. It is therefore
essential that we invest in training and support for the
generalist workforce, most notably those in social care who are
often omitted from NHS plans. Recognition through investment,
enabling the workforce to provide high-quality care, will boost
staff retention, morale, and, if scaled up, improve
cross-boundary collaboration in ICBs.
4. National policy – this would help deliver Government policy
objectives.
The NHS Long Term Plan affirmed the importance of proactive,
personalised care for people in the last year of life. The 2022
Health and Care Act builds on the interdependence of health
and care through ICSs and population-based thinking. Statutory
Guidance to ICBs on this subject highlights the need for
workforce skill mix, access to specialist palliative care and
quality care across all settings. Extending this mandate to
generalist EOLC training would complement and bolster existing
government policy and lead to improved collaboration with
system-wide benefits. The NHS Long Term Workforce Plan
highlights the need for improved recruitment, retention and
reform, but excludes the social care workforce. Levels of staff
satisfaction, morale and retention are enhanced by
confidence-boosting EOLC training such as GSF . Inclusion by the
regulators of generalist EOLC training in ICBs and care providers
is vital to the success of this reform.
These benefits are attainable. Everyone dies, yet each person
only dies once. It is within our power to ensure that more are
supported to live and die well. There are several examples of
EOLC training , with encouraging progress. For over
25 years, GSF has been training and accrediting thousands of
generalist frontline teams in health and social care . These GSF
Accreditation Awards are endorsed and co-badged by these
Coalition co-signatories in their respective areas, and the
exemplar GSF accredited teams show what is possible to achieve.
We, as a coalition of leading health and care frontline
organisations, urge you to improve EOLC:
1. At workforce service level - to support all frontline
generalist staff in health and social care to receive enhanced
training to provide quality, proactive, compassionate care for
people nearing the end of life;
2. ICB System level - scale this up in ICBs for whole-system
approaches to integrated joined-up care; and
3. Nationally - policy and CQC regulation to support better care
for older people nearing the end of life.
We would be grateful to hear your response to the points outlined
in this letter and would welcome the opportunity to meet with you
to discuss them in more detail.
Yours sincerely,
Prof Keri Thomas OBE, Founder & Chair, GSF Centre UK &
Director GSF International
Prof Martin Green OBE, Chief Executive, Care England
Sarah Mistry, Chief Executive, British Geriatrics Society
Prof Vic Rayner OBE, Chief Executive, National Care Forum
Dr Jane Townson OBE, Chief Executive, Homecare Association
Dr Kirsty Protherough, Director and Chair, Community Hospitals
Association
Michael Voges, Chief Executive, Association of Retirement
Communities Operators
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