The rising number of patients ending their lives in hospitals could impact the level of treatment this winter, a group of regional NHS leaders has been told.
A consultant in palliative care highlighted the impending “crisis” during an online internal meeting of health leaders in Sussex, a recording of which has been heard by the BBC.
A consultant to University Hospitals Sussex NHS Trust described the dilemmas facing hospital managers when some patients have to be given end-of-life care in A&E corridors.
The disappointing assessment is likely to be echoed in other NHS areas as winter pressures increase the challenge of finding hospital beds for sick patients who need care.
the Princess Royal Hospital is in Haywards.
The University Hospitals of Sussex Trust includes Worthing Hospital, the Royal Sussex County Hospital, St. Richard’s Hospital in Chichester, and the Princess Royal Hospital in Haywards Heath.
Doctors and officers from East Sussex Healthcare NHS Trust, which includes Conquest Hospital in Hastings and Eastbourne District General Hospital, also attended the meeting along with community health representatives.
The consultant gave a slide presentation titled “Palliative and end-of-life care in Sussex” at the meeting on 4 November.
He told the audience that local hospices were struggling and it was difficult to find space for patients who needed end-of-life care, while it was sometimes unclear how much support they could find in the local community when people were sent home.
“I’m really concerned that patients who have treatable conditions will not be able to be admitted to the hospital and treated because there are so many patients reaching the end of their lives in hospital beds,” he said.
He added, “We are no longer putting patients on the waiting list for transfer who are simply dying,” focusing only on those with complex needs.
On delivering advanced palliative care in A&E, the consultant said it was a “really tough choice – do you admit them to corridor care or do you turn them around and put them in the back of the ambulance, where they could die on the way home?”
He argued that “there are many patients in hospital who don’t need to be there, a lot of patients with complex needs whose needs are not being met.”
He concluded, “We all know this crisis is coming – it’s going to get worse.”
The NHS in Sussex, according to a spokesperson, is committed to providing patients with “the best possible, high-quality palliative and end-of-life care.”
He said, “This includes providing compassionate, person-centred care across a range of venues—and importantly, where possible, in settings outside the hospital, such as community settings and our hospices.”
“Emergent care services across Sussex are under immense pressure, but staff are working incredibly hard to ensure patients can get the care they need in our hospitals and across all our health and care services.
“Strong partnership work is underway over the winter period to support individual care plans and ensure people are in the right NHS service for their needs.”
But the Royal College of Emergency Medicine said delayed discharges are a major challenge in the NHS, and a lack of social or community care could mean some patients who need care and support at the end of life cannot leave hospital.
Its chairman, Dr. Ian Higginson, said the college is “concerned about the number of patients who require end-of-life care but end up in emergency departments and then hospitals because the dedicated services they need are not available.”
He said, “Patients who would prefer to stay at home end up in our corridors, which are not the right place for anyone, let alone those at the end of their lives.”
An NHS doctor, who wished to remain anonymous, contacted the BBC and said the problems had persisted for some time: “
End-of-life care delivered via emergency departments, corridors, ambulances or unsupported discharge homes has become increasingly routine in many areas.
What is particularly striking is the recurring pattern: hospital beds are occupied by dying patients who should never have been there, and there is limited or delayed access to hospice or community care.”
hospitals could become the “default option”
The NHS Confederation, which represents NHS leaders, said hospitals could become the “default option” when community and social care provision is under pressure or unavailable.
“The solution is not about asking hospitals alone to shoulder more pressure – it’s about investing in the whole system,” said Rory Deaton, director of the confederation’s acute network.
Hospices are warning of a funding crisis, while community services have also suffered.
Toby Porter, chief executive of Hospice UK, said, “Although a hospital may be the right place for some people, a busy ward is not the right place for the majority of people who are dying.
“Hospitals across the country want to provide more care in the community, but this year we’ve seen cutbacks due to funding pressures. And that’s having a deep impact on hospitals.”
