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End of life care: Is London the worst place to die?

This, the question asked by the London Assembly who earlier this week held a meeting to discuss end of life care and barriers to access in our capital city. Tes Smith responds. 
Morning-at-Saint-Francis-Hospice
The London Assembly have highlighted a number of groups of people who are more likely to receive poor end of life care - including people who live alone, people with a non-cancer diagnosis, and people from an ethnic minority.  

This investigation follows hot on the heels of the Economist Intelligence Unit ranking the UK the best in the world for end of life care. However, there are major discrepancies across London, and improvement is urgently needed.   

Yesterday we were asked to comment on this story for Time FM, and our stance is clear: while the figures disappoint us, it also doesn't come as a surprise to us and we welcome the report and attempts to improve end of life care. Our ethos is also clear: we want to provide end of life care to anyone in our community who needs it - regardless of age, sex, ethnic or cultural background, and ideally in the place that they choose.  

Family Support Paul and Kian 600 x 666 (cropped) Family Support Paul and Kian 600 x 666 (cropped)

But we are aware that there are inequalities in access to end of life care. We know it's not reaching everyone to the levels that we would hope and expect it to; so this is why some of London Assembly's claims don't come as a shock.   

We also need to make it clear that we, Saint Francis Hospice, are already working very hard to tackle some of the issues highlighted by the London Assembly - many have been our areas of focus for many years, others have been identified in our strategy as areas of real focus for us over the next five years.  

For example, the majority of our care takes place in the community, so we are already reaching out to people whether they live alone or with their families.

Our care is available to anyone with a life-limiting illness, which of course includes cancer but extends to conditions like motor neurone disease, lung failure, heart failure and neurological conditions - this is an area of real growth for us, with now over 25% of those receiving our care living with a non-cancer diagnosis. 

We provide our services to everybody, regardless of religion or spiritual beliefs. Our specialist workforce are not only specialists in palliative care, but respectful of religious and spiritual preferences, rituals and routine - it forms part of our holistic approach to care.   

As with all hospices, our care is tailored to the needs of each individual; whether they are elderly, young, have families, live alone, have religious beliefs of preferences in how they would like to die, we will strive to accommodate those to the very best of our ability. It's our passion and drive and we would love to see this approach across the board.    

Family Support Paul and Kian 600 x 666 (cropped) Family Support Paul and Kian 600 x 666 (cropped)

But there are limitations, difficulties and challenges. We know that not everyone is aware of the number of services we provide, who we provide them to, or quite exactly what hospices are. We know that not everyone accesses our care as easily as they should.   

So what more needs to be done?  

We are actively working with our CCGs and other end of life care providers across our catchment to improve access. We feel a collaborative approach is essential, we cannot do it alone. Funding is also an issue; we aspire to care for an additional 1000 people a year, but our current infrastructure wouldn't cope. We need and want to grow our volunteer base; we have exceptional support from 800 people across all areas of Saint Francis Hospice, and without them we will struggle to flourish. And let's not forget training; the more health and social care staff know and learn about end of life care, the better provision will be.

We look forward to hearing more about the findings and recommendations from the London Assembly as their work progresses. We welcome efforts to highlight the need for improvement in end of life care, because it enables us to add both further evidence and the clout we need to forge plans and move forward. Because London should be an excellent place to die, no matter who you are or what your circumstances. We will fight to see that goal achieved.       
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