Nurse workforce issues are affecting the ability of terminally ill people to get the care and support they need during evenings and weekends, warns a new report.
The research, funded by charity Marie Curie and carried out by academics from three UK universities, highlighted the key role of nurses in delivering palliative and end-of-life care.
“Care often relied too heavily on over-stretched GPs and district nurses”
However, it found that patients continued to face a “postcode lottery” in terms of access to such services in the community out of hours.
Specialist palliative care nurse visits were widely available during the day including weekends, but the research found overnight visits were “much less common” and were unavailable in 80% of UK areas looked at.
The Better End of Life report, led by King’s College London’s Cicely Saunders Institute, Hull York Medical School at the University of Hull, and the University of Cambridge, said the lack of overnight coverage “may be because of capacity issues”.
It found that general community and district nurses played a major role in delivering out-of-hours care to people at the end of life, but that these services were also extremely stretched and that this could result in waits for the patient.
“Our research reiterates the extensive role of district nurses and community nursing teams in providing hands-on care out-of-hours, but also reflects the huge pressures on this workforce which limit the care that can be provided,” stated the report.
“A frequent theme in our interviews was that services were theoretically available to provide care, but in practice stretched beyond capacity.”
One of the researchers, Professor Fliss Murtagh, director of the Wolfson Palliative Care Research Centre, from Hull York Medical School at the University of Hull, commented further on the nursing findings from the report.
She said: “Throughout the UK, major reliance on district nurses or community nursing teams for out-of-hours palliative and end of life care was evident.
“Services are often available in principle, but our research revealed large gaps between what was technically available and delivery ‘on the ground’.
“Care often relied too heavily on over-stretched GPs and district nurses, who do their best but cannot always reach those needing support in a timely way.”
“It is essential that the gaps in services out-of-hours are addressed”
The researchers said investment was needed in workforce planning to address current shortfalls and meet the future needs of dying people across the UK.
They also recommended that every area of the UK should have a designated 24/7 palliative and end-of-life care telephone line, staffed by experienced palliative care professionals.
Ensuring the right community care was in place was “imperative” not only for the sake of patients, but also to reduce strain on emergency departments and acute hospital beds, warned the researchers.
Their study found that emergency department attendances increased “rapidly” during the final three months of a person’s life.
Lead researcher on the Better End of Life programme, Professor Katherine Sleeman, from King’s College London, said: “Our research uncovers considerable variation in the care and services that are provided in the evening or at weekends across the UK.
“If these services are not in place, people may have no choice but to go to hospital, even if their preference is to stay at home.
“Because we know that demand for palliative and end-of-life care will increase over the next decade, it is essential that the gaps in services out-of-hours are addressed, so that everyone with advanced illness has access to the right care, whenever and wherever they need it.”