A rising number of end-of-life patients in hospitals could affect the level of treatment carried out this winter, a group of regional NHS leaders have 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.
The consultant at University Hospitals Sussex NHS Trust described dilemmas facing hospital managers when some patients are having to be given end-of-life care in A&E corridors.
The bleak assessment is likely to be echoed in other NHS regions as building winter pressures increase the challenge of trying to find hospital beds for sick patients needing care.
University Hospitals Sussex Trust includes Worthing Hospital, Royal Sussex County Hospital, St Richard’s Hospital in Chichester and Princess Royal Hospital in Haywards Heath.
Doctors and officials from East Sussex Healthcare NHS Trust, which includes Conquest Hospital in Hastings and Eastbourne District General Hospital, also took part in the meeting along with community health representatives.
The consultant made a slide presentation entitled “Palliative and End of Life Care in Sussex” at the meeting, which took place on 4 November.
She told the audience that local hospices were struggling and it was difficult to find places for patients who need end-of-life care, while it was sometimes not clear how much support there might be in the local community when people are sent home.
She said: “I am really worried that patients who have treatable conditions are not going to be able to get into hospital and be treated because there are so many end-of-life patients in hospital beds.”
She went on to say “we are no longer putting patients on the waiting list for transfer who are just straightforward dying”, focusing only on those with complex needs.
On giving enhanced palliative care in A&E, the consultant said it was a “really difficult choice – do you admit them for corridor care or do you turn them round, put them in the back of the ambulance where they may die on the way home”.
She argued there were “lots of patients in hospital who don’t need to be there, lots of patients with complex needs who don’t have their needs met”.
She concluded: “We’ve all known this crisis is coming – it is getting worse and worse”.
A spokesperson for the NHS in Sussex said it was committed to ensuring that patients have access to the “best possible, high-quality palliative and end-of-life care”.
They said: “This includes providing a range of places for compassionate, person-centred care – and importantly, where possible, in settings out of hospital, such as community settings, and our hospices.
“Emergency care services across Sussex remain under significant pressure but staff continue to work incredibly hard to make sure patients can receive the care they need at our hospitals, and across all our health and care services.
“There is robust partnership work in place over the winter period to support individual care plans, and to ensure that people are in the right NHS service for their needs.”
But the Royal College of Emergency Medicine said delayed discharges were a huge challenge across the NHS, and a lack of social or community care could mean some patients needing end-of-life care and support could not leave hospitals.
Its president, Dr Ian Higginson, said the college was “worried about the number of patients who need end-of-life care who end up in emergency departments, and then hospitals, because the dedicated services they need are not available”.
He said: “Patients who would prefer to be at home may end up in our corridors, which are not the right places for anyone, let alone those who are at the end of their lives.”
One NHS clinician, who wished to remain anonymous, contacted the BBC, saying problems had built up for some time: “End-of-life care delivered in emergency departments, corridors, ambulances, or via unsupported discharges home has become increasingly routine across multiple regions. What is particularly striking is the recurring pattern: hospital beds occupied by dying patients who should never be there and limited or delayed access to hospice or community care.”
The NHS Confederation, which represents NHS leaders, said hospitals can be the “default option” when community and social care provision is under pressure or unavailable.
“The solution is not about asking hospitals alone to absorb more pressure – it is about investing across the whole system,” said Rory Deighton, director of the Confederation’s acute network.
Meanwhile, community services are also stretched and hospices are warning of a funding crisis.
Toby Porter, chief executive of Hospice UK said: “While hospital can be the right place for some, a busy ward just isn’t the right place for most people who die.
“Hospices across the country want to provide more care in the community but this year we’ve seen it cut back because of funding pressures. And that is having a knock-on effect in hospitals.”
