The Coalition of Frontline Care for People Nearing the End of Life is urging radical changes in care for older people nearing the end of life, by investing in training and support for the 3 million frontline health and care workers who provide that care.
In a new report, End of Life is Everyone’s Business, published today, the Coalition calls on the Government to make changes across health and care at national, systems, and workforce levels as part of its NHS reforms and 10 Year Plan.
These changes will enable national policy aims of shifting care closer to home, preventing over-use of hospitals, reducing waiting lists, and recognising the vital contribution of the workforce.
With the ageing population, the increasing numbers needing care at the end of life, and the breakdown in health and social care integration all too apparent, there is a growing need for a joined-up approach to care for people nearing the end of life with any condition, in any setting, given by any care provider.
Investing in the frontline health and care workforce through core quality improvement training could be the key to making a radical difference to the care for people in their final years. It would enable the delivery of quality, proactive, personalised care for more people nearing the end of life, with improved support from specialists in palliative care, geriatric medicine, and dementia care.
Professor Keri Thomas OBE, Chair of the Coalition, said:
“There has never been a more important time to transform care and enable better end of life care for more people than now.
“Most of the hands-on care for most people in their final years is given by frontline health and care staff. It, therefore, makes perfect sense to invest in the frontline generalist workforce in all settings now.
“But there is currently little investment in proactive, preventative, systematic training for the workforce caring for most people in their final year of life. It is essential that all teams caring for these people are well-trained, with access to specialist support, and work in systems that support the delivery of gold standard care at the end of life.
“The NHS Reforms and 10 Year Plan are a wonderful opportunity to invest in the hard-working teams across the country to deliver a radical step change in care for thousands of people and their families, now and in the future. Nothing else would be as effective in helping the NHS achieve its policy ambitions of bringing care closer to home, preventing over-use of hospitals, enabling the workforce at the bedside, and integrating health and social care to provide better care for more people.”
About 650,000 people die each year, almost 1% of the population, with about 30% of hospital patients and about 80% of care home residents being in their final year of life. This number dying each year is predicted to rise by 25% by 2040, meaning that more people will need end of life care in the future.
Most people would like to remain at home at the end of their life, but still, 44% die in hospital. Almost a third of hospital emergency admissions are for people in the last year of life. About 40% of emergency hospital admissions of care home residents are considered preventable, and end of life care training such as GSF can dramatically decrease these.
More people are dying of age-related conditions now, mainly dementia, frailty, and multimorbidities. For many people, their decline and death can be anticipated, and their care proactively planned.
The assisted dying debate shines a spotlight on the importance of improving end of life care for more of our population in every setting.
Many more people 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 increase bed access for others, making economic and practical sense. It would help with the government’s target of reducing waiting times.
About a third of the NHS budget is spent caring for people in the last year of their lives. A modest investment reaps significant benefits at all levels, including cost-effective use of our hospital beds, better collaboration with specialists and other resources.
A 2023 survey suggested two-thirds of people (67%) agreed that the Government should provide more resources and training for end of life care as a national priority.
Liz Jones, Policy Director, at the National Care Forum, said:
“We welcome this report and its ambition to urge government to invest in improving training and support in end-of-life care for frontline generalist staff across health and social care. With a combined health and care workforce of 3 million people, and the changing demographics that are expected over the next 20 years, it’s more important than ever that we make sure we have really good quality, core training on end-of-life care.
“Only with government investment can we ensure this essential workforce is equipped to provide quality, proactive, compassionate care for people at the end of their lives, and their families. This investment must be fed into the government’s 10-year plan for the NHS as now is the time to embed this training to support our amazing workforce to achieve the very best care outcomes for people.”
Dr Jane Townson OBE, CEO of the Homecare Association, said:
“Most care workers love their jobs and the ability to improve lives for people who are in their final years. They show commitment to ensuring people receive the right care at the right time and provide care in accordance with their wishes and preferences. Too many though feel they lack sufficient training to provide more complex care at the end of people’s lives. With an ageing population, the time has never been more pressing to recognise the vital role care workers play in supporting people to live and die well. Investing in our social care workforce is key to building a more compassionate care system for all.”
Professor Martin Green OBE, Chief Executive, Care England, said:
“Care England supports the objective of the coalition to ensure that all staff have the training and support necessary to deliver a good End of Life Care. This will require some leadership and resources from the Government, and getting this right is an essential building block of integrated care and health system and should be an essential part of the NHS 10-year plan.”
The Coalition is a partnership of leading organisations from across health and social care, united by a desire to promote best practice in the care older people receive in their final years of life. The Coalition’s members represent most of the health and social care workforce who care for most people in their last years of life across all settings.
With the new Government’s calls for reform, its commitment to improve both health and social care, the time is right for a radical step change in care for people nearing the end of their life now and for the future. Only by mobilising the three million strong frontline workforce could the Government achieve its aims of bringing care closer to home, prevent over-use of hospitals, support the workforce, and include technological innovations to improve care.
The report affirms that end of life care is everyone’s business and calls both for training for generalist frontline teams and better access to support from specialists in palliative care, geriatrics, and dementia. It describes the multiple benefits that could ensue at humanitarian, economic, and workforce levels.
There are outstanding examples of excellence around the country in all settings that should be rolled out across the country. To be effective, the Coalition is calling for changes at three levels:
- National: A strategic focus and investment in end of life care and the 3 million strong health and social care workforce, plus development of social care and the planned National Care Service.
- System: Integrated Care Boards (ICBs) prioritising whole-system integration and collaboration of health and care for people nearing the end of life, enhancing community care, and preventing over-hospitalisation, enabling more people to live and die where they choose, usually at home.
- Workforce: To invest in the frontline health and care workforce and roll out the provision of enhanced core training and support to deliver quality, proactive, personalised care for people nearing the end of life with support from specialists in specialist palliative care, geriatric medicine, and dementia care.
The NHS definition of end of life care is care for people in their final year of life, including, but not only, the care of people in their final days. There is recognition of the need for improving the provision of end of life care in all health and care settings, notably in care homes and care given by domiciliary care providers. Only about 11% of patients require specialist palliative care and only 4% die in hospices.
The Coalition report, End of Life Care is Everyone’s Business, executive summary, and appendix will be available to download here once the embargo lifts:
www.goldstandardsframework.org.uk/coalition-of-frontline-care
