News and Comment

Hospices and commissioners must work together to support ageing population

Friday 2 May 2014


Heather Richardson is Clinical Lead at Help the Hospices and was a speaker at OPM’s recent seminar on end of life care

Demand for high-quality end of life care – including that provided by hospices – is set to surge in the next few decades, driven by the UK’s rapidly ageing population. An increasing number of people are living for much longer, many with multiple, complex health conditions. The number of people aged 85 and over alone is expected to double in the next 20 years. In addition, more young people with life-shortening conditions are living for longer. These changes all present huge challenges for all organisations involved in planning and delivering care for people with terminal illness throughout different stages of their condition and as they approach the end of their lives.

This was the topic under discussion at a recent seminar event held by OPM and Help the Hospices attended by commissioners and individuals working in hospices. It focused on the recommendations of a national Commission into the Future of Hospice Care which describes what hospices and others involved in end of life care, such as commissioners, need to do over the next 2-3 years to adapt to the challenges and opportunities facing health and social care over the next 10-15 years. The Commission confirmed that hospices are important players in the future in supporting people who are dying, and those who face loss. It also highlighted that there is an important role for commissioners and others that must work with hospices to help create a context in which hospice care can flourish.

Public support for hospice care

The hospice sector cares for 360,000 people each year, of which a third are patients and predominately those with cancer. Those using hospice services as patients, families or carers have confirmed its value to them through positive feedback such as the Voices Survey. The invaluable and significant support provided by the public through fundraising confirms the value that local people place on hospice care. However, concerns have been identified about hospice provision in the future. Firstly, that there are insufficient levels of hospice care to reflect current and future needs. The number of people cared for currently is expected to at least double in the next two decades and the reality is that more hospice care will be needed for many more people with a far wider range of life-limiting conditions such as dementia and heart failure. Last year Help the Hospices commissioned a poll with Populus which showed that seven in ten people think demand for hospice care will “rocket” in coming decades because of the UK’s rapidly ageing population. Almost half of those surveyed (48%) said they were concerned there won’t be enough hospice care available in the future to support them or their loved ones if they need this. This rose to almost two thirds of people (63%) among those aged 65 and over. Secondly, there is concern that hospice care will not be identified as a significant solution by government, local health and wellbeing boards, commissioners and others in plans to meet future needs. While much work is underway currently to revise local systems and structures of end of life care, hospices are often excluded from such plans. It denies local developments of the expertise, innovation and commitment to high quality patient care that has driven hospice care in the past.

How hospices need to change in the future

Led by Dame Clare Tickell, with support from leaders from across the palliative and end of life care sector, the Commission into the Future of Hospice Care calls for adaptation on the part of hospices and particularly:

  • investment in the development of new models of care and adaptation of existing services to meet increasing and changing demands for their services
  • greater integration with the NHS and local authorities and strong relationships with care homes
  • service as advocates and champions of change on behalf of the communities that they serve to influence health and social care service delivery in their locality
  • closer engagement with other providers of end of life care as a means of sharing their expertise in providing person-centred care more widely with other organisations, including hospitals.

Increased partnership working will be particularly important for hospices in the future. The OPM event highlighted several examples of hospices working much more closely with a range of providers in their local communities. For example, some hospices are actively leading co-commissioning for end of life care and working in partnership with commissioners to shape and develop services that more closely match the needs of people in their local populations. Commissioners present also described ways in which they are working closely with hospices in their area to redress areas of shared concern. The potential role of hospices in meeting future need must not be ignored within the broader systems of health and social care. They bring a legacy of innovation and adaptation to people’s evolving needs, strong links with their local communities and have a unique position as both funders as well as providers of expert care. Hospices are keener than ever to work in partnership. It is important now that commissioners and others respond – engaging with them to find important solutions fit for the future.