Changing the way end-of-life care is funded across the country would save millions of pounds and help focus on individual patient needs, according to a government-ordered review.
A national payment structure would cut variation around the country in what the state pays for and what it does not, and support far more people to be cared for in their own homes.
At the moment, the amount PCTs in England spend on end-of-life care varies widely, from £186 per patient in one area to £6,213 in another.
Access to services, including round-the-clock nursing care, also depends on where people live.
Far more people die in hospital than wish to, and experts estimate that more than 90,000 people are not having their palliative care needs met.
The Palliative Care Funding Review, ordered by health secretary Andrew Lansley last summer, proposes a “fair and transparent” funding system where the money is linked to the individual patient.
Under the scheme, people would receive an initial assessment of their needs, which would then be combined with other factors such as their age and capabilities.
This “needs classification system” would have 25 separate classes (13 for adults and 12 for children), each with its own pot of funding.
The funding would take account of things such as personal care needs, including help with washing and eating, the provision of 24/7 nursing care to support people at home and a co-ordinator to help patients work out their state entitlements as well as access to local charitable services.
Thomas Hughes-Hallett, chair of the review and chief executive of Marie Curie Cancer Care, said: “No other country in the world has introduced such a system for both adults and children, so the step is both a bold and necessary one.”
Professor Sir Alan Craft, adviser to the review, said: “The government must act on the recommendations contained in the review because evidence shows us that incentivising the provision of palliative care leads to better outcomes for patients, supports choice and is the most cost effective way of using NHS resources.
“We need to remove the barriers within the current system to enable this to happen.”