Phil McCarvill picks out the best ideas from our Twitter chat on how to care for people and the end of life outside of the hospital setting

This article was part of the End of Life Care channel, in association with Marie Curie Cancer Care. The channel is no longer being updated.

On 11 April @HSJnews hosted a third Twitter chat in association with @MarieCurieEOLC. Joining me was Michael Cooke, head of analytics at Marie Curie Cancer Care.

The discussion focused on how we can commission care that keeps terminally ill people, who have no medical reason to be there, out of hospital. This is a particularly important debate in light of our increasing ageing population and the fact that death rates are set to rise by 17 per cent between 2012 and 2030. This will lead to greater pressure on the health and social care system, meaning that we will need to find better ways to care for people at the end of life.  

Phil McCarvill

‘We know that almost 90 per cent of people who die currently receive hospital care in the final year of life’

As in our previous Twitter chats, the hour-long discussion benefited from the views of a number of commissioners and healthcare professionals and explored a wide range of related issues, from how we can move resources to a community based model of care to ensuring end of life care is more person-centric.

Early on in the discussion, it was highlighted how, while there are scenarios when a hospital admission is justified, evidence such as this recent Belgian study suggests around a quarter of  hospital admissions are avoidable. We know that most people say that they do not want to die in hospital and there was fundamental agreement during the chat that end of life care has to be centred around the needs of the terminally person and their families.

Help for providers

There was also discussion around the role of commissioning and the measures needed to enable 24/7 cover for end of life services and to prevent emergency admissions. Communication was also a key issue, with electronic palliative care coordination systems, summary care records and integrated care records variously being cited as tools that have a role to play.

The role of social care in preventing avoidable admissions was also considered. The importance of social care is reflected in research from the Nuffield Trust showing that, in the last 12 months of people’s lives, local authority funded social care is received by over a quarter of those who die in England. However, overall, we know that almost 90 per cent of people who die currently receive hospital care in the final year of life.

Among the various other areas of the debate, there was also consideration about the place of a lead provider model in end of life care. There was recognition of the challenge that commissioners face supporting smaller organisations that provide excellent end of life care. Service design (such as Marie Curie’s Delivering Choice programme) was highlighted as one of the many ways to help ensure providers work together to deliver integrated care.

Phil McCarvill is head of policy and public affairs at Marie Curie Cancer Care