Memorandum by Dr Mary Parkinson (PC 4)
Observations have been confined to sections
dealing with choice of provision, including support of people
in their own homes, Communication between clinicians and patients,
support services including domiciliary support and personal care,
and The impact and effect of Government Policy. Recommendations:
(a) That consideration be given to ensuring
that any recommendations given for the provision of palliative
care as a result of a full comprehensive assessment should explicitly
take into account the available resources, to enable the care
to be successfully carried out particularly if this care is to
be provided at home.
(b) That where the location of proposed
palliative care would prevent or delay this service, that regulations
permit boundaries to be crossed for this purpose.
Issues of choice in the provision, location
and timeliness of palliative care services, including support
to people in their own home. Within the last year, J, a man of
80 was admitted to an acute hospital outside the county where
he lived with multiple problems. Palliative care was arranged
at home in accordance with the wishes of the Patient. After a
fully comprehensive multi-disciplinary assessment under the Single
Assessment process, He was awarded fully funded continuing care,
and required nursing care at home. Although all the equipment
to enable him to be transferred home was provided, it was not
possible to deliver the promises of care made, as no Registered
Nursing was available in Domiciliary Care. Efforts to find a private
nurse failed because the only organisation supplying private "hands
on" nurses was just outside the County border and they could
not supply the care. J died in hospital.
He had to be moved to a small community hospital
within his own county which delayed his discharge home. Equipment
in the smaller hospital which was required included an air mattress
and there was delay in getting this, because he was considered
Location problems, and the lack of registered
nursing care at home prevented J receiving the Palliative care
that had been agreed in the Comprehensive assessment.
Communication between clinicians and patients
and service provision: In the case of J, communication between
Clinicians and the patient and family were excellent both in the
acute hospital and the community hospital However, had the family
been informed about the absence of nursing care availability at
home, and had there not been the necessary delay in transfer to
his home, it is possible that a different decision might have
been taken with regard to the location of the Palliative care,
or at least more time would have been available to arrange this.
M, aged 80, died in an acute hospital after
a stay of two months. She had superb Palliative care, and was
looked after Spiritually by the Chaplain who was with her to within
half an hour of her death on August Bank Holiday Sunday morning.
A colleague of the Chaplain was with her when she died. In the
same hospital, D aged 90, also had excellent Palliative care,
and the family were kept closely informed about her condition.
Support Services and Domiciliary care. The arrangements
for these were unsatisfactory in the case of J. Instead of full
care that was to be provided, there were to be two care workers
three times a day and the District Nurse was to have visited only
once daily. This would have put an intolerable strain on the family,
most of whom lived some distance away from J's home.
The impact and effectiveness of Government Policy.
The Single assessment and Person centred care which is enshrined
in Standard 2 of the National Service Framework for older people
was correctly carried out with J. Had "Fair access to Care"
been considered alongside the assessment a different recommendation
might well have been made with regard to J's care in his final
Both "M" and "D" received
excellent person centred care, and at no time during the stay
of all three patients in hospital was there any sign of explicit
or implicit age discrimination, (Standard 1 of the National Service
Framework for older people).