APPENDIX 44
Letter from Dr T Noble, the University
of Sheffield, to the Clerk of the Committee (PC 64)
I understand that the deadline for evidence
for the Palliative Care Committee has passed. However, in a discussion
with Baroness Finlay following her plenary at the Palliative Care
Congress last week, she suggested that I write with two important
pieces of evidence from our experience in Sheffield.
The first concerns provision of specialised
palliative care in-patient beds. Sheffield has a population of
about 560,000. Up to May 2001 there were 33 hospice beds and there
existed a waiting list for admission such that patients referred
to the hospice were sometimes obliged to wait for a bed becoming
available. Inevitably, some died before admission. Following the
opening of the Sheffield Macmillan Unit for Palliative Care on
the Northern General Hospital site with 18 additional beds, it
is now very rare for a patient to be admitted more than 24 to
48 hours after referral. Our bed occupancy rates at the Sheffield
Macmillan Unit for Palliative Care are about 90% and therefore
we think that the establishment of 51 beds is probably about right
for our population.
The second point concerns the potential extra
workload involved in treating patients with palliative care needs
who have diagnoses other than cancer. At the Macmillan Unit in
Sheffield we surveyed our referrals to the palliative care team
which provides both hospital support and in-patient care. The
hospital has no neurology services and no GU Medicine services
so we have virtually no referrals for degenerative neurological
disease or HIV related illness. In spite of this, non-cancer patients
represent about 20% of our referrals. However they are under-represented
on the in-patient unit. The time they spend under our care from
referral to either discharge or death is about half that of cancer
patients. The implications of this piece of information, were
it to be a general finding in other centres, is that an open policy
of non-cancer palliative care patients, while increasing the number
of referrals, would not proportionately increase the workload.
We think that referrals to our service for non-cancer patients
are triggered mostly by end of life issues rather than by symptom
control for long-term problems.
21 March 2004
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