Select Committee on Health Written Evidence


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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