Exploring NHS Limitations in Providing Optimal Palliative Care

Abstract

Introduction: Palliative care is specialised medical care which has the aim to provide relief from pain or other distressing symptoms to the patients in end-of-life condition.

Aim: The study aims to explain the statement that is the reason behind NHS not being the best provider of palliative care.

Methods: In this study, the data for arguing the statement of NHS not being the best provider of palliative care is to be gathered by using secondary research. The inclusion criteria to be followed for involving information in the study are articles and government reports published on and after 2013, written and presented in English language, related to NHS palliative care, fully accessible, contains primary and secondary data and academic in nature.

Results: In the UK, it is mentioned that nearly 75% of the deaths (335,000) each year have preceded the need for palliative care. Moreover, out of 335,000 availing palliative care in the UK, 171,000 people are identified to require specialist palliative care. The other countries where better palliative care is provided compared to the UK are Australia, Sweden and USA. The factor affecting NHS failure to be the best provider of palliative care in the UK are shortage of spec list nurses and physician, financial resources, a well-develop management system and others. The challenge faced in NHS to deliver palliative care are lack of food care model, well-trained and knowledgable staff, hindered attitude of nurses towards dying and others.

Conclusion: The NHS does show failure in the enhanced delivery of palliative care to people in the UK.

Introduction

Palliative care is referred to as the care approach which enhances the quality of life of the patient (children and adults) as well as their families who are experiencing problem-related to a life-threatening illness. The care assists to prevent and relieve the suffering of the individuals through the delivery of early health identification, right health assessment and treatment plan of pain and the associated problem of the patients whether they are physical, spiritual or psychosocial (macmillan.org.uk, 2018). In the UK, palliative care is provided as a part of end-of-life care to help the patients to lead a comfortable life by controlling their pain and distressing symptoms. The NHS provides palliative care free of cost to the service users at their home and hospitals. In the international list, the UK has been regarded as the top-quality palliative care provider in the country through the help of NHS mainly compared to the US, Australia and Sweden (Hasson et al., 2020). However, it is reported within the UK by health professionals is that the quality of the palliative care provided by the NHS is not of top quality and there are shortcomings which is causing the patients in their end-of-life to face hindrance in dealing with pain and health problems (Jones, 2019). Thus, the current study is developed to determine and argue the truth behind the NHS not being the best provider of palliative care in the UK and the way it is affecting the health condition of the patients in their end-of-life conditions. This is to be explained in comparison to other countries like Australia, the USA and Sweden to determine in which aspect compared to the UK the other countries are providing better palliative that is to be considered by the UK to enhance their services. Moreover, the aspects in which UK palliative care are failing to retain its standards are also to be discussed.

Methodology

The secondary research is the process of gathering information from existing studies and articles which are later summarized and presented in conducting the study (Kim et al., 2020). The benefit of using secondary research is that data to be collected is readily available on the internet which can be easily identified by the use of keywords. Moreover, secondary research is beneficial because it is economical as data on the internet is available free of cost or require a negligible amount for accessing it to be included in the study (Rumbold and Pierscionek, 2017). However, the disadvantage of using secondary data is that the authenticity of the data cannot be ensured. This is because the personal beliefs of the researcher may influence the credibility of the data during its presentation (Meystre et al., 2017). In this relation, the data to be presented in the study is to be evaluated with reference from previous studies to determine the credibility and authenticity of the information is ensured. The primary research is not be used in conducting the study because it is time-consuming and requires increased financial expenditure. It is evident as researchers require an increased amount of time for connecting and selecting the participants in primary research for gathering data from them to be used in the study (Cruz Rivera et al., 2017).

The inclusion criteria to be followed for involving information in the study are articles and government reports published on and after 2013, written and presented in English language, related to NHS palliative care, fully accessible, contains primary and secondary data and academic in nature. The exclusion criteria to be followed in the study are articles published before 2013, not written in English language, only abstract is available, related with information regarding any NHS care pathway other than palliative care and non-academic in nature. The articles published and written in the English language is to be used in the study because the research is based in the UK where the key language spoken is English. Thus, using articles published in other languages would not be understood by the researchers as well as cannot be used to get proper reference by the readers while exploring the current study. Therefore, to ensure meaningful data is presented with proper understanding by the researchers, the articles written in English is to be used. The articles and government reports published on and after 2013 is to be used as they contain valuable data in most current form to ensure enriched data is presented in the study.

Results and Discussion

In this section, based on the following themes data is to be explored to provide a detailed account of NHS not being the best palliative care provider in the UK.

Overview of Palliative care and its situation in the UK

Palliative care is specialised medical care that has the aim to provide relief from pain or other distressing symptoms to the patients, affirms regards to dying as a normal approach, intends to smoothen death, integrates emotional and spiritual care and offer a support system to be patients till they meet their death (Kavalieratos et al., 2017). Thus, palliative care is important because it leads the patient to overcome pain and other symptoms of serious and end-of-life diseases no matter at what stage the disease has been diagnosed by professionals. The palliative care not only enhances the quality of life of the patients but also their families by offering support to the family to manage the patients. The care is provided to people who are suffering from cancer heart transplant, end-stage liver or kidney disease and others (Sobanski et al., 2020). The NHS, UK is seen to be responsible for arranging and delivering palliative care to the needed individuals as they are the authorised healthcare body in the UK (NHS, 2019). As reported by Economist Intelligence Unit (EIU), palliative care in the UK in 2015 was ranked the best among the 80 countries from the world with Australia and New Zealand being placed second and third in position. The reason showcased behind the rank provided to UK is its extensive existing integrated palliative acre services present within the NHS along with deeper community engagement from the healthcare staffs as well as societies (Triggle, 2015). However, the fact is not true because malfunction within palliative care system in the UK is been identified which has led it to be considered not the best in the world. This is evident as in the UK, it is mentioned that 8 out of 10 charitable palliative care hospitals are flagged red in the coming year of 2021 (Jones, 2020). This indicates many of the charitable palliative care hospitals do not have effective finances to support the continuation of the care for the needy people of the lower social classes in the UK.

In the UK, it is mentioned that nearly 75% of the deaths (335,000) each year have preceded the need for palliative care. Moreover, out of 335,000 availing palliative care in the UK, 171,000 people are identified to require specialist palliative care. However, the number of people requiring general palliative care is not identified in the reports. Further, 50% (92,000) out of the remaining 184,000 people in the UK for palliative care are mentioned to have been benefited from the care not received any generalist or specialist palliative care at all during their need (mariecurie, 2015). These number when expanded as per countries in the UK, it is seen that nearly 6,200 individuals in Wales, 10,800 individuals in Scotland and 3,000 individuals in Northern Ireland die without receiving any palliative care instead of their need of the care (mariecurie, 2015). In England, from another report, it is mentioned that 975 people mentioned the need of palliative care but 469 of the individuals did not received any palliative care instead of their need. It equals 19 people dying each hour in England in pain and suffering without effective end-of-life care (dyingmatters, 2018). This indicates that a majority of the individuals are found unable to receive any palliative care and are dying in pain and suffering showing failure of the NHS to effectively reach palliative care services to the needy individuals for their better end-of-life care. It also mentions that the situation of palliative care in the UK is poor and immediate actions are required to improve its efficacy of delivery to the needed individuals.

Impact of failure of NHS to deliver best palliative care in the UK

The impact of the failure of the NHS to deliver effective palliative care for the UK population is that the patients who are in their end-of-life are experiencing lack of fulfilment of the core desires and goals. It would make the patients distressed and agitated out of their needs not being met which would eventually make them feel lack of zeal to live and feel death to come sooner to help them overcome their distressing life (Jones, 2020). Thus, failure of palliative care by NHS is leading people to accept distressing death. The other impact to be faced due to failure of the NHS to deliver effective palliative care in the UK is that the families of patients who are in their end-of-life condition who lack support to cope with the acceptance of death of the patients, This, in turn, would lead the family member to develop trauma out failure to support in meeting end-of-life need of the patient and become depressed (Jones, 2020). The impact of the failure of the NHS to deliver effective palliative care to needy individual is that it is leading patient and families unable to understand the way complex treatment plan are to be followed in supporting effective end-of-life condition of the patients. This in turn is creating an error in care that is hindering and further complicating the life of the patients who are near to death (dyingmatters, 2018). As argued by Black et al. (2018), effective palliative care includes specialist individuals who educate the patient and families along with support them in managing the complex care plan. This is because they are trained and have enhanced knowledge and skills from experience to provide the care as well as support others in delivering it. Another impact in the UK due to the failure of the NHS in delivering enhanced palliative care is that it is leading individuals in need of end-of-life care to be unable to receive even the general care at the hospital. This is evident as the failure of managing palliative care has led 40% of the hospital bed to be unnecessarily occupied by patients who do not need the care and is lading people in need of care at the hospital; for end-of-condition to suffer in pain and anxiety from the deteriorating health condition (dyingmatters, 2018).

The impact of the failure of the NHS in the UK to deliver effective palliative care is that it has resulted in the rise of unnecessarily hospital admission too which has led to increased care cot for patients. This is evident as in 2017, 341,074 unnecessary hospital admission of patients who are 65 years and above are seen to be made. It is equal to 1000 elderly people being unnecessarily admitted to the hospital each day for unavoidable reason (thegoodcaregroup, 2019). This has led to create 42,000 bed days to be lost each month, in turn, creating hindered availability of hospital assistance for the end-of-life patients in serious situation (thegoodcaregroup, 2019). The other impact of the failure of the palliative care in the UK is the inability to effectively mind the body and spirit of the suffering patients. This has led the end-of-life condition patients to experience chaos in life and be regarded as a burden of care on the family. It eventually led them to die without quality support meaning they experience painful death (Dionne-Odom et al., 2017).

Comparison of palliative care in the UK with other countries

The other countries where better palliative care is provided compared to the UK are Australia, Sweden and USA. In Australia, it is seen that there is separate workforce created for delivering palliative care to the patients. This is evident as in 2020 it is informed that 271 palliative medicine physicians and 3,528 palliative care nurses are separately present in the country to deliver the services (aihw.gov.au, 2020). However, in the UK, it is mentioned that only 224 specialised palliative care physicians are present (rcpmedicalcare.org.uk, 2019). This indicates that the palliative care workforce is more in Australia compared to the UK creating higher availability of physicians to needy patients. In 2019, in Australia, 47,214 specialist palliative care is been provided from 148 palliative care centres and 64,297 episodes of palliative care are provided (aihw.gov.au, 2019). In comparison, England has 155 palliative care centres (mariecurie, 2015). The total population of the UK is nearly 65.8 million whereas in Australia it is near to 40.3 million indicating there are more people to be delivered palliative care in the UK compared to Australia (mylifeelsewhere, 2019). In this respect, the number of palliative care centres in the UK are compared to be less than Australia per people in the country. The UK is considered better than Australia in pallative care in regard to funding for the care. This is because in the UK nearly 80-100% of the palliative care cost is paid by the NHS for the patient whereas in Australia few parts of palliative care are sometimes required to be privately funded by the patient (Siddique, 2015; health.gov.au, 2018).

In the USA, it is reported that 72% of the hospitals in the country has more than 50 beds for palliative care which has risen from 67% in 2015. It also mentioned that 87% of the hospitalised patient are seen to receive timely palliative care (Hughes and Smith, 2014). However, in the UK it is mentioned that 50% of the patients receive palliative care in the country with many been deprived of the care (mariecurie, 2015). This indicates that there is greater availability of palliative care in the USA compared to the UK. In the USA, it is seen that 98% of cancer patients received palliative care (Hughes and Smith, 2014). This indicates that the USA a well-constructed palliative care system for people suffering from cancer. The figure is similar to the people affected by cancer receiving palliative care in the UK which indicates that both nations are effectively contributing to deliver palliative care for the cancer patients (mariecurie, 2015). In the UK, palliative care is free of cost and available to all irrespective of any discrimination (NHS, 2019). However, in the USA, palliative care is not free and Americans are mentioned to spend $365 billion for availing it (Abbott, 2019). In this context, palliative care is better in the UK compared to the USA. This is because free palliative care allows the poor people also to be able to access it without thinking of the finances required which are often present in constrained amount for them and makes them unable to avail many natures of care.

Factor affecting NHS failure to be the best provider of palliative care in the UK

One of the factors behind the failure of the NHS to become the best provider of palliative care is their shortage of specialist carers. This is evident as the OCED report mentioned in between 2000-2017 there are nearly 28.7% of British doctors seen to be qualifying abroad. However, there are only 2.8 doctors and specialist present per 1000 people in the UK. This is compared to the average of 3.5 doctors per 1000 people in the OCED which makes the UK after Poland, the country with a lesser number of doctors per 1000 population (Skopeliti, 2019). In palliative care, it is seen that people remain mostly in deteriorated health condition due to which the adequate number of doctors are required to be present all the time. This is to ensure the patients when in need can immediately get assistance from the doctors and experience enhanced palliative care (Skopeliti, 2019). However, the lack of adequate specialist doctors in the UK is creating a gap for immediate care delivery required in palliative care, in turn, making NHS fail to be the best care palliative care provider.

The presence of well-developed palliative care management system that reviews and monitors the health of the patients in palliative care in consistent manner to meet their health demand timely and ensure their well-being is required to be available for enhanced care delivery by organisations (Callaway et al., 2018). However, it is found to be lacking in the UK due to which it is considered as another factor that is affecting NHS to fail to be the best palliative care provider in the country. This is evident as 10% of the patients dying in palliative care was identified to be never assessed if they required additional consumption of fluid to remain hydrated in the last few days (Campbell, 2016). The National Institute for Health care Excellence (NICE) mentions that hydration is considered to be important in palliative care for patients to ensure them avoid being at risk of dehydration (NICE, 2018).

Thus, it indicates that palliative care constructs in the NHS are directly violating NICE guidelines out of hindered systematic management due to which failure in effective palliative care is seen. The case notes regarding patients in palliative care on review mentions that only 31% of the patients on admission to the hospital are assessed by the member of the palliative care team to determine if they require palliative care assistance (Jones, 2020). This indicates that there is huge systematic error in the NHS hospitals which is leading palliative care members to inappropriately work and show care for patients in the hospital.

The lack of effective amount of finances from the government in supporting palliative care activities in the NHS is leading the organisation to show failure in its enhanced delivery to the patients (Jones, 2020). This is evident as in the UK, it is mentioned that 1000,000 of the people dying in palliative and hospices care are mentioned not to die in comfort. In the UK, only one-third of the expenditure in the NHS for palliative care is provided by the government with the rest been required to be managed from public funding that is scarce and untimely to be accessed (Jones, 2020). The lack of adequate supply finances is leading the NHS to show failure in arranging enhanced resources and activities within the palliative care environment to show support to the patient to prevent them from dying and facing deteriorated health state. It is eventually leading NHS to show failure in ensuring enhanced quality palliative care to be provided. Thus, systematic, workforce and finances related downfall in the palliative care management and operation in the NHS is seen that is leading them fail in delivering enhanced palliative support to patients.

Challenges faced by NHS in providing palliative care

In providing enhanced palliative care to the patients, the presence of improved models of care is to be present that dictates and support the general staffs and professionals in palliative care regarding the way to work and deliver care. This is because the enhanced care model helps in developing important principles and supportive guidelines to be followed from this theoretical perspective to assist in delivering improved quality palliative care (Clark et al., 2020). In the NHS, the lack of presence of improved model of care in the palliative care environment is creating a challenge for them in delivering high-quality palliative care. This is because without the good care model, the palliative care staffs are facing hindrance in determining the way to handle and manage complex care in the palliative care environment. Moreover, it is making them face hindrance to understand the way enhanced communication with the patients at the palliative care is to be formed so that their needs can be effectively understood, and related care is provided to them for their health management (Cain et al., 2018).

The study by Peters et al. (2013) mentions that nurse's attitude towards death and dying is considered not to be in pace with the expectation and perceptions of the common people and patients. A certain number of nurses in the NHS, UK are seen to have negative attitude towards the death and dying of people in the palliative care. It is creating challenge for the NHS in holistically delivering enhanced palliative care to all (Jones, 2020). This is because the negative attitude of the nurses towards death in palliative care influences them to consider that death is inevitable, and no amount of care is able to reverse the effect and their concerned care is not going to save the patients in the palliative care as they are eventually going to die. The death being inevitable attitude leads the palliative care nurses feel anxious and fear for the patients which interfere with their confidence to deliver enhanced care (Peters et al., 2013).

The lower staffing level and lack of adequate time of care been spent for the patients in the palliative care is another challenge been faced within the NHS in delivering enhanced palliative support to patients. This is evident as in Britain there is shortage of 3500 palliative care nurses which is predicted to be doubled by the decade (Dixon et al., 2015). The lack of qualified palliative care nurses creates skill and knowledge gap in the care environment. It leads to hindered care and support been provided to the patients in palliative care which eventually deteriorates the health of the patients and make them die in painful manner. It also indicates the failure of enhanced palliative care management which has the key to support improved health and peaceful death of patients (Dixon et al., 2015). The other challenge faced by NHS in providing palliative care is increased error or mistakes in care made by the existing nurses. The mistakes in care in the palliative environment is leading the patients to suffer in their end-of-life condition and increased report against the NHS's inefficiency to deliver quality palliative care is been mentioned in turn promoting lowering of their care standards (nursingtimes, 2015).

Strategies for NHS to deliver better palliative care

In order to manage the challenges in palliative care delivery by the NHS and resolve the failure, enhanced strategic changes are required within the system. One of the strategies to be used by NHS in delivering enhanced palliative care is earlier recognition of patients who are approaching the end-of-life stage or going to face uncertain health condition. It is to be executed by earlier review and monitoring of the patient's health immediately after admission to the hospital (NHS, 2019). This is because earlier recognition of end-of-life condition of the patient leads the nurses to be prepared to understand which of them are to be involved in palliative care and the amount of resource they are needed to arrange to ensure better palliative care condition within the NHS for the exiting patients. The other strategy is facilitating and raising opportunity for the earlier conversation of palliative nurses with the patient and their families (NHS, 2019). This is required to make the palliative care nurses understand the needs and preferences of care of patients in their end-of-life condition which is going to assist them in developing enhanced concept for care plan development of the patient to deliver them quality care support in palliative care.

The NHS is required to improve the documentation of the conversation and health checking of patients in palliative care (NHS, 2019). This is because it would help to determine and follow care constructs of the palliative care patients and the way the care needs are to be changed to ensure them better support in the palliative care condition. The other strategy to be developed by NHS to deliver enhanced palliative care is increasing the number of nurses and physician specialist in the palliative care field. This is because it would increase the overall workforce in the palliative care environment offering lesser work pressure on the existing staffs and creating the opportunity for increased nurses to be present in caring for each patient in the palliative care in the UK (NHS, 2019). The other strategy to be implemented by NHS in palliative care improvement is the inclusion of multi-disciplinary team in the environment who would act with the existing staffs to share the care delivery and understanding needs of the patients (NHS, 2019). This is because multidisciplinary team contain expertise from different medical field to be involved together in sharing expertise to effectively determine the varied key needs of patients that is not possible for single nurses and physicians to identified (Barratt et al., 2018).

Conclusion

The above discussion mentions that NHS though being considered as best palliative care provider but is currently seen to fail in delivering enhanced care support to the patients. This is evident as an increased number of people are reporting to avail hindered care at the palliative environment in the NHS hospitals. The factor responsible for NH failure in palliative care delivering is the shortage of staff, lack of finances and resources, unstructured system and policies and others. The impact of NHS failure in delivering enhanced palliative care is readmission of the patient in the hospital, lower mortality rate, painful death and others. The challenges faced in NHS palliative care delivery are lack of food care model, knowledge and trained staffs and others.

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