Care 'failing the terminally ill'
By Nick Triggle
Health reporter, BBC News
End of life care is getting extra money
Terminally ill people and their families are being let down by failings in end of life care, a watchdog says.
The National Audit Office said while most people wanted to die at home, the majority ended their days in hospital.
The report said families, hospices and care homes in England needed more help to provide better end of life services.
And the watchdog cast doubt on the government's plans to improve care. Ministers insist that an improvement plan for care is "right on track".
About 500,000 people a year die in England, mostly following a period of chronic illness such as heart disease, cancer or dementia.
About a third happen at home or in a care home, while 58% die in hospital.
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The report, compiled through surveys of patients, doctors, nurses and NHS trusts, said there was a lack of support to help keep people at home or in care homes leading to "unplanned and unwanted" admissions to hospital during the final days of life.
It pointed out front-line staff lacked basic training with only 29% of doctors and 18% of nurses receiving training in end of life care. Meanwhile, there is no formal training for care home staff.
The watchdog said hospices offered a valuable alternative to hospital, but struggled through lack of funding and support from the NHS and local authorities.
Age discrimination continues to haunt older people even at the end of life
Gordon Lishman, of Age Concern
There were also wide variations in the spending on palliative care - specialist care to relieve suffering - with spending per trust ranging from £154 to over £1,600 on the average patient.
The report said there were no good reasons for such big differences.
Karen Taylor, head of health at the National Audit Office, said there were real problems with the system, but also added basic measures such as treating people with "dignity and respect" were missing.
"There are examples of good practice out there, but generally the system is not meeting the needs of people.
"The lack of training is undermining the confidence and expectation of involvement of many health professionals.
"It means families and care homes are left on their own to cope."
She also questioned whether the government's end of life strategy, published in the summer, was going to significantly improve the situation.
An extra £286m is being pumped into the system in the coming years to help boost services in the community.
In particular, ministers said they wanted to see rapid response teams of nurses to be on hand to stop the last-minute unwanted hospital admissions.
But Ms Taylor said while the vision was ambitious, there was no time-frame and a lack of support from the Department of Health to ensure improvements were made.
Gordon Lishman, of Age Concern, said: "Age discrimination continues to haunt older people even at the end of life.
"The government and the NHS need to stop dragging their feet on ageist practice and ensure everyone can get good quality care at the end of their lives."
But care services minister Phil Hope said the government's plans to improve care were "right on track".
"Our strategy addresses many of the recommendations made in this report to enhance choice and quality and equality for everyone involved in end of life care."