The research was led by David Taylor, Professor of Pharmaceutical and Public Health Policy at the School of Pharmacy, University of London. He has acted as an adviser to bodies ranging from the WHO and Unicef to the Department of Health, the BMA and the RPSGB.
Valuing Choice - Dying at Home
Prof Taylor's report - Valuing Choice - Dying at Home (a case for the more equitable provision of high quality support for people who wish to die at home) is available as a downloadable pdf and includes the following summary:
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Most people would prefer to die well supported at home
Most people would prefer to die well supported at home. But relatively few have the opportunity to do so.
Even among individuals living with cancer - between a half and three quarters of whom would ideally choose a home death - under a quarter actually end their lives at home.
Most cancer patients die in hospital.
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Supportive services do help
Supportive services like those given by Marie Curie Nurses (about two thirds of whose total costs are met by voluntary donations) help ensure that dying people are protected from pain and other forms of distress or indignity.
They can alleviate the anxiety and stress experienced by family and other informal carers, by providing practical help and respite and comfort.
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Hospital admissions at the end of life can be vital
Hospital admissions at the end of life can be vital. But a significant proportion are due to poorly co-ordinated or otherwise inadequate palliative and supportive care services being available at home. This leads to problems such as poor symptom control, and carer fatigue.
Reducing hospital admissions and enabling patients to decide to die at home can, provided that service users' preferences are genuinely respected, reduce financial costs to the NHS and improve the quality of life for patients and their carers.
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The Government's responsibility
The government is seen as having a responsibility to improve services and choice for people who are dying by over 90 per cent of voters. The Department of Health has recognised the need to achieve better service standards in this field, and recently announced the investment of an additional £12 million for training staff presently in post to provide high quality palliative care at home.
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Medium to long term investment
In the medium to long term every £1 extra invested in the appropriate provision of hospice at home will release £2 in the hospital services. But hospital savings will not become apparent until relatively large numbers of admissions are avoided. This limits local decision makers' opportunities to improve care.
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Supporting local service developments
National policy makers and budget holders ought to support local service developments.
They should strengthen dying individuals' and their families' awareness of their rights to appropriate end-of-life care at home; reduce inequalities in access to services by promoting 'quality of death' audits in practices and across local health economies; and provide new financial incentives for practices, PCTs and other agencies - including voluntary sector bodies such as Marie Curie Cancer Care - to improve organisational performance and service user choice.
Related document
Download the full Economic Case study (pdf 225 KB).
