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Who pays for palliative care: an opportunity to get it right
  1. Jane Maher
  1. Correspondence to Jane Maher, Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ, UK; jmaher{at}macmillan.org.uk

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In July 2010, the Secretary of State for Health convened an independent review of the funding of “dedicated palliative care” for adults and children in England. The aim was to develop, for the first time, a per patient mechanism to fund palliative care to meet the needs of the approximately 457 000 people who require palliative care every year, and in particular, the 92 000 who are currently not being reached.1

The review team aimed to create a fair and transparent funding system delivering better outcomes for patients and providing better value for the National Health Service (NHS). This required the development of a palliative care tariff based on assessed need, a funding system which incentivises good outcomes for patients irrespective of time and setting, and the commissioning of integrated care packages which stimulate community based services to enable more people to be cared for outside the acute sector. The team suggest important levers for change (table 1).

View this table:
Table 1

Proposed levers

Before the tariff could be discussed, the knotty question of defining “dedicated palliative care services” had to be addressed. In the report they have been defined as “services which ensure that people achieve an acceptable quality of life enabling them to die in the place of their choice”, with a division of services into three categories: specialist care services (care delivered by specialist providers such as specialist in-patient services), core services (services whose primary focus is palliative care, eg, community nursing teams) and universal palliative care services delivered by non-specialists (eg, general practitioners and social workers). One of the aims of pilot testing may be to refine these categories. For example, there are a number of successful multidisciplinary specialist services without dedicated in-patient beds.

Very wide consultation (760 individuals and 380 organisations) was carried out to define what …

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