Background In response to the 2015 Marie Curie commissioned document ‘Equity in the provision of palliative care in the UK: Review of evidence’ which found inequalities in the provision of Palliative Care across a number of domains including social deprivation, I undertook a review of our service in the deprived areas within our area of care.
The Rowans Hospice covers Portsmouth city and South East Hampshire and includes coverage of a number of areas which are within the 20% most deprived in the country.
Method I identified all patients referred to the inpatient unit or our Hospice at home service from deprived areas over one year, using Office of National Statistics data, Indices of Multiple Deprivation and computerised records. I noted demographics, diagnosis, referrer, time with service, preferred and actual place of death.
Results Compared with the area as a whole, I found that for patients from deprived areas:
Access to Hospice at Home and inpatient services appears equitable
Proportion of cancer to non-cancer seems similar
Average time under the care of Hospice at Home is lower
Likelihood of being admitted to the Hospice more than once is lower
Length of inpatient stay is longer
Chance of a greater than 21 day stay is longer
PPD is less likely to be recorded
Dying at home was less likely: but if patients had expressed a wish to die at home they were more likely to achieve this
More likely than the national average to achieve their PPD
Conclusions The findings of this service review were interesting and broadly positive. Exploring some of the differences found with both service users and professionals would be helpful, and a new initiative (The Living Well Centre) may allow us to connect with those who may not engage with the traditional Hospice model.
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