Background Palliative care is inequitably distributed in our society according to diagnosis, age, postcode, wealth and social group (Sleeman, 2016; Dixon & King, 2015; Gomes et al., 2006; Care Quality Commission, 2016; Gao et al., 2013).
Aim Hospice strategic development addressing local inequality in palliative care provision.
Method We evaluated the equality of local service provision in relation to postcode, diagnosis and deprivation indices. We also examined the access equity to the local electronic palliative care coordination system (EPaCCs). We identified an inequality in access to hospice services, particularly inpatient beds, dependant on postcode. Only 3% of people who died from the coastal area died in the hospice, compared to 6% who live locally. The majority of those accessing hospice services had a diagnosis of cancer. Numbers of people accessing hospice services with a primary diagnosis of dementia were low. Only 1% of people on the local electronic palliative care register lived in a care home despite 25% of deaths occurring there.
The hospice developed an action plan to address these inequalities:
Partnership working with the local mental health team to improve palliative care for those with dementia
GP Associate roles to promote timely identification of those approaching the end of life.
Increased multidisciplinary work with renal, respiratory, heart failure and neurology teams.
A joint project with Macmillan to outreach to marginalised groups.
Care home education to promote access to EPaCCs.
A business plan for hospice beds in the coastal area is under development.
Results Over the last two years the number of people with a primary diagnosis of dementia or frailty accessing hospice care has quadrupled, the proportion of hospice patients with non-cancer diagnoses has increased from 21% to 33% and the proportion of people on the EPaCCs system living in a care home has increased from 1% to 12%.
Conclusion Hospices strategy can address the inequalities in palliative care provision.
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