John Compton: Savings plans pose enormous questions over end of life care
My comments immediately following the announcement of a public consultation on £70m savings needed by the five Health and Social Care Trusts (Belfast Telegraph, 25 August), concluded that reform is essential and realism about finance is unavoidable.
But looking beyond the statistics, and as the consultation period has now ended, my attention is now turned by the four adult hospice providers in NI; Marie Curie, Foyle Hospice, Northern Ireland Hospice and Southern Area Hospice who highlight very real concerns about the Health Trusts' saving plans. They envisage a huge inevitable impact on the horizon for the most vulnerable people in Northern Ireland.
As a Trustee for Marie Curie, I regularly hear how the right care and support at the right time can make a difference. What is concerning, say the organisations, is that the proposals as currently presented will create stress for individuals and undue pressure on end of life care services - with patients and their loved ones feeling the force of the impact. The focus of the concern is twofold. With proposals aimed at controlling costs in community care, there is considerable anxiety that the unintended consequences will mean people at this most difficult time in their lives will inevitably experience less than adequate support. The quality of care for people at end of life will be less than it should be, with people being discharged from hospital with inadequate care packages in place, or remaining in hospital because no packages are available.
The risk is that hospice care providers may also be unable to discharge patients when they are ready to go home, preventing new patients from being admitted when they need care and support. The organisations working in this field have already experienced growing pressure in recent months, and the stark reality is that people who have been assessed for a hospice bed are dying whilst waiting for that service. Given most people want to be cared for at home, there is concern that a reduction in domiciliary care packages will also mean more demand for already stretched hospice services. Plus, an increased reliance on carers, who already provide crucial support for people approaching end of life. Carers make a huge contribution to the health service in NI, often at the expense of their own health and wellbeing and a reduction in services will put them under increased stress.
Secondly, there is concern about the impact of cuts to agency and temporary staff. We already have a shortage of nurses in NI, and the proposals could create something of a workforce merry-go-round, with one service pulling staff away from another. This will put pressure on smaller providers and has the potential to affect the scale and quality of support available. All staff need to be trained to confidently and compassionately provide the best possible care for the patient and support for those closest to them. Both scenarios would have a negative impact on service availability and quality of care, especially for those with a terminal illness.
We all realise that the health service needs to be responsible with financial controls, but the proposals do not show, in the opinion I share with Marie Curie, Foyle Hospice, Northern Ireland Hospice and Southern Area Hospice, an appreciation of the genuine impact cuts will have on people with terminal illness and their loved ones. End of life care is different to other services, because there is no second chance to get it right. Care is either good quality or it is not, and a key measure of any society is how it supports people through such vulnerable and difficult times.
With such potential reductions in service on the horizon, it is crucial that NI has political leadership to steer through the financial challenges facing the health service and ensure balance sheet decisions aren't taken without proper consideration of the direct impact they will have on the most vulnerable.
John Compton CBE is a Marie Curie Trustee and former chief executive of Northern Ireland's Health and Social Care Board