Palliative care is not just “terminal care” over a few weeks or days. Palliative care approaches are relevant to people living with advance disease, regardless of length or clarity of prognosis.
Around 38 000 people with palliative care needs die in Scotland each year and a much larger number are living with advanced progressive disease. Most are older people. Around 30% of acute bed days are used by people in their last year of life, and over 50% of people will die in hospital, although most people express a preference to die at home. How Scotland cares for those approaching the end of life is therefore an issue of major and universal significance for the Scottish population and has a major impact on how Scotland uses scarce healthcare resources.
Palliative care is an integral part of achieving the transformational change (and shift of resources) envisioned in Reshaping Care for Older People. Regardless of the success of preventative strategies death and dying is inevitable. And unless we get this part of the trajectory right we are likely to continue to commit huge health care resources to providing care in the acute sector for people whose preference would be for care elsewhere.
Good quality palliative and end of life care is fundamental to delivering the safe, effective and person-centred care described in the Dementia Strategy and the Healthcare Quality Strategy.
Research indicates that patients who have been identified and placed on a palliative care register are more likely to have their needs/wishes met, for example they are more likely to die at home (75%) as opposed to those who are not on the register (22% die at home). Currently, most people on a register have a cancer diagnosis but palliative care is relevant to people with any advanced life threatening disease. References: Murray S.A, Boyd K, Sheikh A, Thomas K, Higginson, IJ. Developing primary palliative care. BMJ. 2004; 329:1056.
Creating a safe and well-designed living space for people with dementia within a general hospital setting. Such a space is a key part of providing care which can improve physical and mental functions of people with dementia, and regular access to fresh air and exercise, and a quiet space away from others helps individuals in becoming less agitated and distressed.
To improve entire patient pathways in the areas of Medicine of the Elderly, orthopaedic rehabilitation, stroke services and management of acute patients with dementia and delirium. Specifically to use lean methodology to:
Improve flow to ensure that patients get timely access to the appropriate services
Reduce lengths of stay for older people
Improve health and social care interfaces
Support the rebalancing of care towards care in the community
Improve the management of patients in acute settings with dementia and delirium.
 (Care Homes not in scope for the programme. MoE encompassed community & social care services (except Stroke, GORU & Dementia).
The aims of the project were to enrich inpatients’ hospital experience and improve nutritional intake through having greater access to volunteer support at mealtimes; to provide support and encouragement at mealtimes for patients who require it; to enable greater partnership working between volunteers and healthcare professionals; and to develop the scope of patient contact volunteering activities available.