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Palliative Care in the UK –now-and where are we going?

Palliative Care in the UK –now-and where are we going?. Professor Mari Lloyd-Williams Professor and Director of Academic Palliative and Supportive Care Studies Group University of Liverpool mlw@liv.ac.uk. History. Specialist Palliative Care in UK centred around hospices

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Palliative Care in the UK –now-and where are we going?

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  1. Palliative Care in the UK –now-and where are we going? Professor Mari Lloyd-Williams Professor and Director of Academic Palliative and Supportive Care Studies Group University of Liverpool mlw@liv.ac.uk

  2. History • Specialist Palliative Care in UK centred around hospices • St Joseph Hackney – earliest • St Christopher - most well known • Remit – patient care ( in patient / out patient / day care) Bereavement support • Most hospices support education - few participate in research

  3. Specialist Palliative Medicine • Doctors entered speciality from variety of backgrounds – General Practice; Medicine; Surgery; Anaesthetics • 1987 palliative medicine recognised as a speciality – access still possible from different backgrounds • Initial curriculum encouraged diversity

  4. Specialist Palliative Medicine • 2004 – medical training reformed in UK. • Shorter training programmes. • Enter specialist training earlier • Aims to have better progression and less competition for posts • Result – too many doctors at consultant level • Less diversity of entrants

  5. Where do Palliative Medicine Specialists work in UK? • Majority work within voluntary hospices • Hospital support teams - advisory • Community support teams • Small number located in academic units • Most work across all areas

  6. Hospices • Major providers of specialist palliative care • Majority of funding raised by donations /events etc • Majority of patients in hospices have cancer • Smaller numbers neurological / respiratory / cardiac disease • Very small numbers dementia

  7. Who receives specialist palliative care? • Patients with cancer • By 2030 deaths from cancer will reduce by 17% in UK • People are living longer (specialist palliative care predominance younger people) • Living with multiple illness • Dementia is increasing

  8. Specialist palliative care • Younger ( under 65) cancer patient • Majority still in last weeks of life • 83% of all patients who receive specialist palliative care will have a cancer diagnosis • However 72% of deaths in UK are not from a cancer diagnosis

  9. Ageing Population • Living longer with multiple co-morbidities – these include cardio respiratory disease, cancer, dementia etc • Depression often factor for older people and end of life • Social isolation, lack of worth, loneliness key factors – need more than medication

  10. Do we need to change • 2013 – “Future Ambitions for Hospice Care” • Summary - Prepare for significant change in the demographics of UK population Strengthen the connection between hospices and local health and social care systems and local communities.

  11. Dementia • Dementia affects one in 1000 people under 65; one in 20 over 65 and one in 5 over age of 85 • Increasing incidence with ageing population • Latter stages patients require all care and over 95% of patients with dementia die in care homes or in hospital

  12. Dementia • Dementia care can be informed by current guidance • One model may not suit all, be flexible, be creative • Communication and collaboration are key • Consultation with carers and people with dementia essential

  13. Dementia Care • Care flexible, planned yet responsive. • Better access to day care and support would allow patients to remain home longer • Within care home setting – person centred holistic care; acknowledge carer as expert; plan and asked “what to do if?” • Allow patients with dementia to return home to die

  14. Dementia Care in UK • Lots of funding being allocated for dementia care – charitable and government • Lots of initiatives specifically set up for people with dementia e.g. Singing / art • However must have carer to attend; have to be formally referred, no transport : ? Stigma of attending dementia service

  15. New models of community care • Regular respite / day care essential for families • However in early / moderate dementia care need not be dementia specific • New models of day care embedded in communities.. Less distance to travel; volunteers; creating new friendships and links

  16. Need for Palliative care in future • Need community based models of care • Links with hospices – feed into hospice for specialist needs / advice / symptom control and links with other community agencies • Based on need not diagnosis • Recognition that hospices / specialist palliative care can not care for everyone

  17. Thank You !

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