End of life patients hospital time cut by one day

Gartnavel Hospital, Glasgow. Picture: Robert Perry
Gartnavel Hospital, Glasgow. Picture: Robert Perry
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EFFORTS to ensure patients spend less time in hospital towards the end of their lives have resulted in them enjoying just one more day at home in their final six months over the last five years, statistics show.

Research reveals that in 2007-8, the average time spent in hospital during the last six months of life in Scotland was 17.5 days. By 2011-12, this had dropped to just 16.5 days.

Campaigners said health boards needed to look more closely to see if more could be done to provide care to people at home towards the end of their lives. The report comes as hospitals face increasing demand to cope with an ageing population, meaning the NHS needs to care for more people in the community to reduce pressures on inpatient beds.

Leading doctors have also warned that this can increase the risk of “boarding” – where patients are moved from ward to ward to cope with a rising number of admissions.

In 2008 the Scottish Government published its Living and Dying Well plan to improve end of life care across the country.

The latest figures to try to assess the effect of such measures, published by Information Services Division (ISD) Scotland, calculated the percentage of the last six months of life spent at home or in a community setting such as a care home or hospice – the assumption being that most people would prefer to be cared for outside of a hospital wherever possible.

In 2007-8, an average of 165 days out of the last six months of life were spent in the community, with 17.5 days in hospital.

“Over the last five financial years there has been an increase of one day spent at home or in a community setting for people in the last six months of their life,” the report said.

“Overall these data show that there is only slight variance over time in the percentage of the last six months of life spent at home or in a community setting.”

The figures also showed wide variation between health boards but for the most recent period, rates ranged from a high of 94.7 per cent in Grampian to 88.5 per cent in NHS Greater Glasgow and Clyde, where an average of 21 days were spent in hospital.

A spokesman for Age Scotland said: “We welcome the increase in the proportion of the last six months of life people in Scotland spend at home.

“However in reviewing local implementation NHS boards reporting lower percentages of home and community based palliative care should reflect on whether they are adopting the best possible practice.”

A Scottish Government spokeswoman said: “We are determined that care should be person-centred, and effective.

“This is to achieve the 2020 vision that everyone is able to live longer, healthier lives at home, or in a homely setting.

“A high percentage of people do spend their last six months of life at home or in a community setting, which reflects that they are being offered choice and given the support to meet these needs.”

Poorest areas have highest rate of emergency caesarean births

The highest rate of women undergoing emergency caesareans is in the most deprived parts of Scotland, figures show.

Factors such as smoking, obesity and ill health are known to pose risks to both mothers and babies during pregnancy, increasing the chances of complications which could lead to them needing emergency surgery to give birth.

The latest figures show that health boards in the west of Scotland, which suffer higher rates of deprivation than other parts of the country, have the highest percentage of emergency caesarean births.

Across Scotland in 2011-12, the rate of emergency caesarean sections stood at 16.3 per cent.

But this rose to 17.9 per cent in NHS Greater Glasgow and Clyde, 17.1 per cent in Ayrshire and Arran and 17 per cent in Lanarkshire.

NHS Forth Valley also had a higher rate at 17.3 per cent of births. Affluent areas had a much lower rate.

Scottish Conservative health spokesman Jackson Carlaw said: “These are disturbing statistics, which will cause further strain on an already stretched health service.

“It’s imperative that research is now done to see if there is a link between the number of overweight mums, poor health and this jump in the number of C-sections.”