If we are serious about ensuring that as people enter their final phase of life, then we must invest in the care they receive

1 in 3 fail to receive palliative care when it is needed, not least those of greatest socioeconomic disadvantage or from minoritised communities. Yet when specialist provision is accessible, it transforms a person’s final phase of life by palliating physical, psychological, emotional, spiritual and social pain and symptoms.

Perhaps the bigger scandal is that the cost of not providing palliative services is costly to the person with worst health outcomes and costly to the NHS, with unnecessary crisis admissions into acute care, when any intervention in the last few months will have very little impact on outcomes. In the last 3 months of life around half of those dying used an ambulance, around half visited their Emergency Department, and one in eight spent more than 30 days in hospital.

It was why I set up the Independent Commission on Palliative and End of Life Care, because I knew too few patients were getting the specialist care they should for a well controlled death, when hearing horror story after story of poor care as the assisted dying debate ensued. I knew the evidence was saying something different, and the evidence has shone a light of what is really going on.

In York, the Frailty Hub provides integration with Palliative Care services and we know that it is stopping unnecessary escalation onto hospital wards, and ensuring more people are cared for at home.

As Professor Sir Chris Whitty wrote in his Chief Medical Officer Report, the key to unlocking good end of life care is to have well trained staff holding a ‘Serious Illness Conversation’, being honest about the level of disease progression and how this can be best managed, and ensuring that the person’s goals and hopes are also part of dialogue. From here care and support can be planned, and when reaching the end stage of the disease process, appropriate interventions to manage pain and symptoms integrated with care and compassion.

It is what Dame Cicely Saunders envisaged when she established the palliative care movement, knowing that excellence can be provided to the final breath, and then good bereavement support provided for family thereafter.

Today medicine has advanced. Good titration of pharmaceuticals can largely manage pain. When this fails, there is palliative radiation, nerve blocks and neuromodulation techniques to relieve patients. Clinical psychologists support patients in accepting their illness and supporting their concerns. Social workers can ensure that people have their wider needs met, and a team of therapists, chaplains, nurses and doctors can wrap around the patient to help them to best live to the end.

My debate comes as Government develop their Modern Services Framework for Palliative Care. This will provide a new mandate for ICBs to commission services according to its guidance. It is a once in a generation to get this right, ensure universal access and care to be delivered in a timely way.

With shortages of community clinicians like district nurses, it has been difficult to ensure that drugs arrive on time to meet pain or for out of hours care to be on hand. This will be an important part of the new clinical mandate, it will demand a realigned workforce, fully trained, and ensure that everyone has a named clinician so they have a single point of contact.

Here is the rub. There is no money. ICBs still settling down from their restructuring, and now half the size, will be expected to deliver these reforms with no financial support. Already the system is creaking , 1 in 6 hospice beds have been deregistered, and bake sales and parachute jumps no longer prop up the ever rising costs of care.

Without investment to train a significant cohort of staff, without funding to run rosters of staff to see people in their homes and without money to embed the transition, it is likely that this will not be the transformative process it must.

While the case for change has long been made, and our well research commission priorities well aired. If we are serious about ensuring that as people enter their final phase of life, then we must invest in the care they receive.

Long term there will be savings, and that is why I am calling for a Service Transition Fund, as this will not only deliver the reforms but deliver outcomes too.

As Dame Cicely Saunders says, “How people die remains in the memory of those who live on”.