HSIB legacy content
This investigation was carried out by the Healthcare Safety Investigation Branch (HSIB). Find out more about HSIB legacy.
National investigation
We have started an investigation looking at variations in the delivery of palliative care services to adults in England.
Palliative care aims to improve the quality of life for patients with life-limiting illness, and their families, by taking a ‘holistic’ approach to physical, psychological, social, and spiritual care needs.
Palliative care may be received at hospital, at home, in a care home or in specialist units and hospices. Palliative care services are funded in England by the NHS and the private sector, including charities. Charitable bodies may support NHS-funded palliative care services or fully-fund services.
Across England, there may be geographical variations in palliative care provision, depending on funding arrangements and organisation of services. This may limit patient choice.
Reference event
The investigation was launched after we were notified of an event involving a 77-year-old man. The patient’s family reported their concerns about the availability of palliative care services within the region the patient lived, particularly a hospice-type environment.
The patient was diagnosed with a soft tissue tumour, following the discovery of a lump in his armpit. He received surgery at a specialist tertiary site, followed by a six-week course of radiotherapy.
Unresolving symptoms of nausea followed by pain just above his hip joint later prompted the patient to seek a review in the private sector. A subsequent CT scan revealed that he had widespread recurrence of the cancer and he was referred for palliative care.
The symptoms of nausea, pain and anxiety could not be controlled at home with the support of community services. Therefore, the patient was admitted to a specialist palliative care bed in a local community hospital, where care was jointly provided with a nearby hospice. Symptom control was challenging and only achieved at the end of his life. He died in the community hospital, nine months after the initial diagnosis.
Investigation summary
The investigation will:
- Seek to understand the context and contributory factors inhibiting the ability of community palliative care teams to proactively consider the holistic requirements of adult palliative patients (physical, psychological, spiritual, and social).
- Examine the ways in which patient and family expectations may differ from what is available in terms of palliative care services for adults in England.
