Access to palliative care services in the UK is inadequate and inequitable, with unacceptable variations in care geographically and across different demographic groups, according to a report by a leading medical professional organisation.
The report, by the Royal College of Physicians, argues that all patients who are suffering and dying should have the opportunity for a good death, with management of symptoms and psychological social and spiritual support.
There is particular disparity between patients with cancer and those suffering from non-malignant conditions. The best care is excellent, the worst may be non-existent, the report says.
The report found that the voluntary sector and charity funding supported about 70% of the costs of specialist care, with the NHS only providing about 30% of funding.
Without this charitable funding and the commitment of local communities palliative care would not have developed, but the lack of NHS funding is entirely unsatisfactory and has led to poor integration of services, the document says.
It argues that sustainable and adequate core funding is essential to allow cohesive development of services across the country.
Research into the efficacy and cost-effectiveness of care is also inadequate, particularly regarding new treatments for symptom control.
It is difficult to undertake randomised controlled trials in such a vulnerable group of patients and there is little commercial incentive to develop new drugs.
Most patients would prefer much of their care to be provided in the community and to die at home, with appropriate support.
Inadequate integration between health and social services, ineffective co-ordination and communication between service providers, and lack of expertise and resources all present major barriers to providing good care in the community, the report says.