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London NHS Primary Care surplus outweighs spending on the dying (11 February 2008)

11 February 2008

London NHS Primary Care surplus outweighs spending on the dying

Dying in the capital is in danger of being ‘surplus to requirements’, says leading campaign group

London Primary Care Trusts are spending less than 0.5% of their annual healthcare budgets on specific care for terminally ill patients, a new investigation has today revealed.

In December 2007, the Royal College of Physicians reported that funding for palliative care services are inadequate and the NHS contributes only 30% of the costs of specialist palliative care. The findings from Dignity in Dying come on the back of Prime Minister Gordon Brown’s commitment in January that the NHS should be a “personal service meeting individual needs”, and in light of the Government’s 2005 election manifesto to double investment in palliative care- which is yet to be honoured.

Dignity in Dying, the UK’s leading organisation campaigning for greater patient choice at the end of life, wrote to all 31 London PCTs requesting the annual percentage spent on palliative care from each borough. 20 PCTs provided detailed figures, reporting an average spend of just 0.43% with some individual figures as low as 0.17%. Six boroughs failed to provide any information, raising concern that the average could be even lower.

Sarah Wootton, Chief Executive of Dignity in Dying, said:

“The findings from our research will come as a shock to terminally ill patients and their families who may not receive the quality of care that they are entitled to.”

“It is clear that not enough is being done to provide patients with adequate choices at the end of their lives. 54% of hospital complaints received by the NHS are currently about end-of-life care. This is simply not good enough1

“This is a clear wake-up call for PCTs to increase their investment and for the Government to meet its manifesto commitment to double investment in palliative care.”

The investigation discovered that seven PCTs reported palliative care spends that were significantly lower than the amount of money left over from their budgets at the end of the last financial year.

Primary Care Trusts in Hackney, Wandsworth, Westminster, Redbridge, Kensington & Chelsea, Harrow and Greenwich all had surplus amounts higher than those of their reported palliative care spend. Wandsworth and Redbridge had the largest surplus amounts of 3.4% each, yet their reported palliative care spends were just 0.29% and 0.55% respectively.

These new findings add to problems exposed during the development of the Government’s End of Life Care Strategy that relatively low priority is given to end-of-life care within the NHS.

Sarah Wootton continued:

“This research should be deeply concerning for anyone involved in healthcare. It was only last year that Help the Hospices reported that there is inadequate support for people with terminal illnesses.

“The fact that surplus amounts in some boroughs are greater than that of their reported palliative care spends shows that, in some cases, funds to improve end-of-life care are already actually available. What is missing is the will to change the priorities.”

Dignity in Dying’s investigation exposed discrepancies in funding allocations between boroughs, with the highest figure being 0.7% from Havering PCT, while Harrow PCT spent the least at just 0.18%. Six boroughs also reported a decrease in spends in the 2006/7 financial year compared to those of 2005/6.

The lowest spenders:
” Harrow- Harrow PCT reported palliative care spend was just 0.17% of its budget for 2006/7- and decreased from 0.18% for 2005/6.
– Hillingdon- Hillingdon spent the same for 2006/7 as they did for 2005/6 and was the third lowest spender at 0.21%.
– Haringey- Haringey also spent just 0.21% of their budget in 2006/7.

The highest spender:
– Havering- Havering PCT reported the largest amount in 2006/7 at 0.7%.

Dignity in Dying’s Chief Executive concluded:

“Every terminally ill patient should have access to good quality end-of-life care as a founding principle of patient choice. The quality of this care received should not be determined by where a patient lives, or indeed any other factor. Our report highlights the fact that care of the dying in London really is a postcode lottery.”

“Until sufficient funds are available, many more people will continue to die without dignity and will suffer uncomfortable and distressing deaths.

The full copy of the investigation, containing a breakdown of individual spends for each London PCT, is available upon request.
For more information on Dignity in Dying, or to become a member, please contact Jessica Tomlin on 020 7479 7736 or


Notes to editor:

1Healthcare Commission, Spotlight on complaints (2007)

About the investigation:

Dignity in Dying contacted all Primary Care Trusts in London from September to December 2007 and requested information on specialist palliative care spending under the Freedom of Information Act.

The amounts provided by the Primary Care Trusts reflect the amounts that could be identified within each Primary Care Trust as being spent on palliative care which is incorporated in to many of the generic services, such as the work done by GPs and district nurses and by acute services.

This investigation confirms concerns about end-of-life care provision in the capital expressed in a recent report Healthcare for London: A Framework for Action, which is aimed at developing new ways to improve the healthcare of Londoners. The report found that best practice techniques for end-of-life care, such as the Liverpool Care Pathway and the Gold Standard Framework, are only used sporadically across London compared to other Strategic Health Authorities. It is worrying to note that less than 25% of GP practices in London are using best practice techniques for end-of-life care.

Palliative Care is the holistic care of patients with advanced progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of illness in conjunction with other treatments.

About Dignity in Dying

Dignity in Dying is the leading organisation in the UK that promotes and campaigns for greater patient choice at the end of life.
The organisation is the country?s leading provider of Advanced Decisions (formerly known as Living Wills).
Dignity in Dying has over 100,000 supporters and receives its funding entirely from donations from the public.

Media enquiries

For all media enquiries, please contact Jessica Tomlin on 020 7479 7736 or