Background to the review

In Somerset we are going to see a significant increase in the numbers of patients in need of palliative care above the current challenging position of 5,000 a year.

Fit 4 Future

The cost of care is overtaking our capacity to generate additional charitable income. This is exacerbated by the falling value in our NHS funding, a pattern that is happening across the country.

The 'Fit for Future' consultation will help us really identify where there are gaps in the provision of care and where we can improve the ways we work with the network, from GPs and hospitals through to paramedics, providers of homecare facilities and carers.

Somerset is very much in the spotlight when it comes to future healthcare challenges as it has one of the biggest ageing populations in the UK. By 2033, the county is likely to have at least 25% of the population aged over 65, and it is projected that there will be as many people in their 80s as in their 20s (source ONS).

The South West of England and Northern Ireland are second only to Wales for the proportion of people living alone, at 22%. In the next 15 years it is predicted that, without changing the way we do things, around 40% of the population will die alone without adequate care and support.

Research has shown that dying alone and in pain are amongst our biggest fears ahead of actually being told you are dying. There are other issues such as continuity of care, insufficient carers, carer fatigue and adequate support in homecare, not just for the elderly and cancer patients, but also for others who have a life-limiting illness.

It costs St. Margaret's Hospice £10m a year to operate. That's over £27,000 a day to provide care to those with an end of life care need. St. Margaret's supports over 3,200 people and their families every year. That's why we need to understand, based on feedback from the community, what we are doing well and where we could make improvements. In some cases we may even be duplicating services, actually making it more complicated for patients.

Fit 4 Future

We are in the fortunate position of building on previous groundbreaking work in this area, including the review of services in 2006 which resulted in the Hospice Without Walls strategy and, in 2008, the Delivering Choice Programme with Marie Curie which resulted in a number of initiatives, including giving patients the choice to be cared for at home at the end of their lives. The importance of this has recently been underlined by the National Council for Palliative Care, Hospice Care and Marie Curie, which has called on healthcare commissioners and service providers to do more to avoid unnecessary hospital stays at the end of life, where patients often don't want, or need, to be.

That's why the 'Fit for Future' review is so crucial.