Palliative Care and the Seldom Heard

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Palliative Care and the Seldom Heard

Palliative Care and the Seldom Heard

Demand for end of life care is rising due to population growth and, combined with funding cuts, traditional methods of delivering palliative care are under the spotlight.

These same challenges have simultaneously resulted in a rise in homelessness in the UK, with the number of people sleeping on the streets increasing by 30% between 2014-15. How do we ensure that those faced with end of life issues without a roof over their head don’t fall by the wayside?  How do we best provide some of the most marginalised, vulnerable and complex members of society with access to support?

According to Homeless Watch, for many in the homeless community, a difficult upbringing can shape early life experiences. Whether this is related to sexual, physical or substance abuse, or even living in relative poverty with a lack of opportunities, these experiences can mould the future we create for ourselves. As a result of these early life experiences, homeless people are more likely to have a combination of chronic physical and mental health issues and substance misuse problems, which can often mean that they require some of the most complex palliative care. Yet homeless communities struggle to access appropriate health and social services.

Due to a lack of education around this hard to reach community, homeless people are often admitted to hospital in times of medical crisis as it’s perceived to be the best place for them. However, for those who have avoided engagement with healthcare professionals in particular, dying in hospital can be an alien environment and somewhere they may not feel comfortable. But even if they are discharged to a shelter rather than the street, are they getting the ongoing support they need?

According to a report by Marie Curie in partnership with St Mungo's, the average life expectancy for homeless people is 55 compared to 81 nationally. As such, the homeless are in need of forward-thinking palliative care services, so that their end of life wishes can be taken into consideration.

It is important that we acknowledge the areas in which our healthcare system can be improved and assess how it can be adapted to cater for the complex needs of these individuals.

This has been part of the current 'Fit for Future' review which is being led by St. Margaret’s Hospice, and is designed to assess how end of life care models can be adapted to be able to cope with the changing dynamics of our society. A ‘one size fits all’ approach is no longer good enough, if indeed it ever was. One of the key challenges highlighted by the initial report is the need for accessibility and equality in an increasingly fractured society.

A growing elderly population and keeping people well for longer means we are having to look after more people in the community, rather than scarce hospice and hospital beds. If we don’t partner with the wider care community, including those who look after what some might consider the fringes of society, more creatively, we run the risk of missing those who are in need of vital care.    

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