Primary and secondary care collaboration for end of life care.

Background The NHS does not deliver the care that people want at the end of life and receives large numbers of complaints about care in hospitals. This is a symptom of a wider problem which leads to over-hospitalisation of elderly people. This was demonstrated clearly in a hospital utilisation study in a south London borough which showed that over 40% of patients needed to be cared for in settings other than the hospital. Community services were also providing care inappropriately. Discussion Three issues need to be addressed: 1. An integrated community service, working with both general practice and consultants from the hospital to provide a flexible response to patients' needs over time. This would focus on maintaining people in the community rather than admitting them to hospital. This would be true for people approaching the end of their lives. 2. Additional, flexible service capacity both in people's homes and in bed-based services including for those people awaiting a continuing care assessment. 3. A system of incentives for hospitals to shift their approach to managing such patients. With these things in place, the delivery of the end of life care service that people have expressly said they want will be feasible.