Dr Nanette Milne, Scottish Conservative MSP for the North East has used a Members Debate in the Scottish Parliament to call on SNP Ministers to review the training of GP’s and primary care staff to help them towards better communication with terminally ill patients.
Dr Nanette Milne, Scottish Conservative MSP for the North East said:
“I am very pleased to have been given the opportunity to lead a Parliamentary discussion on the report “How Good is Primary Care at Identifying Patients Who Need Palliative Care?”, just 9 days after its publication in the European Journal of Palliative Care, and I thank all those MSP’s who have supported my motion since it was lodged last week.
“This study was the first in the UK to examine the point at which patients are formally identified for palliative care, and it obtained its information from the experience of 684 patients across 9 Scottish GP practices. It found that, whilst 75% of cancer patients were identified for palliative care before dying, only 20% of patients with organ failure as a result of chronic heart, lung, liver or kidney disease, or with dementia, either asked for, or were identified, for palliative care, and most patients received it too late to gain full benefit from it, as on average care was initiated just 8 weeks before death.
“The study also found that few patients openly admitted that they might die, put off by the negative connotations and lack of understanding around terms such as “palliative” and “hospice”, and sadly GP’s found it difficult to discuss death and dying with their patients, particularly those with a non-cancer diagnosis, even though doctors recognised that open discussion is helpful for patients, their relatives and those taking care of them.
“The task of identifying patients who would benefit from palliative care was easier for GP’s if patients and/or family members asked them for information and extra support, and specific tools, such as multi-disciplinary meetings and national guidance, were of help to them in making decisions around formally identifying these patients.
“The World Health Organisation has stated that all patients with a life threatening condition can benefit from palliative care, which it recommends should be phased in from the point of diagnosis. However, currently many such patients are not being identified either in hospital or primary care, and the resultant late access to palliative care limits the opportunities to improve the quality of life of patients in their last year of life.
“The study concludes with 4 recommendations – that patients diagnosed with life threatening illnesses should be encouraged to discuss and plan their future care so that their wishes can be accommodated, and that doctors and nurses should offer supportive and palliative care to more people with such conditions.
“The Scottish taboo around talking about death should be tackled, and the report considers that the Scottish Government should lead a public discussion around the issues of death, and promote more widely its national plan for palliative care, the “Good Life, Good Death, Good Grief” initiative. Finally, all doctors and nurses should be trained in how to identify when patients need palliative care support, in addition to the normal treatment for their condition – and this training should include supporting health professionals to have conversations about death and dying.
“There is no rocket science about any of this, but if these recommendations were taken on board, many more patients and their families would be helped towards a positive end of life experience, through the prevention and relief of suffering by the early identification, assessment and treatment of pain, and associated physical, psychosocial and spiritual problems, and through being given the choice about where they want to be cared for, and where they wish to die.
“So I would ask the Minister in his response to the debate, what plans there are, in conjunction with the Royal College of General Practitioners, to review the training of GP’s and primary care staff to help them towards better communication with their terminally ill patients, and to ensure that more non-cancer patients access palliative care in the last year of their lives. I would also ask the Government, particularly at this time when we will soon be hearing the arguments for and against Margo McDonald’s proposals for patient autonomy in deciding when to end life, how and when it will initiate a public debate on death and dying in an attempt to overcome the taboo which currently surrounds the issue in Scotland.
“We’ve all heard of Marie Curie nurses, but the breadth and extent of the Charity’s work is not so well known. Its 740 employees in Scotland, its 300+ volunteers, and the 3000+ people who collected for this year’s Great Daffodil Appeal, mean that nearly 4500 patients, in 31 out of 32 Scottish Local Authorities, are supported by nearly 400 Marie Curie nurses, giving them excellent end of life care, and the choice to die at home if that is what they wish. Research shows that although the vast majority of people wish to die at home or in a hospice, nearly 60% of deaths in Scotland actually occur in a hospital, and I firmly believe that without the support of Marie Curie nurses, that proportion would be significantly higher.
“Well over 900 patients have been cared for in the Marie Curie hospices in Edinburgh and Glasgow in the past year, and nearly 5000 have been supported in the community in these two cities alone. Marie Curie also provides emotional support and companionship for many patients with terminal illness, and supports their families and carers after the patient has died, through its bereavement support services.
“Moreover, the Charity, as well as doing its own research, funds one of the largest palliative care research programmes in the UK. Much of this research is collaborative, such as the study we are discussing today, and is aimed at finding practical ways to improve the care of terminally ill people (from whatever cause) and their families.”