It is not a great statistic to dwell on, but on average, we will use most health and social care resources in our last year of life. It is also a time when how we are cared for matters most. Here in Highland we are focussing our efforts on improving the end of life experience for people, supporting as many as we can to die in the place of their choice, whilst also making the most efficient use of our limited health and social care resources. And what we are doing is working!

Last year, throughout the Highlands, around 2,000 people received support from our health and social care system in the weeks and months before they died. That ‘system’ involves Highland Hospice, GPs, district nursing, care homes, care at home, Macmillan nurses, Marie Curie, the Ambulance Service and hospitals. There is a huge commitment to care but by working more effectively together to deliver care in the right place at the right time, the quality of experience for people and their families can be improved and could help resolve many other problems in the health and social care system. This is the mission of the End of Life Care Together Partnership in Highland.

When we ask people where they would least like to be cared for at the end of their lives, the answer is usually hospital. Where is the most expensive place to look after people at the end of life? Yes you guessed it - hospital.

One in three hospital beds are currently occupied by people in their last year of life and emergency admissions to hospital, especially in the last three months of life, are on the rise.

Of course hospital often is the right place for our care, if it can be of benefit to us. However it is estimated that between 20-40% of emergency admissions towards the end of our lives could be avoided if there was responsive care available to support us at home.

So why are we not improving this? Our hospitals are often in ‘code black’ which basically means there are no beds available. It means people being admitted will be cared for in corridors or even car parks. Of course this isn’t just about caring for people toward the end of life. It also means there are no beds for what hospitals are very good at - fixing people. Operations will be cancelled and waiting lists will grow...

Around £45m a year is spent on end of life care in HighlandAround £45m a year is spent on end of life care in Highland (Image: Getty)

If being cared for at home is our preference why are we not doing everything possible to enable this? Or to put it more bluntly why are we not using taxpayers money more wisely to deliver better care for everyone?

We will be told it is very complex and difficult. Excuses such as recruiting social care workers, the impact of Brexit, challenges of Covid recovery and lack of money will all be rolled out. All certainly challenges and issues, but are they really insurmountable? We don’t think so.

In Highland we have identified that around £45m a year is spent on end of life care, with 73% of that spent on hospital care. If we reduced hospital use by 20% that equates to around an extra £9m a year to support people at home. That would make a huge difference in our ability to deliver more care at home.

So how are we making a difference in Highland? We work collaboratively with a group of over 20 organisations with an interest in improving end of life care all working together to support our community.

We proactively identify people who may need support with end of life care, recording what their wishes are for care and sharing that information with everyone that might be involved. It is a sad fact that Tesco, Amazon and Facebook know more about our personal preferences than our healthcare system. That needs to change.

We provide 24/7 access to support and advice to maintain care at home. Our Palliative Care Helpline is taking over 300 calls every month and we expect this number to double as awareness grows. As well as supporting families directly the helpline is supporting ambulance personnel to administer medications and providing confidence to care home staff to avoid unnecessary admissions to hospital for their residents.

We also provide access to responsive care through a Palliative Care Response Service that has been piloted in the Inverness area. This service aims to provide care at home within four hours in an emergency. Less time than the average wait in A and E. It’s a different way of delivering social care and yes we can find staff.

So is it working? It is early days but yes, the evidence is starting to build up.

People who died having used the Palliative Care Helpline spent on average six fewer days in hospital than would have been expected for this patient cohort. Over a 12 month period this is the financial equivalent of over £3,000,000.

The results from having access to the Inverness-wide Palliative Care Response Service are even more impressive.

People who died having been supported by the service spent on average 20 fewer days in hospital than would have been expected for this patient cohort.

When the additional cost of the rapid response care is subtracted from the savings in hospital care this amounts to just over £2 million annually. There are far greater efficiencies to be had if we could scale this up across the whole health board area.

These interventions are very low cost when compared to hospital care and are hugely appreciated by the people and families being supported.

This demonstration of a different way of working that provides better care at better value is being funded largely though charitable money from Macmillan Cancer.

This demonstration of a different way of working that provides better care at better value is led by Highland Hospice and part-funded by Macmillan Cancer Support, with additional social investment expertise provided by Social Finance.

It's working here and we believe it could, with a little bit of goodwill and fresh thinking, work throughout Scotland, providing expert care and advice at home and freeing up badly needed hospital beds in the process.

Kenny Steele, CEO, Highland Hospice