What does the future hold for Farleigh?

Our Director of Care, Matt Sweeting, reflects on the changes that the pandemic has brought and looks at where end of life and palliative care is going in the future.

So much has changed in the last two years. At Farleigh, we have recently reviewed local and national trends to help us understand what the future holds for the hospice.

We’ve looked carefully at what are we doing now and asked ourselves ‘what do we need to continue and what do we need to change to meet the future needs of our population’? As part of this we’ve looked at changes in end of life referrals, numbers of deaths , where people are dying and what implications all of these have for the future.

At Farleigh we serve a population of approximately 400,000 people in mid-Essex. Of those people, 1% a year (approximately 4000) will be expected to be in the last year of their life.

On a national level, there has been a significant rise in the number of referrals to end of life care services compared to before the pandemic. Here at Farleigh we’ve seen a 19% increase in case numbers and a 25% increase in number of referrals to our services since before COVID-19 struck.

In terms of acuity, which is the sickness level or the complexity of the patient’s needs, we’ve seen an increase of 13% in urgent cases. Between 50% and 60% of people referred into our locality service need to be responded to within 24 to 48 hours. Both of these rises mean that there is increased pressure on our front-line staff.

We also provide essential ‘personal care services’ to those people in the last phase of their life who require care at home (washing, moving, pressure care). We cared for 675 people in 2021, our biggest number ever. It is clear to see that we are needed by our community more now than ever before.

In terms of the number of people dying using our service, it stands to reason that the numbers have increased since COVID-19 struck. In April 2020, we saw a 50% increase in mortality compared to 2019, nearly exclusively down to COVID. This was repeated again in January 2021, but to a lesser extent. However, month on month, we have seen an increase in the number of deaths for those cared for under Farleigh. These mainly occur in the community, but reflects a sustained mortality increase compared to pre-pandemic.

And it’s not just within Farleigh, across the country end of life and palliative care providers are busier and their cases are more complicated than before the pandemic.

An important trend for us to study is where people are dying as this has a big impact on what services are required. The big take home message is that more people are dying at home compared to pre-pandemic times.

According to the Office of National Statistics (ONS), those dying at home in England, from whatever the cause, have increased by 25-30% compared to pre-pandemic levels. This is even higher at Farleigh, with a 38% shift to people dying at home.

If more people are dying at home, then more people will require high quality palliative services going forward, whether this is specialist or personal care (both of which we provide).

I’m proud to say that our team has continued to provide these high-quality services despite the increasing workloads. Our Virtual Ward model has been a great success and is now nationally recognised. Our IPU is open again for our most complex patients, offering up to 6 beds.

But all these increased demands have consequences for our workforce and our finances. Our staff are working harder than they ever have, have more demands on their time, and are also recovering from 2 years of COVID. They are having to work in different ways to meet this demand. Our spend on services has also increased. We have secured extra NHS money for our personal services and from government grants, but we must ensure Farleigh remains financially viable.

We believe passionately that we have the model right, locality-based multidisciplinary teams that can reach into their local communities. But we can’t rest on our laurels. We need to think about where we go in the future. The landscape is changing and whilst we believe our model does reflect the best way to manage these changes, there is still work to be done to make sure our services are sustainable.

We can do this by continuing our focus on high quality personal care and specialist services, using our inpatient beds and virtual ward to support. There are opportunities at a regional and national levels to get involved in working to improve efficiencies and focus on delivering 24/7 care across the region by working more closely with our health care partners.

We’ve done really well at adapting our way of working to meet the demands of the pandemic, but we need to push forward in the future to make sure our patients get the best standard of care. And not only our patients, but those families who come into contact with our services.

Since COVID-19 hit, more people are dying at home nationally without access to high quality palliative care. According to estimations from Hospice UK, 66,000 people died at home since the start of the pandemic without the right end of life care in place. This is why the recent amendment to the Health and Care Bill, which puts a greater emphasis on palliative care in our healthcare system, is so significant. This will mean local health systems must fund palliative services as core services.

We eagerly await the outcome of the white paper going through Parliament at the moment calling for end of life care services to be part of the statutory offer of the NHS. Farleigh’s future, I hope, will be a world where hospice care services have dedicated and appropriate NHS monies going towards the provision of essential end of life services. I’m passionate about making this a reality. But I also want to see us retain what we are – as a charity we’re able to flex and change to develop our services quickly in response to the needs of our community, and I know we will continue to do so regardless of how the landscape changes. The challenge is a big one, but Farleigh has done it for 40 years, let’s aim for another 40 years!