Minimum dataset activity for hospice and hospital palliative care servicesin the UK 1997/98

This study reports on the third in an annual series of surveys covering Eng land, Wales, Scotland and Northern Ireland on the activity of palliative ca re services. This report concentrates on inpatient (hospice and hospital) s ervices. All 640 known UK palliative services were sent a standardized questionnaire asking about the characteristics and numbers of patients cared for. Result s were analysed for those services primarily for adults. From the 189 inpatient units (2955 beds) there was an 84% response rate in total, but the response to many of the questions was lower than this. Sixty per cent of services recorded 24362 new patients, and about 50% provided d etails showing that 96.7% patients had cancer, and one-third were aged unde r 65 years. This is higher than the national distribution of cancer deaths where 24% are under 65 years. Conversely, only 7% were in the over 84 age g roup, which has 14% of cancer deaths. Most patients (73%) were admitted fro m their own home. Half of the admissions ended in death, and the majority o f discharges were to the patient's own home. The mean length of stay was 13 .1 days, with larger units tending to have a longer length of stay. Forty p er cent of admissions were for one week or less (2.3% of patients died on t he day of admission) and 15% were for more than three weeks. Bed occupancy varied between 99.7 and 48.9%. Responses were received from 74% of the 326 hospital support services, although again many questions were answered by l ess than half of those eligible to do so. Details of 37194 new patients wer e reported (5.9% did not have cancer, although there was a wide range betwe en services). Patients typically had four contacts with the service, althou gh almost a quarter were single contacts. Three-quarters of the contacts we re by a clinical nurse specialist. National estimates suggest that of the 155000 patients dying of cancer in t he UK each year 27600 (18%) die in a hospice. There are 39000 new hospice a dmissions each year and about 100000 patients have contact with a hospital support service. Overall, the national provision of palliative care is incr easing but there are groups who still appear to be missing out on palliativ e care, especially older people. Increasingly, patients appear to be admitt ed to a hospice earlier in care and are discharged home.