Shetland GP Susan Bowie raised her concerns about the gap in ‘hospital at home care’ for  patients who require ‘end of life’ care  with Local  MSP David Stewart, Labour, and has now received reports from other concerned doctors from out with the area.

David Stewart MSP with Dr Susan Bowie

She has passed on the anonymised reports to Mr Stewart, also the Labour’s Shadow Public Health Minister in Scotland, whose Scottish Parliament motion for debate on the issue received cross-party support.

One GP explained:

“What you are describing has been the status quo here for so long that people no longer expect to die at home and choose the community hospital because they are afraid of the lack of support at home. We do occasionally achieve a well-supported death at home, but usually because of extraordinary family commitment.”

Another wrote that home palliative care is practically impossible, and a lack of overnight care meant a patient was admitted to hospice. Although that care was good, it was not what the patient or the family had wanted.

David Stewart said:

“This affects many patients and families across the country and I am delighted that other MSPs have now supported the debate on this important subject.

“I know that constituents have been lobbying other Parties to add to the debate and it’s not too late for other MSPs to sign up.”

Shetland GP Susan Bowie has also received the support of David Stewart’s Highlands and Islands Labour MSP colleague, Rhoda Grant.

The GP and the MSPs say there should be an automatic right for people to have full care at home day or night for their last few days of life, so that then can have their wish fulfilled to die at home.

Dr Bowie is contesting information from NHS Shetland which states that there are currently carers and nurses available during the daytime, at weekends and evenings who do support people to die at home and nurses are also on call overnight.

Dr Bowie said:

“Shetland patients dying at home don’t have access to overnight carers, and there is only one District Nurse for the whole of the mainland, and they can’t be there all night with a patient. There is also no cover at short notice at weekends.”

Simon Boker Ingram, NHS Shetland’s Interim Chief Executive, said that figures from ISD Scotland (Information Services Division) show that in 2018/19 Shetland had a percentage of 94% of time in the last six months of life spent at home or in a community setting – the highest percentage of anywhere in Scotland, and consistently the highest percentage in Scotland since 2013/14.

But Rhoda Grant added:

“Although the figures look good, you can’t get away from the fact that this isn’t reflected by the experience of GPs who are dealing with patients day-to-day. We need to ensure that this gap is filled, not only in Shetland but elsewhere.”

Mr Boker Ingram said that the health board and integration joint board recognise the desire for a more comprehensive offer of health and social care provision across the islands, providing more choice to people including end of life care and there was work underway to achieve this as part of the action plan.

• In 2018/19, there were 52,436 deaths in Scotland excluding those where an external cause of death was recorded (including falls). For these individuals, 88.1% of their last six months of life was spent either at home or in a community setting, with the remaining 11.9% spent in hospital. This is equivalent to an average of 22 days in hospital in the six months prior to death.
• Over the past nine years, the percentage of time spent at home or in a community setting has gradually increased from 85.3% in 2010/11 to 88.1% in 2018/19.
• In 2018/19, females aged 85 and over spent a higher percentage of their last six months of life in the community (89.3%) compared to males (86.9%); this equates to females spending, on average an extra four days in the community in their last six months of life. ISD Scotland

Percentage of last 6 months of life spent at home or in a community setting (Local Authority)

Percentage of last 6 months of life spent at home or in a community setting (Local Authority)

David Stewart will be asking for a date for the debate to take place.