Exclusive survey reveals nurse staffing levels to be the biggest barrier to end of life care

• One third of nurses said staffing levels are the main barrier to providing quality end of life care
• Over half of nurses felt the quality of end of life care got worse as a result of the ongoing pandemic
• Nurses raised concerns about the rise in deaths at home and not enough staff in the community to support dying people and their loved ones

One in three nurses (30%) said staffing levels are the main barrier to provide quality end of life care¹, an exclusive survey has revealed. Over half of nurses (52%) who responded to the survey also felt the quality of end of life care for dying people got worse as a result of the ongoing Covid pandemic².

The annual survey, carried out by Nursing Standard and end of life charity Marie Curie, was answered by nearly 600 nurses and other caring staff across the UK who reflected on their experiences of caring for people at the end of their lives.

Recent data from the Office for National Statistics (ONS) has shown that a third more people died at home during 2020 in England and Wales³ and the majority of the excess deaths were not due to Covid, but conditions such as cancer, dementia and heart disease. Respondents in the survey reflected on their own concerns that despite this rise, there was not enough staff in the community to support people to have a good death at home.

One nurse wrote: "Much more investment is needed in the community to care for more people at home which is usually preferred pace of care and death."

Another added: "If more [people] are dying at home then there is a huge pressure on local district nursing teams which struggle with staffing as it is."

Despite these difficulties, nurses and healthcare professionals have grown in confidence over the last few years in initiating conversations about end of life care needs with patients, families and loved ones. In the 2019 survey results, a quarter (27%) felt very confident initiating these conversations, this has risen to almost half (47%)⁴ feeling very confident in 2021.

Julie Pearce, Chief Nurse and Executive Director of Quality & Caring Services at Marie Curie, said: "The pandemic has accelerated change across many care settings. More people are dying at home and staffing to support this shift isn't there. The data shows a hidden crisis happening behind closed doors and people dying without access to pain relief or the dignity they deserve. As a charity, we are urging MPs to support calls for an amendment to the Health and Care Bill to create a legal duty to commission palliative care services in every part of England.

Julie Pearce adds: "It is promising, however, to see healthcare professionals have grown in confidence initiating conversations about end of life care needs - It's essential we support patients and their loved ones through this journey and start conversations much earlier so that care can be better planned in advance. The focus for each conversation should start with what matters most to the individual; these conversations may not be the easiest to have but are the most important. We know there are not enough healthcare professionals to facilitate this for everyone, so conversations about our wishes must become a normal discourse between the person (patient), their loves ones, their friends and their carer."

Flavia Munn, Editor at Nursing Standard said: "Our survey lays bare the nurse staffing crisis which is impacting patient care across all services. Nurses want to do their very best and support people who wish to die at home but there simply aren't enough of them. The pandemic has highlighted many extraordinarily difficult decisions facing nurses over end of life care, choosing which patient to prioritise is one heart-breaking example.

"Being able to make a person comfortable in their final days and hours and reduce the burden on their loved ones is of paramount importance. Ministers must pay attention to the human impact of chronic nursing staff shortages on patients, families - and the profession itself."

The full results of the survey are available here: https://rcni.com/nursing-standard/newsroom/analysis/dying-home-not-enough-community-staff-to-support-a-good-death-nurses-say-179206

The Marie Curie Information & Support Service offers practical information and emotional support on all aspects of death, dying and bereavement. Call free on 0800 090 209 or visit mariecurie.org.uk/support

Ends
For further information and for copies of the results of the survey in full please contact:
Josie Roberts – Marie Curie Media & PR Officer
josie.roberts@mariecurie.org.uk
07926772974

Notes to Editor
The survey was open from 6th September until 27th September and was open to staff across the UK from various nursing roles in both acute and community settings such as clinical nurse specialists, midwives, healthcare assistants and general staff nurses. The survey was answered by 548 healthcare professionals. From those taking part 75% were based in England, 14% Scotland, 7& Wales and 4% Northern Ireland.

References. Full questions asked
1. During the pandemic, what if any, do you see as the main barrier to you being able to provide end of life care?
2. In your experience/opinion, how has the ongoing COVID-19 pandemic impacted on end-of-life care?
4. How confident do you feel about having to initiate a conversation about end of life care needs and wishes with a patient?
ONS reference
3. Deaths at home increased by a third in 2020, while deaths in hospitals fell except for COVID-19.
There were around 167,000 deaths from all causes in private homes in England and Wales in 2020, compared with an average of 125,000 between 2015 and 2019.
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathsathomeincreasedbyathirdin2020whiledeathsinhospitalsfellexceptforcovid19/2021-05-07

About Marie Curie
Marie Curie is the UK's leading end of life charity. The charity provides essential frontline nursing and hospice care for people with any terminal illness, a free support line and a wealth of information and support on all aspects of dying, death and bereavement. It is the largest charity funder of palliative and end of life care research in the UK. Marie Curie is committed to sharing its expertise to improve quality of care and ensuring that everyone has a good end of life experience. Marie Curie is calling for recognition and sustainable funding of end of life care and bereavement support.

National Day of Reflection - 23 March
An opportunity for the Nation to reflect, remember and celebrate the lives of everyone that died during the pandemic – from Covid and other causes. The charity believes it is important to talk more openly about dying, death and bereavement to improve experiences at end of life and to help reduce the lasting effects of grief.

Please note we are 'Marie Curie' (not 'Marie Curie Cancer Care')
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Marie Curie Information and Support line
The Support Line is available for anyone with any questions about dying, death, bereavement and terminal illness. Calls are free on 0800 090 2309. Lines are open 8am-6pm Monday to Friday and 11am-5pm on Saturday. You can also visit www.mariecurie.org.uk/help/support