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David Oliver: A new legal duty to provide specialist palliative care

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1146 (Published 11 May 2022) Cite this as: BMJ 2022;377:o1146

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Re: David Oliver: A new legal duty to provide specialist palliative care

Dear Editor

The inclusion of specialist palliative care in the Health and Social Care Bill for England is welcome but overdue. As David Oliver notes, many challenges also remain before consistent provision and access can be assured. These include implementation, prioritisation and crucially, resourcing of specialist palliative care. Despite a growing evidence base, we know precious little about the costs of specialist palliative care provision in the UK. In our 2016 systematic review (Gardiner 2018) we identified only 10 papers which presented data on the costs of a palliative care approach in the UK. The identified studies displayed such significant variation in their estimates of the cost of palliative care, that it was not possible to present an accurate aggregate cost of palliative care in the UK. A more recent report for the charity Sue Ryder (London Economics 2021) projected future demand and costs for providing specialist palliative care, but acknowledged the uncertainty inherent in any cost analysis, due to the complexity and inconsistency of funding arrangements which involve NHS and independent sector providers. Needless to say, without a firm grasp of the financial commitment required to properly resource specialist palliative care services, ICS’s are going to be placed in an extraordinarily difficult position when commissioning and implementing services and ensuring equitable access for the whole population.

Clare Gardiner
Professor of Palliative Care
The University of Sheffield

Gardiner C, Ryan T, Gott M. What is the cost of palliative care in the UK? A systematic review BMJ Supportive & Palliative Care 2018;8:250-257.

London Economics. Modelling demand and costs for palliative care services in England A final report for Sue Ryder. Feb 2021. https://www.sueryder.org/sites/default/files/2021-03/Modelling_Demand_an... (accessed 22.6.22)

Competing interests: No competing interests

22 June 2022
Clare L Gardiner
Professor of Palliative Care
The University of Sheffield
Health Sciences School, The University of Sheffield, Sheffield