Adopt new policy standards for terminally ill patients with substance use problems, says report

Research with Mersey Care NHS Foundation Trust funded by Chancellor's Fellowship award

Researchers from Manchester Metropolitan University have outlined six policy standards

Researchers from Manchester Metropolitan University have outlined six policy standards

Health and social care policy must respond to the growing demand for palliative and end-of-life care services for people with experience of problematic substance use, says a new report.

Researchers from Manchester Metropolitan University have outlined six policy standards urging policy-makers, NHS commissioners and service providers to introduce measures that would improve provision and tackle stigma towards terminally ill patients who are, or have been, problematic users of alcohol or other drugs.

The recommendations – the first of their kind in the UK – are based on consultation  with professionals in leadership and policy roles across health and social care services in Liverpool, particularly specialist palliative, end-of-life and substance use services. 

The report Policy Standards: A Working Document. Palliative and End of Life Care for People with Alcohol and Drug Problems, authored by Professor Sarah Galvani and Dr Sam Wright from Manchester Metropolitan, is being launched at an event in Liverpool on Thursday, May 16.

Chancellor's Fellowship

It is the result of the Manchester Metropolitan’s Chancellor’s Fellowship award, which allowed the team to work with Dr Yasir Abassi, Consultant in Addictions Psychiatry from Mersey Care NHS Foundation Trust, and colleagues from Marie Curie Hospice in Liverpool.

Joe Rafferty, Chief Executive at Mersey Care, said: “This report is a great example of the work that can be done in partnership between NHS Trusts and academic institutions like Manchester Metropolitan University.

“It’s only by working together in a joint approach that we are going to be able to provide real care for some of the most vulnerable people in our society. There are very close links between deprivation, mental ill health and addictions and the recommendations in this report should be closely evaluated by all stakeholders and look towards providing a better experience for all.”

The report’s authors call on national and local strategic health bodies to begin work jointly with NHS trusts, local authorities and third-sector organisations to develop policy standards that will support service delivery and reduce health inequalities for this vulnerable group of people.

Dr Sarah Galvani, Professor of Social Research and Substance Use, said: “We hear a lot about groups of people facing health inequalities and people with alcohol and other drug problems are among that group. We anticipate that health and social care services are going to see a growth in the number of people presenting with life limiting conditions and current, or past, substance use, given our ageing population and their higher rates of hospital admissions for alcohol-related harm in particular.

“Services and the staff within them need policy and practice guidance to support both them as practitioners and also their practice response.”

The report includes case studies that demonstrate the challenges people at, or near, the end of life face when they have problematic substance use. In one case, a person hospitalised twice for severe stomach pain was treated with an alcohol detox despite no longer drinking, leaving the underlying health problems unaddressed.

This report is a great example of the work that can be done in partnership between NHS Trusts and academic institutions like Manchester Metropolitan University

Dr Sam Wright, Senior Research Associate, said: “We know there is good practice out there but this is by no means widespread. We hope these policy standards will begin a conversation that will lead to more consistent good practice and improved integrated working.”

Previous research by Professor Galvani, Dr Wright and their team has sought the views of people living with life-limiting illness and substance use, their family members and the professionals who work with them.

We anticipate that health and social care services are going to see a growth in the number of people presenting with life limiting conditions and current, or past, substance use, given our ageing population and their higher rates of hospital admissions for alcohol-related harm in particular

They found missed opportunities for health and social care professionals to intervene and were given multiple examples of people receiving poor quality care as their substance use diverted professionals’ attention from their underlying health and social care needs.

Report authors argue that a new integrated approach could focus on the complex and multi-faceted needs of problematic drug users, for example treating physical health problems ranging from COPD, Hepatitis B and C and liver disease, to addressing mental health problems and homelessness.

The Manchester Metropolitan’s Chancellor’s Fellowship is ran by MetroPolis – the University’s think-tank linking research, policy and practice. The Chancellor’s Fellowships help researchers understand policy makers and processes by embedding academics in policy contexts. As of 2019, MetroPolis has awarded 10 fellowships.

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