Referral patterns and access to
specialist palliative care
In this chapter, I present evidence on the availability of specialist palliative care services and on who accesses them. I draw primarily, but not exclusively, on data from the UK. The appropriateness or otherwise of these services focusing primarily on cancer patients is discussed, as is the question of whether older people are disadvantaged in terms of access to these services. Variations in access to specialist palliative care by social class and ethnic group are not considered here as they are discussed elsewhere in this book.
Access to health services is determined both by availability and eligibility. The availability of specialist palliative care services in the UK has increased considerably over the past 20 years. In 1990, there were 124 in-patient units, 277 community palliative care teams and more than 40 hospital palliative care teams (St Christopher's Information Service 1990). By 2002, this had risen to 209, 338 and 325, respectively.1 New forms of specialist palliative care service have also developed, for example hospice day care, of which there were 245 in 2002, and hospice at home services, providing 24-hour nursing care for limited periods, of which there were 70.
Much of the development of these services has taken place outside of the National Health Service (NHS), although the NHS is playing an increasing role in the provision of these services, particularly of community and hospital palliative care services. However, although there are 56 in-patient units funded and managed by the NHS, most are independent and receive on average 35 per cent of their funding from the NHS, the rest coming from local fund-raising and charitable contributions. These services have been initiated by local enthusiasts in response to local perceived need, rather than resulting from local or national health care planning. This has given them