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Friday 28th October 2016

The cancer reform strategy

13th May 2008

Writing in Health Service Journal, Aleix Bacardit, healthcare and pharmaceutical practice manager at management consultancy AT Kearney, stresses the importance of clarifying the issues over “place of death.


While the government’s cancer reform strategy provides a comprehensive agenda for tackling cancer, using place of death variables to inform management decisions raises a number of issues around data collection and measurement.

Information is critical in monitoring performance but the place of death metric is meaningless if the patient’s choice is not considered.

That choice can change, often frequently, towards the end of a patient’s life and actually asking the question has difficulties of its own.

This leaves carers to try to agree on that choice, but decoupling it from management decisions could lead to misguided decisions, particularly in the area of bed days as a cost driver.

There is very little evidence-based research on palliative care and it is difficult asking people in that position to report on quality of death, quality of care, and best resolution of bereavement.

Equally, there are limited options without this evidence. A one-size-fits-all policy is wrong in cost and moral terms, while more elaborate policies are weak on supportive evidence.

With the shift towards more decentralised decision-making there is the risk that local commissioners faced with an imbalance between knowing the place of death but not knowing the patient choice could “attribute a meaning to an isolated place of death metric.?

Whatever meaning is derived for place of death as a managerial metric, it must leave “no room for ambiguity.?


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