Following a series of seminars with leading experts undertaken before the coronavirus pandemic, the organisations found that despite examples of good care, many hospitals are still not identifying enough patients who could benefit from palliative care, and who are unfairly missing out on the right care at the end of life. With hospital services under pressure due to coronavirus this situation is likely to have worsened over the last six months.
With the Scottish Government’s Strategic Framework for Action running to 2021, Marie Curie and the University of Glasgow have offered 12 themed recommendations for consideration by the next Scottish Government, NHS Boards and Integration Authorities.
Maria McGill former CHAS Chief Executive supports the recommendations as her father was cared for in hospital prior to dying at home from heart failure and did not receive any palliative care.
She said: "Dad was admitted to hospital through the emergency department via 999 ambulance twice in 10 months. There were missed opportunities. Had conversations been started with him, and importantly including mum and me, instead of the rush to discharge him two weeks later, the second admission might have been avoided and they would have both been in a better position to understand what was happening to dad. Early discharge planning and engagement with community services is key, but those conversations should involve the family. Our experience was that dad was told he was being discharged and we weren’t involved in the discussion.
"Staff in all settings having the ability to listen, really listen, and I really do understand that for some staff this might cause them anxiety about what they might hear, that they might not know what to do, or have the time to do anything. However, it is so important this opportunity isn’t missed. Even during that second admission 8 weeks before dad died - there wasn’t a recognition of dad’s deterioration."
Marie Curie and the University of Glasgow are also calling for the Scottish Government to set aside £15 million for a nationwide Change and Innovation Fund to test new models of integrated care involving acute settings. This could help ensure patients get better care, but also improve efficiencies in care across community and hospital settings.
Marie Curie Head of Policy and Public Affairs Scotland Richard Meade said: "Hospitals are absolutely the right place for some dying people to be, but we need definitive action to ensure people get the care they need when in a hospital. More and more people are likely to present with multi-morbidity and complex needs and by 2040 it is expected that up to 31,000 people could be dying in a Scottish hospital. 
"While it’s clear that there are some excellent examples of care across Scottish hospitals, we found a worrying level of inconsistency and gaps in care. It’s particularly concerning that knowledge of palliative care among healthcare professionals was patchy with some not understanding that it can be provided alongside curative treatments."
Professor David Clark and Welcome Trust investigator at the University of Glasgow said: "Over the last 10 years our research has consistently shown that on any given day almost one third of patients in Scottish hospitals  are in the last year of life and 10% will die on their current admission. We are not grasping the opportunity to identify these people and to have conversations about their end of life preferences.
"Covid-19 has revealed the shocking absence of advance care plans in many cases, making it even more difficult to give the right kind of care in pandemic conditions."
The 12 recommendations from Marie Curie and the University of Glasgow are:
Caroline McIlwain Marie Curie PR & Communications Manager firstname.lastname@example.org / Marie Curie Press Office 0845 073 8699 email@example.com
Áine Allardyce, Communication Manager, University of Glasgow on firstname.lastname@example.org
The full report "Past, Present and Future: Caring for those approaching the end of life in Scottish Hospitals" Marie Curie and the University of Glasgow is available on www.mariecurie.org.uk/policy/publications
References Finucane, A.M., Bone, A.E., Evans, C.J. et al. The impact of population ageing on end-of-life care in Scotland: projections of place of death and recommendations for future service provision. BMC Palliat Care 18, 112 (2019). doi.org/10.1186/s12904-019-0490-x
 Clark, D., Armstrong, M., Allan, A., Graham, F., Carnon, A., & Isles, C. (2014). Imminence of death among hospital inpatients: Prevalent cohort study. Palliative Medicine, 28(6), 474-479. doi.org/10.1177/0269216314526443