What do we mean by widening access?

It is also available as a PDF to download.

It is taken from 'Widening access to hospice care – a briefing paper for managers and trustees' by Yasmin Gunaratnam, November 2006. Copies are available from the publications team at Help the Hospices or can be downloaded from our website.

While some of the material needs updating, eg information on equality legislation, the key concepts outlined in the paper and the practical suggestions it makes remain current. 
             

What do we mean by widening access?

Widening access to hospice care is about fairness. It involves:

• the pursuit of equity in relation to who uses hospice services
• the identification and reduction of barriers to services
• a concern with reducing the effects of wider social inequalities.

Why is it important?

There are many reasons why access should be improved. For example there is growing evidence¹ that access to hospice services is affected by:

• who you are
• where you live
  
• what illness you have.

Therefore to ensure that everyone in our society gets an equal chance of receiving good quality end of life care when they need it, then actions need to be taken to improve services.  

There are also legal obligations upon organisations as employers and providers of public services to promote equality and diversity, for example the Equality Act 2010.

What does it mean in practice?

Any initiatives to make access to services more equitable to all should be driven by the need in the area that a particular hospice/unit serves. However at its most basic, access consists of four main components to consider.

1. Service availability

Fair access involves ensuring adequate and timely services in relation to need and with regard to social disadvantage. This also includes the physical accessibility of services, so for example are they easy to get to for those with disabilities and those living in rural or deprived areas?

2. Service use

This can vary according to:

• awareness of what is available
• expectation about entitlements to care
• resources of informal care
• referral practices.

Identifying and reducing financial, organisational and social barriers to hospice care can result in fairer access for all. For example targeted awareness-raising about hospice care in under-represented groups, such as travellers or black and minority ethnic groups, could be a way of reducing barriers caused by misunderstanding, fear and anxiety about hospice services.

3. Service relevance and responsiveness

Equitable services need to be relevant and effective in responding to the specific care needs of individuals or groups in society that are currently under-represented within the services a particular hospice/unit offers.

Providing services that are responsive to need could mean:

• adapting existing services
• providing a new one
• targeting initiatives at specific groups.

For example working closely with others, such as prisons, homeless, mental health and learning disability organisations can be effective in making access to services more equitable to all.

4. Quality

To understand and ensure that services are equitable to all, then it is essential to learn about the experiences of patients and carers. Involving users as a group is one approach and there are others which are equally valuable in gaining insight into the quality and appropriateness of hospice services offered for all who need it.

Further information

Please contact the grants team for further information or help. There are also some frequently asked questions about the grant programme on our website.

Reference

¹ Department of Health. End of Life Care Strategy: promoting high quality care for all adults at the end of life. Equality Impact Assessment  (2008)