Gaps in out-of-hours care for people with advanced illness

Key messages

• significant gaps exist in out-of-hours care, particularly during evenings, weekends and bank holidays
• limited out-of-hours support increases stress, burnout and isolation for informal carers
• availability and quality of out-of-hours care vary by region, creating inequities
• a national framework is recommended to ensure equitable access to high-quality out-of-hours care
• improved coordination and communication between providers are needed to better support patients and carers.

Policy implications

• national oversight may be needed to reduce regional variation in out-of-hours care
• better coordination across services could improve continuity and responsiveness
• planning should explicitly consider the needs of informal carers alongside patients
• proactive approaches to out-of-hours care may reduce crisis-driven service use.

Gaps

• limited evidence on the impact of out-of-hours gaps on longer-term outcomes for carers
• lack of comparative evaluation of different regional models
• limited insight into how unmet need varies across population groups.

Commentary
This report highlights clear inequities in access to out-of-hours care for people with advanced illness and their informal carers. Gaps in provision during evenings, weekends and bank holidays leave many individuals without timely support, with impacts felt most acutely by carers.

Regional variation in service availability contributes to unequal experiences of care. People in some areas receive consistent out-of-hours support, while others face fragmented or limited provision, reinforcing place-based inequities.

Unpaid carers are particularly affected by these gaps. Insufficient professional support during out-of-hours periods increases stress and isolation, placing additional pressure on individuals who are already providing substantial care.

From a care equity perspective, the report points to the need for a coordinated national approach. Improved planning, communication and integration across providers could help ensure that access to out-of-hours care is based on need rather than location or time, supporting fairer outcomes for both those who draw on care and support and carers.