A national framework for local action on end-of-life care | Prof Bee Wee

older persons hands

Great strides have been made to recognise palliative and end-of-life care as an important area of healthcare, but more needs to be done. Here, Prof Bee Wee sheds some light on a new framework to make a big difference to people’s final days.

The primary purpose of the NHS – and the primary motivation of all health and care professionals for joining the NHS family – is to save, prolong and improve lives.

But however hard we work and however skilfully we perform our duties, and however advanced the prevention, identification, treatment and care options available to us become, every life comes to an end. It’s therefore crucial that meeting the distinct needs of people who are reaching the end of their lives is a priority across the health and social care system, and for the professionals who work within it.

We’ve made great strides in the past in recognising palliative and end-of-life care as an important area of healthcare in its own right. Improving the experience of patients and their loved ones has also, quite rightly, been a consistent focus of campaigners, clinical leaders and politicians, leading to important pieces of work such as the 2008 national strategy for end-of-life care, and the 2011 NICE quality standard for end-of-life care.

But nobody would argue that we’re there yet. While a recent Office for National Statistics report found that 75 per cent of bereaved people rate the overall quality of end-of-life care for their relative as good or better, we know that there is much more we need to do, and particularly as there remains significant variation and inequity in the way care is provided and experienced.

I, as national clinical director, also know that there is only so much that can be achieved through acting independently and by issuing edicts from on high. So many different agencies and groups have a stake in end-of-life care and are able to contribute their own perspectives and expertise, that meaningful change could only ever be achieved through collaboration and cooperation.

I was therefore delighted to be part of a huge collective effort between 27 such organisations – covering the gamut of statutory bodies, royal colleges and other groups representing professionals, service providers, charities and groups representing patients and their families – to develop a framework to achieve the ambitions we all share in this area.

Our document – Ambitions for palliative and end-of-life care – isn’t a new strategy; it builds on the 2008 strategy but recognises that it was developed in a different world and a different NHS to the one that exists now. Today, the emphasis is on local decision-making and delivery, so this document provides a national framework for local action over the next five years.

The six ambitions we agreed upon are simple, but important. Each person should be seen as an individual. Each individual should get fair access to care. Comfort and wellbeing should be maximised. Care should be coordinated. All staff should be prepared for and part of that care; and each community is prepared to help.

Each of these are achievable – and we have set out in detail what is required to achieve them – but we know that if we are to realise these ambitions, we are relying on the collective commitment and effort of commissioners, providers, professionals and community groups to adopt and meet them in local areas.

This framework represents a shared vision for the quality of care that people should expect to receive towards the end of their lives, and a shared commitment to help local decision-makers, service providers and people to improve the services in their area. As individual organisations, we are all committed to supporting this work and will be reviewing progress as well as using our own influence to bring about change.

However, we know that to succeed we must also inspire a wide range of professionals and organisations to join us and to accelerate the pace of improvement. Just as death comes to all of us, it is all of our responsibility – as front-line health professionals, as managers, as clinical leaders – to ensure that wherever we can, we help patients to have the kind of ‘living well until death’ that we would want for ourselves and our loved ones. Dignified, empowered, with minimal pain and discomfort, and spent where we want, how we want and with those who matter to us most.

So I ask, as those who can make a real difference to the final days, weeks or months of a person’s life, and to what can be the most difficult time of the lives of those who love them, please read Ambitions for palliative and end-of-life care and commit to putting this framework into practice.

Dr Bee Wee is national clinical director for end-of-life care at NHS England. Follow the organisation on Twitter @NHSEngland

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