Baroness Finlay: The UK is a world leader in end-of-life care, but it cannot be maintained in a vacuum

3 min read14 March 2017

Government's ambition to make end-of-life care a core priority in the NHS will require commitments to new standards and protocols, says Baroness Finlay

The 2015 publication “What’s Important to Me. A review of choice in end of life care”, highlighted that people want the right care at the right time delivered by appropriately trained staff – and for their family to be cared for, before and after their death.

The same year saw a second important publication: “Ambitions for Palliative and End of Life Care: a national framework for local action 2015-2020”. This was co-produced by a partnership of 27 national organisations across the voluntary and statutory sector, and set out their shared vision for what needs to happen to improve end of life care in localities.

Then in 2016, came “Our Commitments to you for end of life care. The Government Response to the Review of Choice in End of Life Care”. In this, the Government declined the call for £130 million ring-fenced for such services, but stated that end of life care would instead become a core priority within all NHS transformation programmes:

“Improvements to end of life care should not occur in isolation. They should be threaded through the most effective New Models of Care that will deliver the new, transformed NHS. STPs should fully take into account the contribution that sustainable, efficiently designed end of life care services can make to achieving better outcomes for dying people.”

But good intentions are not enough. An academic study, published earlier this month, found wide variations in the budgeted amounts by Clinical Commissioning Groups (CCGs) for palliative care.

And an initial analysis by the National Council for Palliative Care found the Sustainability and Transformation Plans (STPs) look no better. Of the 44 “footprints” across England:

7 (16%) gave no mention of end of life care at all
18 (41%) mentioned end of life care transiently
13 (29%) mentioned end of life care, and provided some detail
6 (14%) embedded end of life care as a strategic priority

This contrasts with Wales, where in 2008 an additional £6 million annually was invested, underpinned by a funding formula for palliative care services. This £2 per head of population has allowed developments to be put in to fill gaps in hospice provision and to work with the voluntary sector. It has enabled 7-day specialist palliative care services and 24/7 consultant advice available to other health and social care professionals caring for people who are terminally ill.

The UK leads the world in palliative and end of life care, but this cannot be maintained in a vacuum. NHS England needs to ensure that STPs reflect the Government’s intention.

We get the care we plan for. We know what a difference good palliative care can make, not only to the dying person but also to their families. Yet if a service doesn’t exist, how can anyone access it at their time of need.

Baroness Finlay of Llandaff is a crossbench peer in the House of Lords and is the Chair of Trustees for the National Council for Palliative Care.

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