September 2015 saw the publication of the national policy document “Ambitions for Palliative and End of Life Care: a national framework for local action”.
This came from the National Palliative and End of Life Care Partnership, made up of statutory bodies including NHS England, the Association of Adult Social Services, charities and groups representing patients and professionals.
This national vision outlines a framework of six ambitions and eight underpinning foundations for palliative and end of life care (PEOLC) for all, “at the heart of an integrated approach to care across system agendas”.
As a busy GP, clinical lead and adviser to commissioners, I recognise that taking national policy recommendations and turning them into a locally-relevant, deliverable implementation plan is complex.
Here I outline how I have made sense of the complexity, and offer three steps towards realising Ambitions anywhere, for any patient population.
The refreshed “Commissioning person centred end of life care – A toolkit for health and social care” by the Sustainable Improvement Team, NHS England, is a valuable online resource support for the commissioning process and an interactive directory of current guidance.
Step 1: Agree definitions of palliative and end of life care
Widely-accepted definitions of PEOLC provide us with a broad philosophy of care, applicable across many disease areas and all sectors and specialties within health and social care.
“Palliative care” means different things to different people; recognising that we may not all be talking the same language, and agreeing what is meant by “palliative care”, “end of life care” and “specialist-level palliative care” – and who exactly each is for – is helpful for localities to start their own conversations.
- WHO Definition of Palliative Care
- General Medical Council: Treatment and care towards the end of life: good practice in decision making
Step 2: Consider the whole system
Strategic and responsive commissioning takes into account how PEOLC can be delivered in any care setting, and the interfaces between those settings: community, hospices and hospitals. By coming together, The National Palliative and End of Life Care Partnership exemplify whole-system leadership.
Recruiting a local team with a broad range of local organisations follows this example, allows open dialogue and a fresh approach to the provision of PEOLC across the whole system.
The NHS England “Specialist Level Palliative Care: Information for Commissioners” outlines one key part of the system. Specialist-level palliative care is vitally important for those within our population who have the most complex needs associated with incurable illness. Commissioning will help to address current inequalities in the access to, and provision of, specialist-level palliative care to all who may benefit, and can also support the ongoing evolution of the specialty by promoting innovation and research, and ensuring indirect care through support from the speciality to the wider workforce.
“Ambitions” recognises that much PEOLC is delivered outside of specialist settings, by the wider workforce. Commissioners have a task to understand what is really provided for patients in other parts of the system, including primary and community care, and hospitals (for which this “How to” guide is now available).
This includes achieving care for patients when they are dying, as outlined in the NICE Guidelines for the Care of the dying adults in the last days of life, as well as ensuring arrangements are in place for access to both specialist-level palliative care and hands on nursing care whenever and wherever it is needed.
Step 3: Keep going
Reports and guidance will keep coming; keeping track and making sense of it can be tricky, but there is help available. You are likely to have clinical expert leaders linked to your Clinical Network, and there are plans for a national PEOLC resource hub.
I am continually inspired by the enduring commitment of individuals to this agenda, not only at a regional or national level, but among my colleagues providing frontline patient care. There are also many committed commissioners around the country who are making significant strides in improving the provision of palliative and end of life care.
In a society where we defy death, but where all of us die, this commitment is imperative. Realising “Ambitions” demands the determination and ongoing commitment of commissioners of local health and social care services, together.
If you have any questions or would like more information regarding:
- Commissioning person centred end of life care – A toolkit for health and social care; and
- Specialist Level Palliative Care: Information for Commissioners
Please email: firstname.lastname@example.org
Dr Sarah Mitchell is the West Midlands Generalist Clinical Lead for Palliative and End of Life Care at NHS England. In this role and as a Birmingham GP, Sarah is committed to working with all to support the local action challenge of the ‘Ambitions’ framework. A champion of excellent palliative and end of life care for people of all ages, Sarah also co-chairs the West Midlands Paediatric Palliative Care Network and is exploring palliative care for children as her PhD at Warwick.