Improving End of Life Care

Why is this important?

End of life care is care that affects us all, at all ages; the living, the dying and the bereaved. Reports and investigations too frequently identify poor care and we have a responsibility to do better. Around half a million people die each year and this is set to increase in line with the growing older population.

Context and challenges

  • In England and Wales 84% of deaths in 2013 were of people aged 65 or older and 39% were of people aged 85 or older.
  • The number of young adults (18 to 40) living with life-limiting conditions such as cerebral palsy and multiple sclerosis that need earlier palliative care in England is estimated to be 56,000. The prevalence of life-limiting conditions in this age group has increased from 26.0 to 34.6 per 10,000 over the last ten years.
  • It is estimated that improved recognition of palliative care needs and services outside hospital could improve care and reduce hospital costs by £180 million per year.
  • Nobody likes talking about death and dying.
  • Death is often seen as a failure of treatment.
  • Dying, death and bereavement are not primarily health and social care events; they affect every aspect of people’s lives and experience.

What is NHS England doing to improve end of life care?

Ambitions framework

NHS England is working with partners, in particular the National Palliative and End of Life Care Partnership – a group of national organisations with experience of, and responsibility for end of life care.

The overarching vision for the partnership is centred on a statement developed in partnership with National Voices and the National Council for Palliative Care:

I can make the last stage of my life as good as possible because everyone works together confidently, honestly and consistently to help me and the people who are important to me, including my carer(s).”

In 2015, the partnership published the ‘Ambitions for palliative and end of life care: a national framework for local action 2015-20’ which centres on six ambitions. Each ambition includes a statement from the point of view of a person nearing the end of life. They are each underpinned by a series of building blocks, which need to be delivered to achieve the related ambition.

Commitment for End of Life Care

NHS England is also working with the government and partners across the health and care system to deliver the ‘End of Life Care commitment’ announced by the government in their response to the independent review on choice in end of life care.

The government’s six commitments, which closely align to the ambitions, are made to the public and aim to end variation in end of life care by 2020. They are:

  • honest discussions between care professionals and dying people;
  • dying people making informed choices about their care;
  • personalised care plans for all;
  • the discussion of personalised care plans with care professionals;
  • the involvement of family and carers in dying people’s care;
  • a key contact so dying people know who to contact at any time of day.

NHS England workstreams

To support implementation and delivery of the Ambitions and the End of Life Care commitment, NHS England has developed three overarching workstreams that bring together system wide action:

  • Enhancing physical and mental wellbeing of of the individual
    • To optimise the person’s mental and physical wellbeing so that they can ‘live as well as they wish’ until they die
    • To optimise the support for their families, carers and those important to them to maximse their wellbeing before and after the person’s death.
  • Transforming experience of End of Life Care in the community and hospitals
    • To significantly improve the experience of end of life care in hospitals, at home, and in care homes, hospices and other institutions.
  • Commissioning quality services that are accessible to all when needed
    • To support commissioners and service providers to design and implement models of care which promote integration and care that feels coordinated to those using, and delivering, end of life care services.

Find out more

If your organisation is involved in End of Life Care projects, or you would like to know more about the work of the national team and the Ambitions Partnership, please contact england.endoflifecare@nhs.net