Last month the Government unveiled a new national commitment on end of life care - the central plank of its long-awaited response to the Review of Choice in End of Life Care.
The response sets out the Government's vision for improving care for dying people and their families. In policy terms it is of major significance as the first clear statement of the Government's position on this area of care since the End of Life Care Strategy published in 2008.
It its response, the Government also addresses each one of the recommendations of the Review of Choice in End of Life Care which was published in 2015.
The Government's national commitment sets out the key components of personalised care that everybody should expect to receive, which are:
• honest discussions between care professionals and dying people
• dying people being given clear information to make informed choices about their care
• personalised care plans for everyone
• discussions on 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
To achieve this personalised care, the Government sets out a raft of measures to help deliver better care for people approaching the end of life on a wide variety of areas.
They range from the roll-out of Electronic Palliative Care Co-ordination Systems (EPaCCS) to all areas by 2020 to asking Sustainability and Transformation Plans (STPs) to include end of life care.
There is much to be welcomed in the Government's response to the choice review.
The clear commitment to improve end of life care for everyone and especially the move to ensure this is explicitly included in NHS mandates will help ensure that this area of care becomes a greater priority at national level.
Introducing new metrics to measure quality and choice in end of life care and ensuring monitoring through existing NHS mechanisms will increase accountability and help to drive improvements in end of life care.
For example, through specific responsibilities for bodies such as NHS England and Health Education England.
It is also very encouraging that longstanding issues such as inadequate training for health professionals delivering end of life care will be tackled through a number of actions, such as promoting best practice in workforce education and developing a refreshed competency framework for health and social care which will include care at the end of life.
Making end of life care a local priority
The Choice Review called for additional investment in community-based end of life care to give people more options about the care that they receive. This recommendation was not accepted by the Government. Consequently, there is no new central funding to support the implementation of the national commitment and any additional investment in end of life care will have to come from existing resources.
Securing additional local funding for end of life care will depend on whether end of life care is a local priority, and national policy statements are not easily translated in to better care. The devolved nature of the health and care system means there are few national levers that can be exerted to deliver change to end of life care consistently across the country.
While the alignment of the national commitment to the five Priorities of Care produced in 2014 and Ambitions for Palliative and End of Life Care will go some way to help support improvements at local level, significant improvements will also depend on the priority given to end of life care in each area by local decision-makers.
As earlier research by Hospice UK shows, end of life care is not a priority for many Clinical Commissioning Groups (CCGs) and Health and Wellbeing Boards (HWBs).
Local ownership and accountability will be critical to helping achieve the vision of the Government's new national commitment. Unless end of life care becomes a priority for all CCGs and HWBs local progress will continue to be patchy and inconsistent.
Implications for hospices
As providers, funders and leaders of end of life care services, hospices have a vital role to play in helping to deliver improvements in end of life care.
Hospices have a real opportunity to use their influence to help more people achieve their wishes and preferences at the end of life, by engaging with the key players such as CCGs, HWBs and STP leaders to ensure that hospice and palliative care is higher up the local agenda.
Hospices also have an important part to play in raising awareness of the new national commitment to end of life care. Their longstanding expertise in providing quality, compassionate care and their widespread links with organisations across their local communities, means their role will be crucial to help deliver the transformation in care for dying people that the Government desires and which is so urgently needed.
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