Challenges in delivering palliative care in the community – a perspective from St Christopher's Hospice, London, UK

Abstract

This article describes the specialist home care service at St Christopher's Hospice in London and its endeavours to meet the challenges and opportunities inherent in England's first national strategy for end-of-life care. It argues that, if the aspiration to deliver good end-of-life care to all is to be achieved, more effective service integration at all levels will be required and that the development of confidence and competence in the generalist healthcare workforce is essential. Specialists have a clear responsibility for the dissemination of knowledge and skills. It is also suggested that the future of specialist palliative care in the community lies in defining the needs of the 'complex dying' and ensuring the competence of nurses as advanced practitioners to deliver to these needs. The article also considers how best to respond to the currently poorly served population of older people in general and those with advanced dementia in particular.