The National End of Life

Abstract

In 2008 the Department of Health published a national end of life care strategy for England, the first of its kind in the world ( Department of Health, 2008 ). The strategy acknowledged that despite examples of excellent care, many people do not die in their preferred setting or after being involved in planning their care. Despite surveys consistently indicating that most would prefer to die at home or in a community setting such as a hospice ( Cicely Saunders International, 2011 ), in 2005, 58% of deaths took place in hospital. The strategy also acknowledged that many people experience unnecessary pain and other symptoms and referred to ‘distressing reports of people not being treated with dignity and respect’. The low priority accorded end of life care (EoLC) by both the NHS and social care, partly due to a societal reluctance to discuss death and dying, has led to wide variations in standards. The absence of a co-ordinated, person-centred approach to EoLC also imposes avoidable costs on the NHS. This article examines the National End of Life Care Programme's key role in promoting and supporting the changes that can deliver the improvements in care and productivity outlined in the strategy. We have approached this by working with partners to achieve whole system transformational change. Both our approach and the resources we have developed complement the recently-published NHS Change Model.