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The aims of the programme are to improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice. We do this by helping health and social care professionals throughout England improve care for their patients regardless of their disease. It is part of a wider initiative in health and social care encouraged by the government. The proposed outcomes are: Available evidence suggests that whilst more than 50 per cent of patients wish to spend their final days at home, fewer than 20 per cent are actually able to do so. In addition, most referrals to specialist palliative care teams are for cancer patients. It is recognised that most palliative care is provided by generalists, so empowering and skilling-up generalists is a key factor in this programme. Since the start of the programme there are now examples of where the end of life care tools are being used for non cancer patients e.g. heart failure patients, renal patients and patients with COPD and training for generalists has increased. The Programme promotes three possible models or tools of care: Gold Standards Framework (GSF) which was developed from within primary care and embodies three processes - firstly it identifies patients nearing the end of life, assesses their care needs and preferences, and then develops a proactive plan of care. The framework promotes seven key tasks which focus on improving communication, continuity of care, advanced care planning, patient and carer support, as well as team working. The GSF national team aims to support facilitators in Strategic Health Authorities, Networks and Primary Care. Liverpool Care Pathway for the dying patient (LCP) was developed to take the best of hospice care into care for people in hospital and other settings including care homes. It is used to care for patients in the last days or hours of life once it is known that they are dying. The LCP involves promoting good communication with the patient and family, anticipatory planning including psychosocial and spiritual needs, symptom control (pain, agitation, and respiratory tract secretions) and care after death. The LCP has accompanying symptom control guidelines and information leaflets for relatives. All three tools can be used jointly to ensure that patients receive all the care they need. Since the awareness of end of life care was raised there has been an increased use of the tools which are now being used in all care settings including care homes. An Introductory Guide to End of Life Care in care homes, the first in a series of publications for care homes, was launched in May 2006. This was a joint publication with the National Council for Palliative Care. The implementation of the End of Life Care Programme is via the Strategic Health Authorities and Primary Care Trusts who have developed local plans according to locally identified priorities. Work is also underway with many statutory and voluntary organisations to help support this work including: Department of Health, Health Care Commission, Commission for Social Care Inspection, Social Care, Patients and carer groups, Clinical networks, Private sector, Care homes, Hospices, Voluntary sector Workforce development It also links with government and other initiatives including More information in the Progress report 2006 can be found on the End of Life Care Website Claire Henry |