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In July 2008 the Department of Health launched the first ever national strategy for End of Life Care (EoLCS) in England. This reflects the importance Government places on end of life care and is supported by several initiatives such as a national coalition to raise public awareness of death, dying and bereavement as led by NCPC, the national End of Life Care Programme team to support implementation and the launch of a national End of Life Care Research Centre. This strategy and these initiatives cover adults with all conditions and in all settings including care homes.

This focus on end of life care (EoLC) has also been supported by the recent NHS Next Stage Review where a key workstream was end of life care. This means that there is not only a national EoLCS but also that each local area has its own EoLCS and EoLC lead across the Strategic Health Authority (SHA), Local Authority and Primary Care Trust (PCT). This process should have been inclusive of local health, social care, voluntary and independent sector providers. These initiatives mean that EoLC is high on the agenda and therefore something that all staff caring for older people need to be considering in terms of what their services are doing at present; how they are going to address the needs of future populations and how they are going to ensure they are involved in their local EoLCS activity.  

A key part of the strategy is the EoLC pathway (figure 1).

Staff should now be looking at this pathway and the local adaptations each SHA have done as to how they currently are able to meet each stage and who in the local area can help them to do this. For example there is a workforce development aspect to each step of the pathway and to begin to address this staff have been broken down into three groups within the EoLCS: 1) staff working in specialist palliative care and hospices; 2) staff who frequently care for those at the end of life and 3) staff who infrequently care for those at the end of life. Staff caring for older people are likely to fall into the second category so will be entitled to training in communication, assessment, advance care planning and symptom control. SHAs will lead on workforce development, Skills for Health and Care are developing competences and e-learning for healthcare is developing a package. You also need to be aware of your PCT strategic plan on EoLC and who you should be linking in with to access the resources available. Each PCT will have collected baseline data around EoLC and this may help you in service and workforce planning and development.

Multiple Conditions: Multiple Challenges
Of course older people don’t fit in to a neat diagnostic box generally experiencing several co-existing conditions and possibly frailty as they move towards the end of life. The pathway above is generic so NCPC with key partners – Age Concern, Help the Aged and British Geriatric Society amongst others - has been considering this closely as older people with multiple conditions are the majority of those coming to the end of their lives. It may be that you can help your local EoLC leads and commissioners to consider this so NCPC have produced guidance to help Multiple Conditions: Multiple Challenges and expect to have a further event in 2009 and to publish an information leaflet for patients and carers jointly with the British Geriatric Society (further information available at www.ncpc.org.uk). 

Dementia
29% of people 85 years old and over with other conditions ie cancer will also have dementia. NCPC has a specific project looking at the palliative and end of life care needs of people with dementia and 3 key publications have been developed (for more info see www.ncpc.org.uk) there is also a national event and launch of guidance on 12th Feb 2009.

NCPC has worked very closely with the Department of Health on the development of the EoLCS and has therefore been in a good position over the last two years to develop work to help services implement the policy some of which is detailed above. If you want to receive all of this free subscribe to NCPC otherwise details of publications and events are available at www.ncpc.org.uk.

Lucy Sutton
Director of Policy Development
The National Council for Palliative Care (NCPC)

BGS Newsletter, March 2009
Issue 19 ISSN 1748-6343 20