On February the 10th, the Joint Strategic Needs Assessment for End of Life Care was published. The JSNA aimed to inform a future strategic approach to end of life care.
The JSNA reinforced the concept that ‘End of Life Care’ is all care delivered in the last year or so of life, and is much wider than the specialist palliative care services such as hospices and specialist teams in hospitals. People approaching the last phase of life experience a range of physical, emotional and spiritual symptoms. To manage these issues effectively requires integrated and multidisciplinary working between teams and across sectors regardless of whether the person is in their home, in hospital, a care home, or hospice.
Good end of life care is also very much about the families, friends and carers of people at end of life, who also experience a range of challenges and will have their own specific needs which must be addressed before, during and after the person’s death.
The focus on supporting people to receive care, and be supported to die in their preferred place of care, requires a future shift in culture which can only be achieved by upskilling the workforce in identifying the dying phase, having ‘difficult’ conversations and managing end of life care needs and preferences. For this reason, the JSNA recommends a comprehensive and joined up training programme for all frontline staff and those who provide care to people in their last few years of life.
Whole Systems Integrated Care (WSIC) and Shaping a Healthier Future (SaHF) strategies and respective local authority strategies provide opportunities to focus on community based care and enhance end of life care.
Key messages for the Third sector
- The community, voluntary and independent sector have a vital role to play in enabling people from all cultures to experience good end of life care
- Community organisations and assets providing practical, emotional and spiritual support should be mapped and mobilised to support end of life care
- Commissioners and providers should work collaboratively with third sector organisations to develop their role and contributions to end of life care
Key messages for CCGs and GPs
- People approaching end of life are not always identified early. This is essential to ensuring that patients have a proper care plan in place which addresses their individual needs and preferences. These care plans need to be created and shared on Coordinate My Care (CMC)
- In order to create open and honest communication with patients and their loved ones, a ‘culture shift’ is needed which addresses the taboos on discussing death and dying.
- There is a need to support professionals to develop confidence in initiating these discussions. This can be achieved through delivery of a coordinated education and training programme for frontline staff.
- To make informed decisions on their care people approaching the end of their life, and their families and carers, require access to good quality information
- Strategic leadership is required to coordinate care across the system. Leadership should reflect a community based model with input from specialist services.
- End of Life Care needs to be integrated into current strategies and projects. Whole Systems Integrated Care is a key delivery mechanism.