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Traditional palliative care services have focused on individuals with cancer. The NHS National End of Life Care Programme, launched in December 2003, has been working to address this anomaly and to try to enhance end of life care provision for other patient groups. This article reports on work in the area of renal failure at Westmorland General Hospital, Cumbria, where the Preferred Priorities for Care tool has been introduced to support patients nearing the end of life.

The place of final care for patients with terminal illness is influenced more by resource availability than patient choice. Resources are not consistently available across the UK to provide successful palliative home care for all those that require this facility. This paper surveys the literature on home care for terminal cancer patients and outlines proposals for a new initiative in Lancashire and South Cumbria to address this issue and improve palliative care services in the community.

Last month the authors described the role of the nurse in the prison service, the need for clinical supervision, and the parameters for a project to implement a clinical supervision model in five prisons in England ( Freshwater et al 2001 ). Here, they examine some of the findings from the project, particularly in relation to practice, education and barriers to implementation.

CLINICAL SUPERVISION has been high on the nursing practice agenda in recent years ( UKCC 1996 ). While implementation in some specialist areas is more advanced, there is growing evidence to suggest that clinical supervision is now well established in many areas of nursing practice ( Bishop and Freshwater 2000, Butterworth et al 1998, Farrington 1995 ). Much of the success of the strategy The New NHS: Modern, Dependable ( DoH 1997 ), and the supporting strategies described in the documents A First Class Service ( DoH 1998a ) and Working Together ( DoH 1998b ), depends upon the ability of key players, and identified clinical leaders, to take forward the clinical supervision agenda.

The inadequacy of some areas of palliative care provision was acknowledged in the NHS Cancer Plan (DoH 2000). Many patients would prefer to die at home, but only one quarter are able to do so because of the lack of community or specialist palliative care teams in some parts of the country. The Lancashire and South Cumbria Cancer Services Network developed an initiative to meet the educational and training needs of practitioners delivering palliative care in the community.