Promoting high quality care for all at the end of life: review of NHS National End of Life Care Programme 2004–2007 and implications for primary care

Background Research shows most people want to die at home yet most in fact die in hospital. The underlying reason for this mismatch is that health and social care services struggle to respond satisfactorily to people's varying end of life care needs. The creation of the National End of Life Care Programme in 2004(1) and the launch of the End of Life Care Strategy in 2008(2) were designed to improve this situation. Setting The National End of Life Care Programme was set up to offer patients nearing the end of their life high quality care and choices about where to die. Particular objectives were reducing the number of unnecessary emergency admissions and improving the skills of the workforce. Question How effective has the National End of Life Care Programme been in its first three years? And given that an increasing proportion of end of life care services will take place in the community, what are the implications for primary care staff? Methods The authors discuss an in-depth evaluation of the National End of Life Care Programme by Nottingham University.(3) They also describe two Department of Health reports indicating how primary care services can improve the quality of end of life care services.(4,5) Results The Nottingham University evaluation shows that the National End of Life Care Programme is having an impact. SHAs with high uptake of end of life care tools tend to have higher rates of home deaths. In addition staff who use the tools are more confident in broaching sensitive issues around dying. Meanwhile the DH reports provide a template for coordination of services and training of staff in the community. Conclusion There are examples around the country of excellent end of life care. But it is essential that the best is spread to the rest. That success depends on better organisation and collaboration, effective use of resources and good communication between commissioners and providers. Above all, care has to be focused on the individuals and their carers.