Recommendation 13

HM Government Accepted

While the NHS has always been required to commission appropriate palliative and end- of-life care services to meet the reasonable needs of local populations, palliative care services were added to the list of services an integrated care board (ICB) must commission, promoting a more consistent national approach and supporting commissioners in prioritising palliative and end-of-life care. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. Further work is ongoing to support ICBs in this legal duty, including: • From April 2024, NHS England is including palliative and end-of-life care in the list of topics for its regular performance discussions between national and regional leads. • NHS England has commissioned the development of an all-age palliative and end of life care dashboard, which brings together relevant local data in one place. The dashboard helps commissioners understand the palliative and end-of-life care needs of those in their local population, enabling ICBs to put plans in place to address and track the improvement of health disparities. Regarding the recommendation to ensure universal coverage of hospice care at home, due to the way the hospice movement organically grew, hospice locations were largely not planned with a view to providing even access across the country or to prioritise areas of greatest need based on demographics. Therefore, there are disparities in access to hospice services, especially for those living in rural or socio- economically deprived areas. While the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at end of life and their families. Most hospices are charitable, independent organisations who receive some statutory funding for providing NHS services. We are working hard to encourage the use of advance care plans (ACPs). We recognise that high-quality palliative and end of life care should include the opportunity for individuals to discuss their wishes and preferences so that these can be taken fully into account in the provision of their future care, also known as advance care planning, a voluntary process of person-centred discussion between an individual and their care providers about their preferences and priorities for their future care. It is important that ACPs are respected, and that individuals’ preferences are honoured as far as possible. NHS England published Universal Principals for Advance Care Planning in March 2022 to provide a consistent national approach to advance care planning. In addition, there is a specific document to support health and care providers supporting advance care planning for those with dementia: NHS England » My future wishes: Advance Care Planning (ACP) for people with dementia in all care settings Resources available to support healthcare professionals in engaging people in advance care planning includes guidelines and a quality statement from the National Institute for Health and Care Excellence (NICE), and a specific module within the End-of-life Care for All e-learning training programme hosted by Health Education England (now part of NHS England). Advice is also available on NHS.UK at the following link: End-of-life Care For All (e-ELCA) - elearning for healthcare (e- lfh.org.uk) As part of the Major Conditions Strategy: Case for change and strategic framework, published in 2023, we recognised that personalised care and empowering patients and service users is particularly important as people near the end of their lives. Advanced care planning, when done well, can allow people to feel they have had the opportunity to plan for their future care.