Meeting local and national priorities for adults and children with terminal and life-shortening conditions in Scotland

Scotland’s 31 new Integration Authorities (‘Partnerships’) have been tasked with delivering what the First Minister has described as the “most radical reform in healthcare since the foundation of the NHS”: the integration of health and social care services.

The scale and pace of integration places huge demands on Partnerships and they have been working to establish the structures and processes by which they will deliver better outcomes for people across Scotland.

As the new structures embed and planning develops, we assess how integration is evolving for people living with palliative and end of life care needs. This briefing is designed by Hospice UK to support ongoing local Strategic Commissioning Plan (SCP) development work and local planning teams in meeting palliative and end of life care needs.

It emphasises the role of hospices in solving local challenges and is intended to complement the Scottish Government’s forthcoming Strategic Commissioning Guidance.

We look at what SCPs currently say about meeting the needs of children and adults living with terminal and life-shortening conditions. We identify opportunities to strengthen planning and build links with hospice care to support the ambitions of integration, and meet the needs of local communities. 

Palliative and end of life care was made a core priority relatively late in the local planning process, and it is not surprising that many of the initial SCPs produced by Partnerships have potential to expand this area. Improving planning through prioritising palliative and end of life care will significantly contribute to transforming outcomes for people and the whole health and social care system locally. 

We focus on reducing unplanned hospital stays and the key role palliative and end of life care, particularly as delivered by hospices, plays in achieving this. Around a third of people in hospital in Scotland are in their last year of life, half of all deaths occur in hospital and almost one in ten people who are in hospital today will die before they are discharged. Many have no medical need to be there and could benefit from palliative and end of life care in the community. 

There are five main ways Partnerships can work toward universal access to palliative and end of life care, deliver better outcomes for people locally and reduce unplanned hospital stays: 

1. In Joint Strategic Needs Assessments, prioritise the identification of people with palliative and end of life care needs; and those with chronic and long-term conditions likely to deteriorate over time. 
2. In SCPs, prioritise meeting needs of those with terminal and life-shortening conditions, and those with chronic and long-term conditions likely to deteriorate over time. 
3. As part of addressing the paucity of data relating to widening access to palliative and end of life care, in statutory reporting, include metrics which capture progress on widening access to palliative and end of life care. 
4. Engage meaningfully with hospice care providers across all aspects of assessment, strategic planning and delivery. 
5. Ensure decision making structures reflect the importance of delivering universal access to palliative and end of life care.

This briefing was written by Eilidh Macdonald and Kathleen Caper at Hospice UK.

Thank you to:

• Richard Meade, Head of Policy and Public Affairs for Marie Curie Scotland
• Stephen McCauley, Policy and Advocacy Manager at Hospice UK
• Dr Sarah Russell, Head of Research and Clinical Innovation at Hospice UK

For more information

Please contact the Policy and Advocacy team at Hospice UK, policy@hospiceuk.org

Published by Hospice UK in December 2017.