Comment: Reassuring move on palliative care

SCOTTISH Government’s new framework document helps put patients’ wishes first, writes Richard Meade

SCOTTISH Government’s new framework document helps put patients’ wishes first, writes Richard Meade

The Scottish Government has now published its Strategic Framework for Action on Palliative and End of Life Care. At its heart is the aim to ensure everyone who needs palliative care will have access to it by the end of 2021. It aims to ensure that everyone has good quality end-of-life care regardless of age, diagnosis, socio-economic background or where they live.

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Every year around 40,000 people in Scotland will need some form of palliative care. This could be at home, in a care or a nursing home, a hospice, a hospital or a combination of all of these. But every year nearly 11,000 people miss out on palliative care or get it far too late to fully benefit.

So, the Scottish Government’s aim is an ambitious one and should be applauded. The framework sets out ten commitments to help deliver on this aim and its wider objectives.

New Integration Joint Boards for health and social care will go live in April 2016 and will be responsible for commissioning palliative care services in community and acute settings. Boards will play a crucial role in delivering on the Scottish Government’s ambition.

To be able to draw upon the vast range of expertise and experience in service delivery that is currently available across Scotland they will need support. The framework has promised to deliver commissioning guidelines for palliative care. This will be a vital tool to support boards in ensuring they have the right mix of services to enable everyone to get the care they need. With Marie Curie services in all but one Integration Joint Board we hope that we will play a key role in this work.

Scotland has a good reputation for palliative care research at home and internationally. Research is vital for supporting the development of good policy and improvement, but far too often it can take too long to get from publication to practice. The framework has seen the establishment of a new Scottish Research Forum for Palliative and End of Life Care. Marie Curie, in partnership with the MND Association and the Chief Scientist Office, has also recently launched a £1.4 million fund for research for the coming year – our biggest ever. The forum will play an important role in co-ordinating this work and enabling an effective exchange of knowledge between academic institutions and with practitioners.

Marie Curie and many others have frequently talked about the need to tackle the “taboo” around dying, death and bereavement. The fact that too many people do not have open and honest conversations means people miss out on the care that they need and would like. A commitment to commissioning work to facilitate greater public and personal discussion is very welcome. We hope this will draw on and work in partnership with Good Life, Good Death, Good Grief an alliance of organisations established to challenge some of these societal issues.

We have often heard that a person’s experience of care can be highly dependent on health and social care professionals. Most people receive excellent care, but we do know that some professionals struggle with delivering palliative care, because they have not had the right training. The framework has committed to establishing a new educational framework which will support professional development. This will make a huge difference and empower staff across community and acute settings to deliver the person-centred care that people need, especially as they approach the end of life.

For far too long we have not been able to get a complete picture in Scotland of palliative care, particularly regarding who gets it, who needs it, and the quality of care when they do receive it. The commitment to establish a National Implementation Support Group to support and co-ordinate the resources and infrastructure required to implement the framework will be essential to enabling improvement in palliative care, as well as show success against the framework’s overarching aim.

The framework has been a long time in development, but now it is published we need to get down to the hard work of implementing it. We need to deliver on the commitments to ensure that in Scotland everyone who needs palliative care gets it at the right time.

• Richard Meade is Marie Curie’s head of policy & public affairs, Scotland. Find out more at