Palliative care strategy: Palliative Care Matters for All

Annex B: Planning and Delivery of Palliative Care

The way in which health and social care services are planned and delivered across Scotland was changed by the Public Bodies (Joint Working) (Scotland) Act 2014. This Act provided for the integration of health and social care, with delegation of some of the functions of Health Boards and Local Authorities to Integration Authorities. With the exception of Highland where the Health Board remains responsible as a lead agency for all adult services, all other areas formed 31 Integration Joint Boards (IJBs) which have functions delegated to them from Health Boards and Local Authorities.

How is palliative care for adults planned and delivered?

IJBs are responsible for planning and resourcing adult palliative care in hospitals and their communities. IJBs need to work in partnership with a wide range of independent and third sector organisations within their own area, or through arrangements with other relevant bodies in other areas. Independent hospices are important system leaders working with IJBs.

Health and Social Care Partnerships (HSCPs) are responsible for delivering local health and social care services, as directed by their IJB. All have a common purpose – to deliver better health and wellbeing outcomes for the people of Scotland. This means that across Scotland, palliative care is delivered within an integrated landscape, with joint working across the NHS, Local Authorities and the third and independent sectors.

Most palliative care for adults is provided by a wide range of health and social care staff as part of their usual care for people with palliative care needs, and by staff and teams who are specialists or experts in other fields, whether at home; in care homes; in hospital; or in other places of care. This is referred to as 'general' palliative care.

Adult specialist palliative care services are delivered by staff with expertise and specialist training when a person and their family need specialised treatment and support, including for pain and other symptoms, family distress, or complex treatment and care planning.

Adult specialist palliative care services are delivered in all places of care by multi-disciplinary teams of staff and through multi-agency partnerships.

Specialist community palliative care services are available in all HSCPs and there is hospital specialist palliative care provision in each Health Board. This includes some joint arrangements between HSCPs to access services from other HSCPs. Collectively, these arrangements provide access to specialist palliative care across Scotland.

There are 14 independent hospices for adults, serving 7 Health Board areas, and 7 NHS specialist palliative care units, serving 8 Health Board areas.

Specialist palliative care services have a key role in supporting other health and social care staff and teams who are providing general palliative care in the community and hospitals through offering specialist advice, education and training.

How is palliative care for children and young people planned and delivered?

Palliative care for children and young people is an active and total approach to care, from the point of diagnosis or recognition of palliative care needs, throughout the child's life. It embraces physical, emotional, social and spiritual elements, and focuses on enhancement of quality of life for the child/young person and support for the family. It includes the management of distressing symptoms, provision of short breaks, care around dying and bereavement support.^[32]

Paediatric palliative care is provided across all places of care (hospital, home and hospice), and is delivered within paediatric services across Scotland by NHS services and one independent hospice provider (Childrens Hospices Across Scotland - CHAS). Children who live with serious health conditions are supported, first and foremost, by their parents, wider families, friends, neighbours, local communities, volunteers and support groups.

Paediatric palliative care services are the responsibility of Health Boards, unless delegated by local arrangement to IJBs. The planning and delivery of palliative care for children and young people also involves multiple sectors and services, including CHAS and other third sector organisations, working in partnership with Health Boards, Local Authorities and IJBs.

IJBs are a statutory partner within Children's Services Planning arrangements, and have a key role in supporting integration across local strategic activity. This includes ensuring the local Children's Services Plan reflects related services (adult services and/or community-based supports) as well as children's services, where these are relevant to i) support provided to a parent or carer which has an impact on child wellbeing ii) provision of holistic whole family support and iii) supporting streamlined transitions for young people as they move between children's and adult services.