Palliative and End-of-Life Care by Integration Authorities: advice note

Important Considerations for Strategic Commissioning

There are a number of key considerations when planning, designing and commissioning palliative and end of life care, including the following:

• Understanding the mortality rates and patterns for populations within your Partnership and beyond, and the profile of advanced or long-term conditions that underpin that.
• Understanding consumption patterns and variation locally, drawing on the person-linked data through Source ^[8] , which makes use of routinely-gathered information to systematically identify opportunities to support and improve people’s pathways of care - so that, that no matter which setting a person is in when they are dying, they have the benefit of effective and high quality PEOLC. This requires a whole system approach, where anyone who wishes to die at home, as far as possible, is supported to do so – and where those who do not wish to die at home benefit from care that has as many elements of home is as practical, person centred and meets their needs.
• Each Partnership will want to be clear about their accountability for the commissioning and delivery of PEOLC to those who need it and to ensure the full breadth and depth of those needs can be met. This may be aided by the identification of a lead person for both PEOLC and for bereavement care, for the Partnership, where such arrangements are not already in place.
• Improving the early identification of those with palliative care needs, as a gateway to establishing support in line with what matters to the person.
• Having conversations about ‘What Matters to Me’ with those affected, leading to a shareable plan – most often an Anticipatory Care plan. Such conversations, to support shared decision making, are featured in the Chief Medical Officers’ annual report ‘Realistic Medicine’. Currently the only available infrastructure capable of supporting such sharing is the Key Information Summary ( KIS) and we now know that having a key information summary is associated with reduced bed-days for people at the end of life ^[9] .