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At the Cross Roads: How can the NHS Long Term Plan improve end of life care in England?

Macmillan Cancer Support have published a new report titled At the Cross Roads: How can the NHS Long Term Plan improve end of life care in England? The report looks at how national and local systems now need to work together to seize the opportunities contained in the NHS Long Term Plan and push forward to achieve lasting improvements in end of life care.

The NHS Long Term Plan has set the national direction of travel for the NHS in England for the next 10 years and outlines that end of life is a priority area for improving care. However, just to state end of life is a policy priority is not enough: for people not receiving personalised care, this now needs to translate into action.

At the Cross Roads is rooted in professionals’ experiences, from commissioners to nurses, and their experience of trying to deliver personalised care for people at the end of life in what remains a fragmented system.

The report presents a clear call to action for every person involved in the next stage of delivering the NHS Long Term Plan. The two primary recommendations are:

  1. NHS England must provide clear guidance on what local health systems are expected to deliver and prioritise in relation to end of life now the Long-Term Plan is getting implemented.
  2. Every Sustainability and Transformation Partnership (STP) and Integrated Care System (ICS) must state how they intend to fulfil the end of life commitments in the Long-Term Plan when they draw up their five-year delivery plans.

Summary of key findings:

  • Many professionals are concerned that end of life care will ‘lose out’ amongst competing priorities of local health systems when they implement the plan.
  • Communication about death and dying is not always happening between health and care professionals, the people they care for at the end of life and their loved ones.
  • The roll-out of Electronic Palliative Care Co-ordination Systems (EPaCC’S) varies across the country, with professionals telling us that the main challenges are clinical buy-in, functionality and data sharing.
  • Professionals largely welcomed the elements in the Long Term Plan that focussed on community based care, and the opportunities this provided to facilitate choice at the end of life. However, many sounded warnings about what needs to happen to ensure these changes work for end of life care.
  • End of life training for professionals in England is a mixed picture. We heard from professionals that workforce pressures mean accessing end of life training is difficult and it is difficult to get buy-in from some professionals to access training.
  • A common theme in our conversations with professionals was the lack of confidence that the wider health and care system can truly facilitate choice at the end of life.

Click here to download the report.

If you would like to discuss the findings of the report, please contact George Holley-Moore at “

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