NHS Long Term Plan and Social Care Green Paper - looking back and looking forward to the next ten years


Health and social care staff working in an acute setting are frequently faced with the difficult challenge between sustaining life or supporting someone (who is in the final days or hours of life) to die in a comfortable and peaceful way. This is especially difficult for those entering the acute hospital through the Emergency Department. Even when a plan has been made for this eventuality it’s still emotionally challenging and stressful for all. 

Getting the balance right between meeting the needs of inpatients, ensuring inpatients are discharged to the most appropriate setting whilst ensuring hospital beds are available for those admitted through the Emergency Department will always be difficult and yet by training, awareness and understanding of End of Life Care issues, lots of this distress and anxiety can be avoided. That’s why at the end of 2018 professionals considered exactly this situation when planning how best to manage the needs of patients over the Winter period. 

Unfortunately, I was unable to attend the event, but know that approximately 200 professionals and people representatives were present. They discussed effective and person-centred approaches to supporting those (who are about to die) within the hospital setting and agreeing the most appropriate place in which the person should die.  This EOLC golden thread that ran through the event was a significant step for those of us that have promoted the needs of people at end of life and I want to thank the organisers of the event for acknowledging this important area of need.  I am sure it will have made a difference to people’s experience over the festive period. See the link for presentations at the event including some excellent videos.

I have continued to be privileged to represent Adult Social Care at a number of National and Local Boards, Networks and Partnerships over the last year and I can honestly say that the last decade of effort has seen some significant and positive movement this year in both awareness and passion for delivering person centred and bespoke services to meet the needs of people in their last year of life. Change is always difficult for institutions and organisations but never more so than during this time of challenging and reducing resources. One aspect that needs attention, is the availability of services and decisions made relating to Continuing Heath Care and I am pleased to say that this issue is to be discussed at a workshop in February 2019 to help better utilise the available resources.   

People are increasingly more passionate about personalisation and making sure that the person is at the core of their own decision making.  Significant work has been done by the NHS Personalised Care Team led by James Sanderson last year. I also know that there is a commitment from all involved in Personal Care to ensure that where Personal Health Budgets and Adult Social Care Budgets are in place the service between the NHS and Local Government must be flexible and inclusive.

It was also heartening to see End of Life Care highlighted in the NHS Long Term Plan that was launched yesterday. As evidenced in the plan, there is an explicit inclusion on earlier identification and personalised care and support planning for people approaching the end of their lives. References to palliative and End of Life Care can be found in paragraphs 1.41, 1.42 and 3.41. End of Life Care also gets a mention at the bottom of page 1 in the 2-page summary.

Before I conclude I wanted to note that this blog has been written on the eve of my father’s 10th anniversary.  As many of you know George had a difficult journey that involved all of the above topics and was ultimately why I became passionately involved in contributing to service change that would improve options for people in their last year of life.  Yes it’s fair to say that there has been significant progress made over this time but as we move into a new year my continued hope is that awareness continues to grow and services move towards a default position that means that people have choice, control and ultimately a good death as a result- read more in the following link.

Happy New Year to you and I hope you had a relaxing time over the festive period.

John Powell, MBE