The NHS Long Term Plan (2019) offers potential for improved care both in general and specifically leading to dignified death and dying for those at the end of their life. This plan heralds a promising era for patients at the end of life, as well as their friends and families, in addition to providing an opportunity for health professionals charged with supporting and caring for these patients to maximise the quality of care at the end of life. For the latter, there is a real opportunity to grasp this LTP and its promised funding and implement the best possible and available care that ‘our’ patients can benefit from sooner rather than later.
It is important for all palliative care practitioners including district nurses to realise that, although the Government has labelled this a long-term plan, most of the patients they care for might not have the same length of time left to benefit from the funding and improved care. It is therefore critical that local and national strategies are quickly formulated to implement the particular aspects of the Plan relevant to palliative and end-of-life care in order to enhance dignity in death and dying for all patients, including those who are homeless.
Section 1.42 of the plan clearly states: ‘with patients, families, local authorities and our voluntary sector partners at both a national and local level, including specialist hospices, the NHS will personalise care, to improve end of life care’. It is up to practitioners, managers and educators to devise ways in which to fulfill this promise. The central and encouraging message here is that the Government accepts the need for personalised care, which subscribes to person-centred care, a concept popularised by the National Voices campaign, which recognises that what matters to someone is not just what is the matter with them. Person-centred care accepts that people's values and preferences are different, and therefore giving people choices indirectly gives them control of their life and, with that, the care outcomes. Nonetheless, exceptions within this concept must also be recognised: the vulnerable, marginalised and homeless may not always have the same choices.
Although the NHS Long Term Plan dedicates just one paragraph to end-of-life care, its meaning goes much deeper than just what the words convey. The emphasis seems to be on partnership working starting with the patient, families and specialist hospices, together with institutions of higher education like universities agreeing on the best balance between theoretical and practical education or training for different staff caring for these patients. The plan rightly aspires to reduce avoidable emergency admissions to hospital and to ensure that more people remain and die in the place of their choosing. If these goals are to be achieved, it must be ensured that all individuals involved, such as paramedics, district nurses, community doctors and nurses, are equipped with the knowledge and skills required to support patients while they remain in a place of their choosing. While devising degrees for online nursing education (see section 4.16 of the plan) can be a quicker and cheaper way of reaching more people, caution is needed when contemplating palliative care education, with specific focus on developing communication skills, empathy and effective rapport with patients and their families. Teaching these skills effectively will require face-to-face modelling, practice and rehearsal, and therefore a blended approach to this would be preferable.
The other point to consider is how to ensure there is continued joined-up thinking and practice between local and national authorities. The message and direction from national authorities should be embedded in local aspirations and take account of local and regional differences. However, what would be a real legacy for most patients is if despite the differences, they can still achieve dignity in death that is unique to them and their family and friends. Dying cannot be stopped and therefore any efforts, with the support of the NHS Long Term Plan, should focus on making the process of dying more bearable with minimal distress and suffering, with the aim of ensuring dignity in death for all.