Journal of Palliative Medicine

End of life services in UK

1
END OF LIFE: CURRENT PROFESSIONAL APPROACH
Introduction
End of the life is a very crucial stage for a person who is dealing with an incurable
disease. The severe consequences of the treatments of the life taking diseases
make the person emotionally weak and depressed. Moreover in most of the cases,
the person suffers from severe pain and depression. In these types of cases, the
happy ending of the life is ensured by the palliative services, by giving a lot of
emotional support and care to the patient. These services are very helpful in
improving the mental and physical position of a person and ensure about a dignified
and peaceful termination of his life.
In this essay an analysis will be done over the End of life cases treated by health
professionals. The focus will be given over the success or failure of the strategies of
the End of life services. A brief analysis will be done over the various regulatory
authorities of the country and trusts, which are offering palliative services. The
usefulness of the strategies of End of life will be scrutinised.
Analysis over End of life care:
End of life care, is a favourable support and facilities provided by doctors and
professionals of health to those people who are in the last year or last months of
their lives. However it is quite true that no one can predict the exact time of death. It
could be from few days to few months or it could be few years to long years. Almost
500,000 people die per year in the UK. Among these deaths 75% are not accidental
or sudden deaths. These deaths are expected (IPPR, 2018). The people who are at
the verge of end of their lives should receive proper care and support by
professionals not only because of humanity concern but also for better memories of
their near and dear ones (England, 2015).
Palliative Care
Palliative care is a support, care and treatment provided to the patients who are
suffering from life time illness. Support is also provided to the family members of the
patients. Sometimes the patients are suffering from incurable diseases like advanced
stages cancer, Neuron diseases, Dementia, Parkinson’s and Alzheimer, which

2
END OF LIFE: CURRENT PROFESSIONAL APPROACH
cannot be treated throughout the life and ultimately the person has to die (England,
2015).
The major objective of Palliative care is to provide a good quality of life to those
people who are at the verge of death because of incurable and severe diseases. No
matter how many days left in their death, the end of their death should not be painful.
Government of UK and other regulatory authorities are offering these services for the
well-being of the patient at the end of their lives (England, 2015).
The major services provided by the hospitals and care homes are:
Fulfilling their basic needs like eating, dressing and treatment related requirements.
Maintaining the basic hygiene of the person like washing, cleaning and clothing is
also provided by care homes. Health care professionals always try to minimize the
physical pain of the patient. Hospitals and care homes also focuses over
psychological and emotional support for the well-being of mental state of the patient
(England, 2014).
Only receiving the palliative care does not indicate that the person is about to die
within few days or few years. Sometimes the patients receive the palliative care for
many years. Persons can receive the palliative care at any stage of their age.
Professional Approach towards End of life care
This approach related to make the patient as comfortable and happy as possible with
in the time he left. The professionals try their best to fulfill the wishes and desires of
the person who is at the end of his life. Even this approach takes care about writing
the will, and settling the finance of the patient and funeral of the patient. This
approach also involved after death services like insurance cases. Totally the End of
life approach take care about all the aspects of the life of the patient who is about to
die because of life taking diseases (Curie, 2019).
Various stages of End of life strategies made by hospitals and care homes
Identifying the people approaching end of life:
First of all the staff members of hospitals and other authorities has to identify the
patients who are really in need to receive palliative care services. Necessary skills,

3
END OF LIFE: CURRENT PROFESSIONAL APPROACH
knowledge and attitude are required to identify the people who are at the verge of
death. The incurable disease is also need to be recognised to make the decision that
whether a person need palliative care or not (Marie Curie, 2019).
Care Planning:
Proper treatment facilities should be available for the patient. Care planning is not
only related to the medical facilities provided to the client but also it is related to
provide sufficient emotional support to the client at the end of his life by giving him
intensive care and immense support.
The care plan should be developed by the complete team with respect to provide
multiple services to the client in order to ensure about his well-being and happiness
(Morgan, 2008).
Co-ordination of care:
The co-ordinating authorities are responsible for proper co-ordination of care
services throughout the country by making the government ensure that each person
who is reaching at the end of his life receives palliative care services. Many PCT’s
(Primary Care Trusts) and LA’s (Local Authorities) are working to provide the intense
care to the clients at the end of their lives (Ira Byock, 2006).
Providing high quality of services:
This is the most crucial stage of the end of life services. A lot of continuous efforts
are needed by health care and mental care professionals and other staff members in
order to provide necessary services to the client. The patient and his family members
need to assure about proper care of the client in order to have a happy end of his
life. Dealing with the treatments of severe diseases is highly painful. Most of the
clients suffered from severe pain like the patients of Chemotherapy, radiotherapy
and other treatments. The mental state of the person is also not satisfactory because
of the improper and painful health conditions. Most of the patients have to suffer by
depression due to the treatments and symptoms of diseases (Ira Byock, 2006).
Because of the above stated critical factors, high quality services are required to
make the client happy and dignified at the end stage of his life.

4
END OF LIFE: CURRENT PROFESSIONAL APPROACH
Care at last day of his life and care after death: The professionals try their best to
provide finest services to the client at the last day of his life. They ensure about his
dignity and do necessary arrangements of his funeral with concern of his family
members and close ones. Professionals ensure about LCP (Liverpool Care Path
Way), which is a protocol with the main objective to ensure about receiving of proper
treatment and dignified death to the dying clients (Guardian, 2016).
Major government authorities and trusts offering palliative services:
NHS: National health services are offering palliative services with the help of Care
homes, hospices and hospitals with well-trained health care professionals who work
their best for the well-being of the patients (England, 2014).
NICE (National Institute for Clinical Excellence): It offers supportive palliative care
services of the clients who are struggling from various types of cancer and at the
verge of death (NHS, 2019).
BCCC (Bristol care co-ordinating centre): It co-ordinates the palliative services to
the clients in the last three months of their life. However the exact time of the death
cannot be predicted but this organisation try to deliver its services in the last few
months before the death of the patient (Trust, 2019).
Marie Curie: It is a charitable organisation in UK which is offering free of cost
nursing care services to the clients who are approaching towards the end of their
lives (Marie Curie, 2019).
St. Peter’s Hospice: It offers a wide range of palliative services to the clients
including 24 hours advisory services, nurses, doctors, counsellors and specialists,
patient’s unit care and hospice at homes. It ensures about the sufficient spiritual and
emotional support to the patient with complete medical care. It makes the patent and
his family member ensure about a comfortable ending of the patient’s life (UK, 2019).
Success of the End of life strategies
Palliative care services ensure about the emotional support provided to the client at
the end years of his life irrespective of hope of success of the treatment of the
incurable disease. Although most of the people like to die at their homes but in 2010,
only 39.3% of died people die at their homes whereas 53.3% of people died at

5
END OF LIFE: CURRENT PROFESSIONAL APPROACH
hospitals and only 5.3% people died at patient hospice bed. Palliative care funding
Review Commissioned research stated that in between around 92,000 and 142,500
people did not met the need of palliative care each year (IPPR, 2018).
This statistics shows that although a lot of people receiving palliative care services at
the end of their lives but still there is a need to identify people who are eligible in
receiving palliative care for a happy end of their lives.
According to NHS and PCT’s of UK, The estimated cost of per bed for palliative care
is around 425 pounds in 2009-2010. Whereas in 2017 by the research of Clinical
Commissioning group (CCG), the budget allocation for per client for palliative
services is varies in the range from pounds 51.83 to pounds 2329.19 (Vicki A.
Jackson, 2008).
Professional’s practices related to end of life services
All essential services provided by professionals in order to ensure about a dignified,
peaceful and comfortable end of the life of a person. The essential services are as
follows:
Hospice Care: Hospice care services offered free of cost service of nursing and
medical treatment in a comfortable and sound environment with proper emotional
support. Even some of the hospices provided its services at the home of the clients.
These services are completely funded by NHS and other charity sources like Marie
Curie (Curie, 2019).
Social Care: These services are related to non-medical services offered to the
clients who are approaching towards the end of their lives like helping them in
fulfilling their day to day tasks involving washing their body and clothes, giving them
meals and dressing them. These services ensured about the well-being of a client by
fulfilling his all day to day requirements (Practitioners, 2019).
Private care workers: The family members of the clients can direct hire a well-
trained paid care worker in order to ensure about the complete care of the client
(Marco Maltoni, 2012).
Helper services: This services is offered by some charitable trust in which a
volunteer helper provide a complete emotional support with necessary treatment to

6
END OF LIFE: CURRENT PROFESSIONAL APPROACH
the client by visiting the home of the patient and by contacting his family members in
a regular manner for ensuring the safety and requirements of the client (Health,
2008).
Other services: Apart of the above stated services, the government and local
authorities are offering free and paid services to the clients according to the need of
the client by consulting his family members. These palliative services are givrn to
ensure about a good mental state of a person during his last days of his life (Stuart J.
Farber, 2004).
Conclusion
The palliative services are proved successful in order to give the patients a
comfortable ending of their life. Despite of its significant cost, these services are
highly useful in maintain the dignity of a person during his last days of life. It also
helps the family members of the person by overcoming from depression and
reducing their pain. Although, a lot need to be done in order to recognise the patients
of palliative services because the data stated that many of the people are unmet
from the palliative services. In most of the cases, professional practices meet the
need of the client and made a happy ending of his life.

7
END OF LIFE: CURRENT PROFESSIONAL APPROACH
References
Curie, M., 2019. A guide to end of life services. [Online]
Available at: https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/
proving-good-quality-care/a-guide-to-end-of-life-services
[Accessed 30 December 2019].
England, N., 2015. Transforming end of life care in acute hospitals: The route to success
‘how to’ guide. [Online]
Available at: https://www.england.nhs.uk/wp-content/uploads/2016/01/transforming-end-of-
life-care-acute-hospitals.pdf
[Accessed 30 December 2019].
England, N. H. E., 2014. End of life care. [Online]
Available at: https://www.hee.nhs.uk/our-work/end-life-care
[Accessed 30 December 2019].
Guardian, T., 2016. Death and dying: End-of-life doulas: the professionals who guide the
dying. [Online]
Available at: https://www.theguardian.com/lifeandstyle/2019/nov/06/end-of-life-doulas-the-
professionals-who-help-you-die
[Accessed 30 December 2019].
Health, D. o., 2008. End of Life Care Strategy:Promoting high quality care for all adults at
the end of life. [Online]
Available at: http://www.cpa.org.uk/cpa/End_of_Life_Care_Strategy.pdf
[Accessed 30 December 2019].

8
END OF LIFE: CURRENT PROFESSIONAL APPROACH
IPPR, 2018. END OF LIFE CARE IN ENGLAND. [Online]
Available at: https://www.ippr.org/files/2018-05/end-of-life-care-in-england-may18.pdf
[Accessed 29 December 2019].
Ira Byock, J. S. T. M. M. a. K. C., 2006. Promoting Excellence in End-of-Life Care: A
Report on Innovative Models of Palliative Care. Journal of Palliative Medicine, 9(1), pp.
137-151.
Marco Maltoni, E. S. M. R. S. D. L. F. F. M., 2012. Palliative Sedation in End-of-Life Care
and Survival:. JOURNAL OF CLINICAL ONCOLOGY, 30(12), pp. 1378-83.
Marie Curie, G. D. A., 2019. What are palliative care and end of life care?. [Online]
Available at: https://www.mariecurie.org.uk/help/support/diagnosed/recent-diagnosis/
palliative-care-end-of-life-care
[Accessed 30 December 2019].
Morgan, J., 2008. End‐of‐life care in UK critical care units–a literature review. Nursing in
critical care, 13(3), pp. 152-161.
NHS, 2019. What end of life care involves:End of life care. [Online]
Available at: https://www.nhs.uk/conditions/end-of-life-care/what-it-involves-and-when-it-
starts/
[Accessed 30 December 2019].
Practitioners, R. C. o. G., 2019. Palliative and End of Life Care Toolkit. [Online]
Available at: https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/palliative-and-
end-of-life-care-toolkit.aspx
[Accessed 30 December 2019].

9
END OF LIFE: CURRENT PROFESSIONAL APPROACH
Stuart J. Farber, T. R. E. J. L. H.-B. T. R. T. a. G. E. G., 2004. Issues in End-of-Life Care:
Patient, Caregiver, and Clinician Perceptions. Journal of Palliative Medicine, 6(1), pp. 19-31.
Trust, N. B. N., 2019. Local Palliative & End of Life Care Services. [Online]
Available at: https://www.nbt.nhs.uk/our-services/a-z-services/palliative-end-life-care/local-
palliative-end-life-care-services
[Accessed 30 December 2019].
UK, H., 2019. About hospice care. [Online]
Available at: https://www.hospiceuk.org/about-hospice-care
[Accessed 30 December 2019].
Vicki A. Jackson, J. M. R. M. M. D. L. A. M. S. R. M. A. J. C. W. a. S. D. B., 2008. A
Qualitative Study of Oncologists' Approaches to End-of-Life Care. Journal of Palliative
Medicine, 11(6), pp. 893-906.