Dying well at home: the case for integrated working


Systemic and organisational issues

The local picture of services is very varied: they should be democratically controlled. GPs should be accountable for [end of life care] services. Patient participation is very important.

Carer [16]


Commissioners should:

  • Review palliative and end of life care services available in the locality to confirm that they are able to support people of different ages, ethnicity and social background to die well at home.
  • Ensure that training is available for ‘generalist’ carers in the community who provide most end of life care for those who die at home. Training needs to include communication and care planning with patients and carers, and improving their own understanding of good-quality palliative care (including the use of analgesia). Less well-qualified staff can provide good responsive care if they are trained and well supervised.
  • Commission specialist palliative rapid response teams and rapid discharge facilitation teams and model possible cost savings.
  • Encourage general practice surgeries to use the electronic palliative care coordination systems (EPaCCS) register to promote patient choice, to improve coordination and to monitor outcomes of improved services.
  • Consider how expertise on specific disease pathways can be made available to community health workers.
  • Ensure that commissioned service practitioners are trained in, and compliant with, the provisions of the Mental Capacity Act 2005.
  • Ensure that commissioned service practitioners are trained in the core competencies developed by the National End of Life Care Programme, Skills for Health, Skills for Care and Department of Health.

Professionals and providers should:

  • Develop local protocols and processes of communication and coordination as these can improve patient and carer experience.
  • Ensure that contracts provide 24-hour access to advice and support, for example a telephone helpline staffed by a palliative specialist to improve patient care and reduce expensive and unnecessary out-of-hours emergency admissions.
  • Ensure that patients, families and the public have access to information about what dying at home may involve and that there are local services that can meet their needs.

Key points from research and policy

Deficiencies in generalist care

Integrated commissioning

The future


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Available downloads:

  • Dying well at home: the case for integrated working
  • Dying well at home: research evidence