Let’s Talk About Palliative Care

Guest Blog by Professor Craig White – Divisional Clinical Lead of the Quality and Planning Division of the Healthcare Quality and Strategy Directorate at the Scottish Government and Honorary Professor in the College of Medicine, Veterinary and Life Sciences at the University of Glasgow

Assets and Expertise

As a society we are facing a growing need for appropriate care in the face of ageing, life limiting illness and death. Although the scale and complexity of this makes this challenging – we have substantial assets and expertise within Scotland with which to respond to this need.cw1

In 2014 the World Health Assembly – the governing body of the World Health Organisation – passed a resolution requiring all governments to recognise palliative care and to make provision for it in their national health policies.

The Strategic Framework for Action on Palliative and End of Life Care is the Scottish Government’s response to that call (http://www.gov.scot/Publications/2015/12/4053/downloads).

Health and Sports Committee

The Health and Sport Committee of the Scottish Parliament has published its report entitled:

‘We Need to Talk About Palliative Care”

(http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Reports/HSS042015R15.pdf ). The Scottish Government have responded to this

(http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Inquiries/20160121-SG_Response.pdf )

and recently welcomed the opportunity to provide evidence to MSPs on progress and future plans


cw2The Framework outlines the vision that by 2021 everyone who needs access to palliative care will have access to it.

Surely everyone in Scotland currently has access to palliative care – after all most people have a GP and everyone who has been diagnosed with a progressive, incurable and/or life-limiting illness has been in touch with a Consultant ?

Theoretically yes, but the vision is for access to the sort of palliative care that the World Health Assembly refers to, where there is “:…palliation across the continuum of care, especially at the primary care level, recognizing that inadequate integration of palliative care into health and social care systems is a major contributing factor to the lack of equitable access to such care.”

This is the vision for what this means for Scotland.

We were fortunate to be able to appoint Professor David Clark as the Consulting Editor for the Framework, ensuring that all of the views received throughout the engagement process were considered objectively against the best available international evidence and expert opinion.

The publication of the Framework and supporting evidence has been welcomed internationally (http://endoflifestudies.academicblogs.co.uk/scottish-government-launches-its-strategic-framework-for-action-on-palliative-and-end-of-life-care/).  As with any change on the scale of that envisaged in a national strategic framework, there are a wide range of ideas and views on how this might be achieved.


The Scottish Government has outlined it’s commitment to supporting changes required to support access to palliative and end of life care being available to all who can benefit from it, regardless of age, gender, diagnosis, social group or location.cw3.png

It has been recognized that people, their families and carers will need to have timely and focused conversations with appropriately skilled professionals to plan their care and support towards the end of life, and to ensure this accords with their needs and preferences.

This will in turn require that a wider range of communities, groups and organisations understand the importance of good palliative and end of life care to the well-being of society.

The health and social care system will be increasingly configured to maximize the changes that people receive health and social care that supports their wellbeing, irrespective of their diagnosis, age, socio-economic background, care setting or proximity to death.  Many more people will have more opportunities to discuss and plan for future possible decline in health, preferably before a crisis occurs, and will be supported to retain independence for as long as possible.   People will need to know how to help and support each other at times of increased health need and in bereavement, recognising the importance of families and communities working alongside formal services.

All of this will be supported by a culture, through resources, systems and processes within health and social care services that empower staff to exercise their skills and provide high quality person-centred care.

Enhanced contribution

All of this can be achieved through improved identification of people who may benefit from palliative and end of life care, supported by an enhanced contribution of  a  wider  range  of  health  and  care  staff.

cw4There must be a stronger sense among staff of feeling adequately trained and supported to provide the palliative and end of life care that is needed, including a better understanding of how people’s health literacy needs can be addressed.

This is likely to be helped through a greater openness about death, dying and bereavement in Scotland – which will in turn be enabled through the recognition of wider sources of support within communities that enable people to live and die well.

I recently had the privilege of working with the Chief Medical Officer and some colleagues on her Annual Report for 2014/15 (http://www.gov.scot/Resource/0049/00492520.pdf).  This report included the suggestion that “Clinical leaders need to challenge their own thinking and ask themselves whether they have a growth mindset.

cw5.pngThis will mean an enhanced awareness of opportunity for self improvement, more engagement with challenge and a greater persistence in the face of obstacles.”  This is pertinent to all of the commitments outlined in the new Framework.

To achieve our vision many people, organisations and agencies will have to work together in a culture of collaboration – ensuring that there is a balance of constructive challenge and a recognition of the benefits of aligning support, engagement and delivery mechanisms for maximum benefit.

Much of the co-ordination, leadership and support for this work will come through the Health and Social Care Partnerships across Scotland.   The way in which these changes will be delivered may require significant changes in the way in which organisations approach the delivery of palliative care provision.

I would be delighted to hear from you, through this blog, email (craig.white@gov.scot) or on twitter  (@craigwhitephd) if you have an interest in this work.

The Strategic Framework for Action on Palliative Care and Supporting Evidence Summary are available at: http://www.gov.scot/Publications/2015/12/4053/downloads

Craig’s blog was originally previously featured on the Ayrshire Health website.


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