Commissioning guides
Published 01 December 2011

Guide for commissioners on end of life care for adults

This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg42

2 A pathways approach to commissioning high-quality integrated end of life care for adults

The Department of Health's 'End of life care strategy' (2008) promotes a whole system approach to commissioning end of life services and highlights the importance of integrated and coordinated services. Commissioners should consider using a care pathway approach to commissioning. This is particularly important in end of life care where services are interconnected and span different sectors and settings. Care pathway commissioning supports commissioning for outcomes and can lead to streamlining of services.

This guide is structured to reflect the areas of care map for the NICE quality standard 'End of life care for adults'.

Figure 3 Areas of care for the NICE quality standard 'End of life care for adults'
QS = quality statement.

Table 1 Quality statements for end of life care for adults

No.

Quality statements

1

People approaching the end of life are identified in a timely way.

2

People approaching the end of life and their families and carers are communicated with, and offered information, in an accessible and sensitive way in response to their needs and preferences.

3

People approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, with the opportunity to discuss, develop and review a personalised care plan for current and future support and treatment.

4

People approaching the end of life have their physical and specific psychological needs safely, effectively and appropriately met at any time of day or night, including access to medicines and equipment.

5

People approaching the end of life are offered timely personalised support for their social, practical and emotional needs, which is appropriate to their preferences, and maximises independence and social participation for as long as possible.

6

People approaching the end of life are offered spiritual and religious support appropriate to their needs and preferences.

7

Families and carers of people approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, and holistic support appropriate to their current needs and preferences.

8

People approaching the end of life receive consistent care that is coordinated effectively across all relevant settings and services at any time of day or night, and delivered by practitioners who are aware of the person's current medical condition, care plan and preferences.

9

People approaching the end of life who experience a crisis at any time of day or night receive prompt, safe and effective urgent care appropriate to their needs and preferences.

10

People approaching the end of life who may benefit from specialist palliative care, are offered this care in a timely way appropriate to their needs and preferences, at any time of day or night.

11

People in the last days of life are identified in a timely way and have their care coordinated and delivered in accordance with their personalised care plan, including rapid access to holistic support, equipment and administration of medication.

12

The body of a person who has died is cared for in a culturally sensitive and dignified manner.

13

Families and carers of people who have died receive timely verification and certification of the death.

14

People closely affected by a death are communicated with in a sensitive way and are offered immediate and ongoing bereavement, emotional and spiritual support appropriate to their needs and preferences.

15

Health and social care workers have the knowledge, skills and attitudes necessary to be competent to provide high-quality care and support for people approaching the end of life and their families and carers.

16

Generalist and specialist services providing care for people approaching the end of life and their families and carers have a multidisciplinary workforce sufficient in number and skill mix to provide high-quality care and support.