Adopting a 'community of practice' between palliative and dementia care nurses.

Dementia usually occurs as a result of brain disease and, while it is usually chronic or progressive in nature, it has not traditionally been conceptualised as a terminal or life-limiting syndrome. However, the median survival time for people with dementia is between 3.5 years and 4.5 years from symptom onset to death, although this varies depending at which stage the dementia is diagnosed and its cause. As such, it has long been recognised that people with dementia and their family carers have palliative care needs equal to those of patients with cancer. However, a palliative approach to dementia care requires both the dementia and palliative care workforces to fully understand the needs of people with dementia and their families towards the end of life. This article describes the development of a 'community of practice' where healthcare professionals from dementia and palliative care services shared their practice and learned from each other in a safe and supportive environment.

Providing high-quality end-of-life care universally.

The National End of Life Care Programme was launched in November 2004, and has been instrumental in delivering the Department of Health's (2008) End-of-Life Care Strategy and the National Institute of Health and Clinical Excellence's (2011) Quality Standard for End of Life Care for Adults. End-of-life care now sits within NHS Improving Quality. In this article we discuss an overview of the programme's successes, challenges and priorities for the future.

Improving end of life care in the community: national strategy.

The National End of Life Care Strategy published last year by the Department of Health called for a 'cultural shift' among the 2.5m strong health and social care workforce. This article explores the competence and principles which those staff should have to provide improved care for those at the end of their lives. It links these to Transforming End of Life Care, one of six guides in the 'Transforming Community Services' series which emerged from the 'NHS Next Stage Review' led by Lord Darzi. Together the three documents explored in this article call for a new emphasis on partnership working and teamwork to provide care that is responsive to the wishes of the person nearing the end of his or her life and their loved ones.

Promoting high quality care for all at the end of life: review of NHS National End of Life Care Programme 2004-2007 and implications for primary care.

Background Research shows most people want to die at home yet most in fact die in hospital. The underlying reason for this mismatch is that health and social care services struggle to respond satisfactorily to people's varying end of life care needs. The creation of the National End of Life Care Programme in 2004(1) and the launch of the End of Life Care Strategy in 2008(2) were designed to improve this situation. Setting The National End of Life Care Programme was set up to offer patients nearing the end of their life high quality care and choices about where to die. Particular objectives were reducing the number of unnecessary emergency admissions and improving the skills of the workforce. Question How effective has the National End of Life Care Programme been in its first three years? And given that an increasing proportion of end of life care services will take place in the community, what are the implications for primary care staff? Methods The authors discuss an in-depth evaluation of the National End of Life Care Programme by Nottingham University.(3) They also describe two Department of Health reports indicating how primary care services can improve the quality of end of life care services.(4,5) Results The Nottingham University evaluation shows that the National End of Life Care Programme is having an impact. SHAs with high uptake of end of life care tools tend to have higher rates of home deaths. In addition staff who use the tools are more confident in broaching sensitive issues around dying. Meanwhile the DH reports provide a template for coordination of services and training of staff in the community. Conclusion There are examples around the country of excellent end of life care. But it is essential that the best is spread to the rest. That success depends on better organisation and collaboration, effective use of resources and good communication between commissioners and providers. Above all, care has to be focused on the individuals and their carers.