UK Hospital Palliative Care Policies
UK hospitals are required to have explicit palliative care policies within each cancer unit, though local arrangements for palliative care vary widely across the country. 1
Current State of Palliative Care Policies in UK Hospitals
- The British Thoracic Society (BTS) explicitly states that arrangements for palliative care should be clearly documented within each cancer unit 1
- Despite this requirement, implementation varies significantly between hospitals and healthcare settings across the UK 1, 2
- Transitions to palliative care approaches in acute hospital settings are often not structured or well-defined, despite policy guidance recommending this 2
Key Components of Hospital Palliative Care Policies
Organizational Structure
- Cancer units should identify a lead clinician responsible for coordinating palliative care services 1
- Hospitals should establish explicit follow-up policies for palliative patients that are appropriate to local needs and resources 1
- It is recommended that hospital cancer units hold regular sessions with palliative medicine physicians to ensure good liaison between hospital and community care 1
Care Coordination Requirements
- Detailed coordination between patients, general practitioners, and hospitals should be facilitated by a nominated specialist nurse (e.g., Macmillan nurse or community district nurse) 1
- All cancer units must have facilities to admit patients directly from general practice for symptom control 1
- All letters detailing care plans should be copied to community/Macmillan nurses as well as to general practitioners 1
Communication Standards
- Patients must be clearly informed about which doctor(s) are supervising their care and who their named nurse is 1
- Patients should be made aware of who to contact and how to call for urgent problems 1
- Patients' wishes should be explicitly sought when major decisions about changes in care patterns are being made 1
Implementation Challenges
- Research shows significant barriers to implementing structured transitions to palliative care in acute hospitals, including professional hierarchies and poor communication 2
- Hospital staff often report difficulty "standing back" in acute situations to consider palliative approaches 2
- Primary care professionals report that patients are frequently discharged from hospitals with "false hope" of cure because palliative care discussions have not occurred 2
Recent Developments and Future Directions
- The National Institute for Health and Clinical Excellence (NICE) has issued guidance on how supportive and palliative care services should be provided for adults with cancer 1
- Recent research indicates that relationship-centered care is crucial to high-quality palliative care within UK healthcare settings, but this was disrupted during the COVID-19 pandemic 3
- Current UK health policies present opportunities to widen palliative care access through three inter-related priorities: integrated care, personalised care, and support for unpaid carers 4
Common Pitfalls in Hospital Palliative Care Policies
- Failure to achieve consensus among clinical teams about transition to palliative care, which is fundamental to effective implementation 2
- Inadequate communication between secondary and primary care settings regarding palliative care plans 2
- Insufficient training for healthcare professionals in palliative care approaches 1
- Lack of explicit documentation about who is responsible for coordinating palliative care 1
Despite policy requirements, the actual implementation of palliative care approaches in UK hospitals remains inconsistent and often falls short of recommended standards. Improving alignment between existing evidence on palliative care benefits and policy priorities could strengthen both policy and care delivery for people who are dying 4.