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End of life care

What do we mean by end-of-life care?

End-of-life care is support for people who are approaching death. It helps them to live as well as possible until they die, and to die with dignity. It also includes support for their family and carers. The aim is to make the patient as comfortable as possible by relieving pain and other distressing symptoms while providing psychological, social and spiritual support for patients and carers.

There are a number of national drivers to improve the quality of end-of-life care, following on from the 2008 Department of Health End of Life Care Strategy. This presented a high-level pathway, and described the building blocks for each of these, including the GSF (Gold Standards Framework). The main recognised target for end of life care is measuring the proportion of people who die in hospital, with the supposition that it is usually desirable to die elsewhere. The reduction of numbers dying in hospital is used as a proxy measure for quality services to support people at the end of life.

What do we know?

The National Audit Office highlights the fact that between 56% and 74% of people request to die at home. However, only around 35% of people actually die at home or in a nursing home. In Shropshire in 2010 just under 20% of people died at home, 11.5% in a nursing home and a further 10.6% in a residential home. Locally around 45% of people died in an acute hospital. In Shropshire people who died from cancer were more likely to die at home or in the hospice compared to all other causes of death. This is in part because the pattern of cancer progression is easier to predict. Previous work undertaken locally has highlighted that significantly more people in the least deprived fifth of Shropshire die at home compared to those in the most deprived fifth.

What are we doing?

The health economy-wide Unscheduled Care Strategy led to the formation of a high level End of Life Care group. This is chaired by the medical director from the Severn Hospice, and has membership from the Clinical Commissioning Group (CCG), Shropshire Council, acute trust, community health trust and the independent sector. The strategic objectives are:

  • Services across the health economy are coordinated and configured to give patients the best possible care at the end of life, including to die wherever possible in the place of their choosing
  • All ‘hands-on’ health and social care staff to have the skills to give the best possible care to patients (and support for their relatives) at the end of life.

This group is taking forward work in the following areas:

  • Out-of-hours care
  • Last six weeks of life – separate key worker role, pathways and communications workstreams
  • Education and training

This builds on work currently taking place, such as ongoing training delivered across the health economy for PPC (Preferred Priorities for Care) which will help people to make their preferred place of death known, and the roll out of the local iteration of the Liverpool Care Pathway, version 12, which is to support people identified as being in their last days or week of life.

Currently in Shropshire there are a number of services operating that provide end-of-life care. These include hospice day services and in-patient care, the Hospice at Home service, specialist palliative care nurses both in the community and in hospital, and district nursing services.

NICE has published quality standards for end-of-life care. The NICE quality standards define clinical best practice within this topic area. They provide specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.

Last updated: 28 October 2013 Print this page

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