A different ending: Addressing inequalities in end of life care
Following the recommendation of More care, less pathway, the independent review of the Liverpool Care Pathway, we carried out this review to look more closely at ‘how dying patients are treated across various settings’. As people’s care in the preceding months has a significant impact on care in the last days, we looked at end of life care from identification through to death and bereavement. In particular, we focused on end of life care for people who may be less likely to receive good care, whether because of diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances.
We asked people from the following groups to tell us about their experience of end of life care, and the barriers that may prevent them from experiencing good, personalised care at the end of life:
- people with conditions other than cancer
- older people
- people with dementia
- people from Black and minority ethnic (BME) groups
- lesbian, gay, bisexual and transgender people
- people with a learning disability
- people with a mental health condition
- people who are homeless
- people who are in secure or detained setting
- Gypsies and Travellers.
We visited local areas to talk to commissioners, providers and staff about how they address the needs of different groups. From these visits, we have identified examples of good practice that we encourage others to learn from. We also asked a sample of clinical commissioning groups to complete a survey about their commissioning of end of life care. Full details of how we carried out our review are available in appendix A.
What we found
The report shows that where commissioners and services are taking an equality-led approach that responds to people’s individual needs, people receive better care. Although some commissioners and providers of end of life care are doing this well, many are not. People from the groups included in the review told us about mixed experiences of end of life care, and highlighted barriers that sometimes prevented them from experiencing good, personalised end of life care.