SPPC Blog

In both polar exploring and public policy it is periodically a good thing to stop, take stock and consider carefully the direction of travel.

It is eight years since SPPC published its last sector-wide analysis of how to improve palliative and end of life care in Scotland [1].

Since then we've seen the first Scottish government action plan on palliative and end of life care, Living and Dying Well, the crisis in public finances as a result of an under-regulated banking sector, the demise of the Liverpool Care Pathway, the Francis Inquiry, and many very positive practical improvements in palliative and end of life care at the local level.

When the Scottish government made its welcome announcement in 2014 that it would produce a new strategic framework for action for palliative and end of life care, SPPC committed to supporting and informing the development of that strategy.

As the representative body for palliative care – with over 50 member organisations – we wanted to ensure that the experience and expertise of the people and organisations in our networks were brought to bear on the complex and large challenges needing to be thought through.

Policy and strategy are never sufficient on their own to achieve change, but they can be helpful. Conversely, a recent survey identified 'confusing strategies' as the number one barrier to change [2].

Grasping the nettle aims to provide a clear consensus view on the way ahead for palliative and end of life care in Scotland. Its purpose was to support inform and enrich development of the Scottish government’s strategic framework.

To that end, the structure of Grasping the nettle is based on the 3-step improvement framework for Scotland’s public services [3], so that palliative and end of life care issues are framed in terms which resonate with the Scottish government's wider public service reform agenda.

The vision articulated in Grasping the nettle is that Scotland will be a place where:

• people’s wellbeing is supported even as their health declines
• people die well
• people are supported throughout bereavement.

In this vision – and throughout the report – we have tried very hard to achieve clarity of terminology and to shine a light on important differences of meaning which sometimes lurk behind stock phrases, creating a false impression of mutual understanding.

In producing the report, SPPC undertook many of the usual tasks of strategic thinking – an analysis of the world in which we are working, an assessment of where palliative and end of life care is at, an assessment of the main challenges and the things which need to change.

Engagement from our 50+ member organisations and other stakeholders has been excellent during a three-stage iterative process from May to November, which was overseen by a multi-disciplinary sub-group of SPPC’s council. Drafts were shared with the Scottish government at each stage, who welcomed the report as a very helpful input to their process of developing the strategic framework for action.

Perhaps the most difficult stage of thinking was to move beyond broad outcomes and to propose a set of specific actions which would achieve significant positive change.

The report identifies 38 actions – a busy agenda, but then this is a big issue and the scale of change required is huge.

The report’s proposals include – but also go beyond – specific issues such as education and advance care planning. In addition, we address leadership and the role of government and others in creating the conditions which support and enable change.

Taken together we believe the proposed actions create the necessary conditions for change, describe specific changes required and specify a broad framework of accountability.

This blog is by Mark Hazelwood, Chief Executive of the Scottish Partnership for Palliative Care.

References

1. Scottish Partnership for Palliative Care. Palliative and end of life care in Scotland: the case for a cohesive approach. Scottish Partnership for Palliative Care; May 2007. Available from:http://www.palliativecarescotland.org.uk/content/publications/?cat=14
2. Health Services Journal. The crowd speaks: Top 10 barriers to change. HSJ; 10 February 2015. Available at: http://www.hsj.co.uk/topics/technology-and-innovation/change-challenge/the-crowd-speaks-top-10-barriers-to-change/5081962.fullarticle
3. The Scottish Government. The 3-step improvement framework for Scotland’s public services. The Scottish Government; 2013. Available at http://www.gov.scot/Resource/0042/00426552.pdf