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Registration Number: {{org_field_registration_no}}

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End-of-Life Care and Palliative Care Policy

1. Purpose

The purpose of this policy is to provide a clear and compassionate framework for delivering high-quality, person-centred palliative and end-of-life care to individuals supported by {{org_field_name}}. This policy ensures that care is delivered with dignity, respect, and in a way that meets each person’s physical, emotional, spiritual, and psychological needs as they approach the end of their life.

The policy outlines our responsibilities and procedures to ensure that individuals receiving care, as well as their families, feel supported, empowered, and reassured. It also sets out our multi-disciplinary approach to ensure coordination with healthcare professionals, hospice services, spiritual leaders, and bereavement support organisations.

This document reflects the requirements of:

• Health and Social Care Standards, particularly:
  • 1.7: “My human rights are protected and promoted, and I experience care that is dignified and respectful.”
  • 1.45: “If I am dying, I am supported to live in a dignified way and die well.”
  • 2.3: “I am supported to understand and uphold my rights.”
• Scottish Government Palliative Care Matters for All: Palliative Care Strategy 2025–2030 (and related NHS Scotland guidance).
• Care Inspectorate A quality framework for support services (care at home…) (effective from 1 June 2022).
• SSSC Codes of Practice for Social Service Workers and Employers (effective from 1 May 2024).

2. Scope

This policy applies to:

• All individuals who receive palliative or end-of-life care from {{org_field_name}}, regardless of diagnosis or background.
• All staff members involved in direct or indirect care provision.
• Managers, senior carers, care coordinators, and administrative support involved in planning or delivering care.
• Healthcare professionals working with us, including GPs, community nurses, and palliative care teams.
• Families, carers, advocates, and spiritual representatives engaged in end-of-life planning.

3. Related Policies

This policy should be read in conjunction with:

• Personal Planning and Outcomes Policy
• Medication Management Policy
• Safeguarding and Protection from Abuse Policy
• Confidentiality and Information Sharing Policy
• Staff Training and Development Policy
• Equality, Diversity and Inclusion Policy
• Incident Reporting and Notifications Policy

4. Policy Statement

At {{org_field_name}}, we are committed to delivering sensitive, compassionate, and well-coordinated care to individuals at the end of their lives. Our approach supports individuals to die with dignity, comfort, and in a setting of their choice, usually their own home, surrounded by those they love and trust.

We view end-of-life care as a continuation of person-centred care. Our role is not only to meet physical needs but also to provide emotional and psychological support, uphold human rights, and ensure the person’s wishes and cultural values are respected.

We recognise that palliative care is not limited to the final days of life. It may be provided alongside active treatment and should begin when a life-limiting condition is diagnosed or anticipated.

5. Definitions

• Palliative care: Holistic support for people with life-limiting conditions, aiming to improve quality of life and provide symptom control and emotional support.
• End-of-life care: The care provided in the last months, weeks, or days of life, when death is imminent.
• Advance care planning (ACP): A process where individuals express their preferences for care and support in the event they can no longer communicate their decisions.
• Anticipatory care plans (ACPs): Documents used in Scotland to record preferences for future care.
• Do Not Attempt Cardiopulmonary Resuscitation (DNACPR): A clearly recorded clinical decision about whether CPR should be attempted if a person’s heart and breathing stop. The DNACPR form is not a legal document; it is an immediately recognisable record of a clinical decision to guide healthcare professionals in an emergency. A DNACPR decision applies only to CPR and does not mean other treatment or an emergency response should be withheld.

6. Our Approach to Palliative and End-of-Life Care

6.1 Person-Centred Planning and Anticipatory Care

We ensure that end-of-life preferences are discussed early and sensitively with the person and, where appropriate, with their families or advocates. These preferences are clearly recorded in their personal plan and Anticipatory Care Plan (ACP), which may include:

• Preferred place of care and death
• Cultural, spiritual, or religious considerations
• Pain and symptom management preferences
• Wishes around resuscitation (DNACPR, where applicable)
• Who they want present in their final days
• Funeral or legacy wishes, if expressed

The care plan is reviewed regularly, particularly as health needs change.

6.2 Compassionate Communication

All staff are trained to communicate with sensitivity, empathy, and active listening. Difficult conversations are approached with honesty and kindness. We support individuals and their families to:

• Understand the prognosis and care plan
• Make informed decisions
• Feel listened to and emotionally supported

Where language or capacity is a barrier, communication aids or advocacy services are used to ensure understanding.

6.3 Holistic Support

Our team supports all aspects of a person’s wellbeing:

• Physical: Managing pain, fatigue, breathlessness, nausea, and other symptoms using prescribed medication and comfort techniques.
• Emotional/Psychological: Providing a listening ear, respecting grief and fear, and signposting to counselling services when needed.
• Spiritual/Cultural: Enabling access to religious or cultural leaders. We respect personal rituals, customs, and final wishes.
• Practical: Supporting with paperwork, coordination with the GP, district nurses, hospices, and ensuring equipment is in place (e.g. hospital bed, hoist, syringe driver).

6.4 Multi-Agency Coordination

We work closely with local healthcare teams and palliative care specialists, such as:

• NHS community nurses
• Palliative Care Consultants
• GPs
• Marie Curie and Macmillan services
• Hospice teams and chaplains

We contribute to and act on shared care plans and participate in multidisciplinary reviews as appropriate.

6.5 Supporting Families and Carers

Families often carry a heavy emotional and practical load. Our staff are trained to offer support and reassurance, including:

• Involving families in care (with consent)
• Providing information and updates
• Offering respite care where possible
• Guiding them through bereavement pathways and available local support

We recognise families may experience anticipatory grief and strive to make space for their needs.

6.6 Death at Home

If a person dies at home, staff follow our Death and Dying Procedure, which includes:

• Ensuring the person is treated with dignity and respect
• Contact the appropriate healthcare professional to verify an expected death in line with local NHS arrangements, and support the family to ensure medical certification is arranged
• Informing the Registered Manager and family
• Preserving privacy and dignity
• Supporting family members and helping with immediate practical needs
• Recording the death accurately in care notes
• Notify the Care Inspectorate of the death within 24 hours using the required notification process, in line with Care Inspectorate guidance

6.7 Staff Support and Supervision

Providing end-of-life care can be emotionally demanding. {{org_field_name}} offers:

• Regular clinical and reflective supervision
• Access to emotional support and external counselling, if needed
• Debriefing sessions after a death
• Ongoing training in bereavement, grief response, and compassionate communication

6.8 Duty of Candour and notifiable events

Where an unintended or unexpected incident connected to the care we provide appears to have resulted in death or serious harm, {{org_field_name}} will follow the organisation’s Duty of Candour procedure, including timely notification to the relevant person, an apology, appropriate review, learning and record keeping. We will also ensure all required Care Inspectorate notifications are submitted within the required timescales.

7. Staff Training and Competency

All staff involved in palliative care will receive appropriate training, including:

• Recognising signs of deterioration
• Pain management and medication protocols
• End-of-life personal care (e.g., mouth care, continence, pressure relief)
• Cultural awareness and equality in end-of-life scenarios
• Basic bereavement support
• Handling death with sensitivity and professionalism

Training will be part of induction, with annual refreshers and updates following changes in guidance or best practice.

8. Medication and Pain Management

Pain relief and comfort measures are central to quality end-of-life care. We work under NHS and prescriber instructions to ensure safe, timely administration of:

• Oral or liquid analgesics
• Transdermal patches
• Syringe driver medication (under nursing supervision)

All medication administration and storage comply with our Medication Management Policy, and staff are trained to monitor for and report side effects, deterioration, or unrelieved pain.

9. Documentation and Record Keeping

All end-of-life preferences, communications, changes in condition, and relevant care activities are thoroughly documented in:

• Personal care plans
• Daily care logs
• Risk assessments
• MAR (Medication Administration Records)
• Incident reports (if applicable)

Documentation is accurate, timely, and managed in line with the UK GDPR and the Data Protection Act 2018. Staff maintain confidentiality and share information appropriately in line with our Confidentiality and Information Sharing Policy.

10. Equality, Diversity and Dignity in Dying

We understand that experiences of death and dying are deeply personal and shaped by culture, identity, faith, and life history. All individuals supported by {{org_field_name}} are treated equally, and their rights and choices upheld, regardless of:

• Ethnicity or nationality
• Religion or belief
• Sexual orientation or gender identity
• Communication ability or capacity
• Socioeconomic background

We also support the use of interpreters or advocates where required, and seek to challenge discrimination or bias.

11. Policy Review

This policy will be reviewed annually, or sooner if there is a change in legal or regulatory requirements, or best practice guidance. The Registered Manager and the Provider (or, where the Provider is an organisation, the organisation’s Relevant Individual(s) as recorded with the Care Inspectorate) are responsible for ensuring updates are implemented, communicated to all staff, and embedded in practice.

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Responsible Person: {{org_field_registered_manager_first_name}}{{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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