{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

End of Life Care and Advance Care Planning Policy

1. Purpose

The purpose of this policy is to provide a clear and comprehensive framework for staff employed by {{org_field_name}} to deliver compassionate, safe, person-centred end of life care and to contribute to effective advance care planning (ACP) for individuals receiving care. As a temporary staffing agency / employment business supplying registered nurses, healthcare assistants and other temporary workers to client health and social care settings, {{org_field_name}} is committed to ensuring that workers supplied by the agency understand their professional, legal and contractual responsibilities when supporting end of life care under the direction, supervision and policies of the client placement.

The policy aims to ensure that staff understand their role and responsibilities in supporting service users who are approaching the end of their lives and are involved in advance care planning processes where appropriate. This policy is aligned, where applicable to the role of a temporary staffing agency and its workers, with the Mental Capacity Act 2005 and Code of Practice, the Equality Act 2010, the Human Rights Act 1998, the Care Act 2014 safeguarding framework, NICE Guideline NG31 on care of dying adults in the last days of life, NHS England’s Universal Principles for Advance Care Planning, relevant professional standards including the Nursing and Midwifery Council Code, and client placement policies. Where a client is a CQC-registered provider, agency workers must work in accordance with the client’s regulated care arrangements and local procedures.

2. Scope

This policy applies to:

• all registered nurses, healthcare assistants and temporary workers supplied by {{org_field_name}} to client placements;
• directors, managers, consultants and office staff involved in recruitment, booking, compliance, training, supervision, incident management or client liaison;
• assignments in care homes, nursing homes, hospices, hospitals, supported living settings and other health or social care environments where end of life care may be provided by the client;
• situations where agency workers support, observe, document or escalate matters relating to end of life care, advance care planning, DNACPR decisions, advance decisions to refuse treatment, mental capacity or best-interests decision-making.

This policy does not authorise agency workers to independently create, amend, approve or cancel advance care plans, DNACPR decisions, advance decisions to refuse treatment, medicines plans, best-interests decisions or clinical treatment plans. These matters must be managed by the client’s responsible clinician, registered manager, multidisciplinary team or other authorised professional in line with the client’s procedures.

3. Related Policies

This policy should be read alongside the following {{org_field_name}} policies and procedures:

• Safeguarding Adults Policy;
• Consent, Mental Capacity and Best Interests Policy;
• Record Keeping and Documentation Policy;
• Incident Reporting Policy;
• Medicines Management Policy, where applicable to the worker’s role;
• Equality, Diversity and Inclusion Policy;
• Complaints and Whistleblowing Policy;
• Staff Training and Development Policy;
• Recruitment, Vetting and Compliance Policy;
• DBS and Barring Referral Policy;
• Data Protection and Confidentiality Policy;
• Health and Safety Policy;
• Agency Worker and Client Assignment Procedure.

Agency workers must also follow all relevant client placement policies, including local end of life care, palliative care, DNACPR, ReSPECT, medicines, escalation, safeguarding, infection prevention and after-death care procedures.

4. Policy Statement

{{org_field_name}} is committed to supplying suitably recruited, vetted, trained and competent workers who support safe, compassionate, dignified and person-centred end of life care when working in client placements.

The client placement is responsible for assessing the service user, developing and reviewing the care plan, confirming clinical instructions, maintaining regulated care records and ensuring that any advance care planning, DNACPR, ADRT, LPA or best-interests arrangements are lawful, current, accessible and communicated appropriately.

Agency workers must:

• follow the client’s care plan, risk assessments and end of life care procedures;
• provide care within their competence, role, professional registration and assignment instructions;
• respect the person’s dignity, privacy, wishes, beliefs and protected characteristics;
• escalate immediately to the client’s nurse in charge, registered manager, responsible clinician or emergency services where there is deterioration, uncertainty, conflict, distress, unmanaged pain or risk of harm;
• document care given and concerns raised in accordance with the client’s record keeping procedure and {{org_field_name}} reporting requirements.

Agency workers must not make independent clinical decisions outside their role or act on unclear, disputed, expired, unsigned or unavailable documents relating to advance care planning, DNACPR or refusal of treatment.

5. Responsibilities

Directors / Agency Management

The directors / agency management of {{org_field_name}} are responsible for:

• ensuring that workers are recruited and supplied in line with the Employment Agencies Act 1973, the Conduct of Employment Agencies and Employment Businesses Regulations 2003 and applicable agency worker legislation;
• confirming, so far as reasonably practicable, workers’ identity, right to work, qualifications, registration status, training, experience, references and suitability for the role before placement;
• ensuring that workers supplied to roles involving regulated activity have appropriate DBS checks and barred list checks where legally eligible and required;
• ensuring that workers receive induction information on end of life care, mental capacity, safeguarding, escalation, confidentiality and professional boundaries;
• confirming with clients, where relevant, the nature of the assignment, known health and safety risks, required skills, training, supervision arrangements and local policies;
• ensuring that concerns about competence, conduct, safeguarding, poor practice or unsafe care are investigated and escalated to the client and relevant external bodies where required;
• maintaining records of training, compliance checks, complaints, incidents and learning actions.

Agency Workers

Agency workers supplied by {{org_field_name}} are responsible for:

• working within their role, competence, professional registration and the assignment instructions issued by the client;
• following the client’s care plans, risk assessments, medicines procedures, escalation routes and end of life care protocols;
• treating service users, families and those important to the person with dignity, compassion and respect;
• recognising and promptly reporting deterioration, pain, distress, breathlessness, agitation, swallowing difficulties, reduced consciousness, falls, safeguarding concerns or any other change in condition;
• checking, at the start of the shift where relevant, whether the client has informed them of any ACP, DNACPR, ADRT, LPA, ReSPECT form or preferred priorities of care;
• not interpreting, amending, disregarding or independently applying documents where there is uncertainty about validity, applicability or current status;
• keeping accurate, factual and timely records in the client’s records and reporting concerns to {{org_field_name}} where required.

Client placement responsibilities

The client placement is responsible for:

• assessing the person’s needs and risks;
• developing, authorising and reviewing care plans, medicines plans and end of life care plans;
• ensuring that ACP, DNACPR, ADRT, LPA, ReSPECT or best-interests documentation is lawful, current, accessible and communicated to staff;
• providing local induction, supervision, handover and escalation arrangements;
• ensuring that agency workers are informed of relevant risks and instructions needed to provide safe care during the assignment;
• managing death certification, medical examiner, coroner, family communication and statutory notification processes in line with law and local procedure.

6. Definition of End of Life Care

End of life care refers to care and support for people who are likely to die within the next 12 months, including people whose death is imminent and people with advanced, progressive or incurable conditions. For the purpose of this policy, it includes support provided during the last year of life, the last days and hours of life, and immediate care after death where this forms part of the worker’s assigned duties.

End of life care may include:

• comfort, dignity, privacy and compassionate communication;
• observing and reporting symptoms such as pain, breathlessness, agitation, nausea, secretions, anxiety or distress;
• supporting nutrition, hydration, mouth care, personal care and repositioning in line with the care plan;
• supporting cultural, religious, spiritual and family needs;
• following documented ACP, DNACPR, ADRT, ReSPECT or preferred priorities of care where the client confirms these are valid and applicable;
• after-death care in line with the client’s procedure and the worker’s competence.

7. Definition of Advance Care Planning (ACP)

Advance Care Planning is a voluntary, person-centred process that enables a person to consider and record their wishes, feelings, beliefs, values and preferences for future care and treatment. ACP should be based on meaningful conversation, should involve the person as far as possible, and should include those important to the person where the person wants this or where it is lawful and appropriate.

ACP may include:

• advance statements of wishes, feelings, beliefs and preferences;
• preferred priorities of care;
• advance decisions to refuse treatment;
• DNACPR decisions;
• ReSPECT or equivalent emergency care and treatment plans used by the client placement;
• Lasting Power of Attorney arrangements for health and welfare;
• best-interests decision-making where the person lacks capacity for the relevant decision.

Agency workers may support the person to express wishes and may pass information to the client’s responsible staff, but they must not lead, complete, approve, amend or cancel ACP, DNACPR, ADRT, LPA or best-interests documentation unless this is expressly within their professional role, competence, client authorisation and applicable law.

8. Key Principles of End of Life Care

Agency staff must provide care that is:

• Person-centred: Respecting each person’s choices, beliefs, and preferences.
• Holistic: Meeting the physical, psychological, social, cultural, and spiritual needs of the individual and their family.
• Inclusive: Involving service users, families, and advocates in decision-making wherever possible.
• Dignified: Ensuring privacy, dignity, and comfort are maintained at all times.
• Sensitive: Delivering care with empathy and compassion, especially during distressing situations.
• Lawful: Acting in accordance with the Mental Capacity Act 2005, equality law, human rights principles, professional standards and client procedures.
• Evidence-informed: Following current national guidance, including NICE NG31 where relevant to care of adults in the last days of life.
• Safely escalated: Promptly reporting deterioration, unmanaged symptoms, uncertainty, conflict or risk to the client’s responsible staff.
• Role-boundaried: Recognising that agency workers support care delivery but do not independently make clinical, legal or care planning decisions outside their role.

9. Communication

Effective communication is fundamental to high-quality end of life care. Agency workers must:

• communicate with compassion, sensitivity and respect;
• use clear, professional and factual language;
• adapt communication to meet individual needs, including sensory impairment, cognitive impairment, dementia, learning disability, language needs, distress, fatigue or fluctuating capacity;
• involve the client’s senior staff where family members ask questions outside the worker’s role or competence;
• avoid giving clinical opinions, prognosis, legal advice or assurances outside their role;
• respect confidentiality while sharing necessary information with the client’s care team on a need-to-know basis;
• report any communication difficulties, conflict, family concerns or uncertainty about wishes or decisions to the nurse in charge, registered manager or responsible clinician.

10. Mental Capacity and Decision Making

Agency workers must work in accordance with the Mental Capacity Act 2005 and the client’s Consent, Mental Capacity and Best Interests procedures when supporting any person who may lack capacity for a specific decision.

The following principles must be followed:

• a person must be assumed to have capacity unless it is established that they lack capacity;
• a person must not be treated as unable to make a decision unless all practicable steps to support them have been taken without success;
• a person must not be treated as unable to make a decision merely because they make an unwise decision;
• any act done or decision made for a person who lacks capacity must be in their best interests;
• before any act is done or decision made, consideration must be given to whether the purpose can be achieved in a less restrictive way.

Agency workers must not make final capacity assessments, best-interests decisions, treatment decisions or legal decisions unless this is clearly within their professional role, competence and client authorisation. Where capacity, consent, ADRT, DNACPR, LPA or best-interests arrangements are unclear, disputed or unavailable, the agency worker must escalate immediately to the client’s responsible staff.

Agency workers must be alert to potential deprivation of liberty, restraint, neglect, coercion or undue influence and must report concerns through the client’s safeguarding procedure and {{org_field_name}}’s safeguarding procedure.

11. DNACPR, ADRT, LPA and ReSPECT

Agency workers must follow the client’s procedure for DNACPR, advance decisions to refuse treatment, Lasting Power of Attorney and ReSPECT or equivalent emergency care and treatment plans.

Agency workers must:

• check relevant handover information at the start of the shift where the person is receiving end of life care;
• follow only documents or instructions that the client confirms are current, valid, applicable and available;
• escalate immediately if a document is missing, unclear, disputed, unsigned, expired, inconsistent with the care plan, or appears not to relate to the person or current circumstances;
• continue to provide comfort, dignity, personal care, symptom observation and appropriate escalation even where a DNACPR decision is in place;
• never assume that a DNACPR decision means “do not treat” or “do not provide care”;
• never apply blanket DNACPR decisions based on age, disability, diagnosis, care setting or any protected characteristic.

Agency workers must not independently complete, authorise, cancel or amend DNACPR, ADRT, LPA or ReSPECT documentation.

12. Supporting Advance Care Planning

Agency workers may, where appropriate and within their role:

• listen to and support the person to express wishes, feelings, beliefs and preferences;
• respect the person’s right to be involved in decisions as far as possible;
• share relevant factual information with the client’s responsible staff;
• support communication with family members, advocates or those important to the person where this is lawful, appropriate and consistent with the person’s wishes;
• follow documented care preferences confirmed by the client;
• record factual observations and information shared with them in accordance with the client’s record keeping procedure.

Agency workers must not:

• pressure a person to make an advance care plan;
• lead ACP discussions unless authorised, trained and competent to do so within the client’s governance arrangements;
• provide legal advice about ADRT, LPA, wills, inheritance or funeral arrangements;
• make assumptions about the person’s wishes based on age, disability, religion, diagnosis, family views, residence in a care home or quality of life judgements;
• ignore concerns that the person may be under pressure, coercion or undue influence.

13. Symptom Management and Comfort

Agency workers must support comfort and symptom management only within their role, competence, training, professional registration and the client’s care plan.

Agency workers must:

• observe and promptly report pain, breathlessness, agitation, restlessness, nausea, vomiting, secretions, anxiety, distress, reduced consciousness, swallowing difficulties, dehydration concerns or other changes;
• assist with comfort measures such as repositioning, mouth care, personal hygiene, pressure area care, continence care, hydration support and emotional reassurance where included in the care plan;
• follow the client’s medicines policy, controlled drugs procedure and delegation arrangements;
• ensure that any medicines administered by registered nurses are given only where lawful, prescribed, authorised, documented and within the nurse’s competence;
• escalate immediately where symptoms are not controlled or where there is any uncertainty about medicines, routes, doses, anticipatory medicines, syringe drivers or “as required” medication.

Healthcare assistants must not administer medicines, alter oxygen, adjust syringe drivers, give clinical advice or undertake clinical tasks unless they are trained, competent, authorised by the client and permitted under the client’s policy.

14. Supporting Families and Significant Others

Agency workers may support families and those important to the person by:

• being compassionate, calm and respectful;
• listening and acknowledging distress;
• providing general information within their role and competence;
• directing questions about prognosis, treatment, death certification, complaints, ACP, DNACPR, ADRT or care planning to the client’s responsible staff;
• respecting confidentiality and the person’s known wishes about information sharing;
• escalating family concerns, conflict, safeguarding issues or complaints immediately to the client’s nurse in charge, registered manager or responsible clinician.

15. After Death Care

Agency workers involved in after-death care must:

• follow the client’s after-death care procedure, infection prevention procedure, manual handling procedure and local cultural or religious care arrangements;
• treat the deceased person with dignity, privacy and respect;
• support family members who are present with compassion and sensitivity;
• notify the client’s nurse in charge, registered manager or responsible clinician immediately;
• document care given and actions taken in accordance with the client’s records procedure;
• preserve the environment and avoid moving or interfering with anything where the death is unexpected, suspicious, subject to safeguarding concern or potentially reportable to the coroner, unless necessary to preserve life or safety;
• cooperate with the client’s process for medical examiner, coroner, family communication and statutory notification arrangements.

Agency workers must not verify death, certify death, complete medical certificates, contact the coroner on behalf of the provider, release the body, or discuss cause of death unless this is expressly within their professional role, competence, client authorisation and local procedure.

16. Safeguarding

Agency workers must remain vigilant for abuse, neglect, acts of omission, poor practice, coercion, undue influence, discriminatory treatment, inappropriate DNACPR decisions, unmanaged pain, failure to provide basic care, unsafe medicines practice or any concern that the person is not receiving dignified and lawful care.

Any safeguarding concern must be reported immediately to:

• the client’s nurse in charge, registered manager or safeguarding lead;
• {{org_field_name}}’s designated safeguarding lead / director;
• external safeguarding bodies where required by {{org_field_name}}’s Safeguarding Adults Policy or where immediate action is needed to protect a person from harm.

Where a worker is removed from an assignment or there are concerns that a worker has harmed, may harm, or poses a risk to adults or children, {{org_field_name}} will consider its duty to make referrals to the DBS, professional regulator, local authority safeguarding team, police or other relevant body.

17. Equality, Diversity, and Inclusion

End of life care must always be delivered without discrimination. Staff must:

• Respect cultural, religious, and spiritual beliefs relating to death and dying.
• Adapt care to meet the needs of individuals from diverse backgrounds.
• Ensure equal access to appropriate care, support, and information.

Decisions and care must not be based on assumptions about age, disability, race, religion or belief, sex, sexual orientation, gender reassignment, marriage and civil partnership, pregnancy or maternity, diagnosis, residence in a care home, perceived quality of life or social value. Reasonable adjustments must be made where required to support communication, dignity, access to information and involvement in decisions.

18. Training

{{org_field_name}} will ensure that temporary workers receive induction and refresher training appropriate to their role, assignment type and client requirements. Training may include:

• principles of palliative and end of life care;
• dignity, privacy, compassion and person-centred care;
• communication with people who are dying and those important to them;
• recognising deterioration and escalating concerns;
• Mental Capacity Act 2005 principles, consent and best-interests awareness;
• ACP, DNACPR, ADRT, LPA and ReSPECT awareness;
• safeguarding adults and recognising neglect or poor practice at end of life;
• equality, diversity, cultural, religious and spiritual needs;
• documentation, confidentiality and information sharing;
• medicines awareness and role-specific limitations;
• after-death care awareness, where relevant to the role.

Registered nurses must maintain their own professional competence, registration and revalidation requirements. Healthcare assistants must work within delegated duties and must not undertake clinical tasks unless trained, competent and authorised by the client.

19. Documentation

Agency workers must maintain accurate, factual, respectful and timely records in accordance with the client’s record keeping procedure and {{org_field_name}}’s reporting requirements.

Records must:

• describe care given, observations made, symptoms reported and escalation actions taken;
• avoid personal opinions, assumptions or unsupported conclusions;
• identify who was informed, when, and what action was requested or taken;
• record concerns about unclear, missing or disputed ACP, DNACPR, ADRT, LPA or ReSPECT documentation;
• be completed as soon as reasonably practicable and before leaving the shift wherever possible.

Agency workers must not create or amend formal ACP, DNACPR, ADRT, LPA, ReSPECT, medicines or treatment documents unless this is expressly authorised by the client, within their professional role and lawful.

20. Confidentiality and Data Protection

Agency workers must protect confidential personal information and special category health information in accordance with the UK GDPR, Data Protection Act 2018, professional standards, {{org_field_name}}’s Data Protection and Confidentiality Policy and the client’s procedures.

Agency workers must:

• access only information needed for the assignment;
• share information only with authorised persons on a need-to-know basis;
• avoid discussing service users in public areas or with unauthorised persons;
• keep records secure and return or store documents in accordance with the client’s procedure;
• report any actual or suspected data breach immediately to the client and {{org_field_name}}.

21. Supervision and Support

{{org_field_name}} will provide agency workers with access to a director, manager or designated senior contact for advice, escalation and support.

Agency workers must seek immediate guidance from the client’s nurse in charge, registered manager or responsible clinician where there is uncertainty during a shift. {{org_field_name}} will provide follow-up support, supervision or debriefing following distressing deaths, complaints, safeguarding concerns, incidents, conflicts or traumatic events.

Workers should be encouraged to raise concerns without fear of detriment where they believe a person is receiving unsafe, undignified, discriminatory or unlawful care.

22. Monitoring and Compliance

The directors / agency management of {{org_field_name}} will monitor compliance with this policy by:

• reviewing training and competency records;
• auditing recruitment, vetting, DBS, right to work, registration and reference checks;
• reviewing client feedback, worker feedback, complaints, safeguarding concerns and incident reports;
• identifying themes relating to end of life care, ACP, DNACPR, medicines, documentation, communication or escalation;
• taking corrective action where workers act outside competence, fail to escalate concerns or fail to follow client procedures;
• sharing learning with workers and updating training or procedures where required;
• reviewing this policy annually or sooner where legislation, guidance, client requirements, incidents or best practice indicate that changes are needed.

23. Agency Compliance and Employment Business Duties

{{org_field_name}} operates as a temporary staffing agency / employment business. It will comply with applicable recruitment and employment business legislation, including the Employment Agencies Act 1973, the Conduct of Employment Agencies and Employment Businesses Regulations 2003, the Agency Workers Regulations 2010, right to work requirements, working time requirements, national minimum wage requirements, equality law, health and safety duties and data protection law.

Before supplying a worker to a client placement, {{org_field_name}} will take reasonable steps to confirm the worker’s identity, right to work, qualifications, professional registration where applicable, experience, training, references and suitability for the role. Where the role involves work with adults or children in regulated activity, {{org_field_name}} will ensure that appropriate DBS and barred list checks are completed where legally eligible and required.

{{org_field_name}} will obtain and share relevant assignment information with the worker, including the type of work, location, hours, supervision arrangements, required skills, known health and safety risks and client procedures that must be followed.

The client remains responsible for the clinical assessment, care planning, regulated activity delivery, local induction, clinical supervision and governance of care provided within the placement.

24. Policy Review

This policy will be reviewed at least annually or sooner where:

new guidance is issued by bodies such as GOV.UK, NHS England, NICE, CQC, DBS, the NMC or relevant professional regulators.

there are changes to legislation, statutory guidance, national guidance or professional standards;

there are changes to {{org_field_name}}’s services, client base or assignment types;

incidents, complaints, safeguarding concerns, audits or client feedback identify a need for review;

---

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.