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Registration Number: {{org_field_registration_no}}

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End of Life and Palliative Care Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides high-quality, compassionate, and person-centred end of life and palliative care to individuals who have a life-limiting condition. This policy aligns with Regulation 9 (Person-Centred Care) and Regulation 10 (Dignity and Respect) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, ensuring compliance with Care Quality Commission (CQC) Fundamental Standards.

This policy ensures that:

• People receiving end of life care are treated with dignity, compassion, and respect.
• Care is planned according to the individual’s wishes, values, and cultural preferences.
• Staff are trained and competent in delivering palliative care support.
• Effective pain management and symptom control are provided in partnership with healthcare professionals.
• Families and carers receive emotional support and bereavement care.

2. Scope

This policy applies to all staff involved in supporting individuals receiving palliative or end of life care at {{org_field_name}}. It covers:

• Identifying individuals requiring palliative care planning.
• Developing Advance Care Plans (ACP) and Do Not Attempt Resuscitation (DNAR) decisions.
• Managing pain, symptom relief, and emotional well-being.
• Coordination with hospice, GP, district nurses, and specialist palliative care teams.
• Supporting families and carers before, during, and after end of life care.

3. Principles of End of Life and Palliative Care

Person-Centred and Holistic Approach

• Care is planned with the individual’s preferences, beliefs, and values at the centre.
• End of life wishes are discussed sensitively and respectfully, ensuring individuals are involved in decisions.
• The Mental Capacity Act 2005 is followed when supporting decision-making.
• Multi-disciplinary team involvement ensures a holistic approach to care.

Identifying and Planning Palliative Care

• Early identification of individuals needing palliative care using the Gold Standards Framework (GSF).
• A Comprehensive End of Life Assessment is carried out covering:
  • Physical, emotional, and psychological needs.
  • Preferred place of care and preferred place of death.
  • Religious, cultural, and spiritual beliefs.
  • Communication needs and how the person wishes to be involved in decisions.
• Advance Care Plans (ACPs) are developed, ensuring clear documentation of wishes.
• Coordination with GPs, community nurses, and palliative care specialists to ensure high-quality support.

Pain and Symptom Management

• Effective pain control is a priority, ensuring individuals remain comfortable.
• Staff are trained to recognise and respond to symptoms such as:
  • Pain, breathlessness, nausea, anxiety, agitation.
• Medication is managed in line with Regulation 12 (Safe Care and Treatment) and in partnership with healthcare professionals.
• Non-medical interventions (e.g., relaxation techniques, holistic therapies) are incorporated where appropriate.

Emotional, Psychological, and Spiritual Support

• Emotional and psychological support is provided through counselling, pastoral care, or external support networks.
• Spiritual care is facilitated by chaplains, faith leaders, or community groups according to the individual’s preferences.
• Staff receive training on active listening, empathy, and emotional resilience when supporting individuals and families.

Family and Carer Involvement

• Families and carers are included in care planning and decisions wherever possible.
• Clear and sensitive communication is maintained throughout the individual’s journey.
• Emotional support is provided to family members, and signposting to bereavement support services is offered.
• Families are informed about expected changes during end of life care to prepare them.

Respecting Choices: DNAR and Advance Decisions

• Where individuals choose to have a Do Not Attempt Resuscitation (DNAR) order, this is documented and respected.
• Staff ensure that individuals understand their choices, providing clear, non-judgmental information.
• Best Interest Meetings are arranged for those who lack capacity, following legal guidelines.

Coordination with External Services

• Collaborative working with:
  • Palliative care teams and hospices to ensure specialist input.
  • GPs and district nurses for ongoing clinical support.
  • Out-of-hours services to ensure continuity of care.
• Multi-disciplinary team (MDT) meetings are held regularly to review care plans.

Dignity and Comfort in the Final Stages

• The individual’s privacy, dignity, and personal choices are upheld at all times.
• Symptom relief and continuous comfort measures are prioritised.
• Loved ones are given time, space, and support to be with the individual in their final moments.
• Staff provide reassurance and compassionate presence during this time.

After-Death Care and Bereavement Support

• Staff provide respectful, sensitive care after death, following religious or cultural customs where possible.
• Families are supported emotionally and practically, including guidance on next steps (e.g., registering the death, funeral arrangements).
• Staff refer families to bereavement support services where appropriate.
• Staff debriefing sessions are provided to support team members following the loss of an individual.

Staff Training and Development

• All staff receive specialist training in end of life and palliative care.
• Ongoing learning includes:
  • Symptom management and medication use.
  • Communication skills for discussing sensitive topics.
  • Recognising and responding to changes in condition.
  • Emotional resilience and coping strategies.

Quality Monitoring and Continuous Improvement

• Regular audits and reviews of end of life care practices ensure high standards are maintained.
• Feedback from individuals, families, and staff is collected to improve care experiences.
• Lessons learned from significant events and complaints inform practice improvements.

4. Roles and Responsibilities

• Registered Manager: Ensures compliance with CQC regulations and oversees quality of end of life care.
• Palliative Care Coordinator: Leads on end of life care planning and multi-agency collaboration.
• All Care Staff: Provide compassionate, dignified support and follow care plans accurately.
• Healthcare Professionals (GPs, nurses, hospice teams): Provide clinical oversight and specialist palliative care input.
• Family and Advocates: Play a key role in decision-making and ensuring care aligns with individual wishes.

5. Related Policies

This policy should be read in conjunction with:

• SL07 – Person-Centred Care Policy
• SL08 – Dignity and Respect Policy
• SL09 – Consent to Care Policy
• SL12 – Pain Management Policy
• SL21 – Medication Management and Administration Policy
• SL25 – Safeguarding Adults from Abuse and Improper Treatment Policy
• SL42 – Communication and Engagement with Service Users and Families Policy

6. Policy Review

This policy will be reviewed annually or sooner if legislative changes, CQC requirements, or organisational needs necessitate an update. Updates will be communicated to all staff to ensure continued compliance with best practices in end of life and palliative care.

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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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