Report on UK Pilot Program to Improve End of Life Care

This report on a 2006 pilot program launched in the UK examines the lessons learned from an attempt to extend a project (the King's Fund Enhancing the Healing Environment [EHE]) to six additional hospitals and two Marie Curie Cancer Care hospices in England and Scotland, in an attempt to "improve the environment of care for those who are dying, bereaved, or deceased." The pilot program has been extended to 20 further facilities in England. The original King's Fund program had previously worked with 119 National Health Service trusts (which provide both primary and acute medical services in England), 2 hospices and 5 prisons. The report's authors include the program director and the funding and development director for the King's Fund EHE, as well as two outside consultants. From the report:

The programme encourages and enables local teams to work in partnership with service users to improve the environment in which they deliver care. The programme consists of two elements: a development programme for a nurse-led, multidisciplinary team and a grant for the team to undertake a project to improve their patient environment. Throughout our work on the environment of care, one theme has remained constant– the need for health care settings that make patients feel cared for and staff feel valued.

. . .

As a result of our practical experience we recommend that all the settings with which end-of-life care occurs provide:

• a room where patient and family can be taken for confidential discussions.


• the option of single room accommodation designed to engender a feeling of homeliness where patients retain control over their environment


• informal gathering spaces and places where families can meet, confer andtalk with care staff


• guest rooms where close family or friends can stay overnight with facilities for catering and internet access


• appropriate places for 'viewing' the deceased.

Our practical experience also leads us to recommend that all health service providers include care of the dying, bereaved and deceased in corporate induction programmes for all staff and that professional training for all staff groups should include material on the impact of the environment in end-of-life care.

As a result of our consultative conference, considering the issues raised by the work, we recommend the Department of Health should develop national standards for the environment for end-of-life care, significantly increase investment in these environments and ensure that policy and practice development enables everybody to make choices about where they would prefer to die and to revisit that choice as their condition changes.