1.2 Analyse the impact of national and local drivers on current approaches to end of life care

This guide will help you answer 1.2 Analyse the impact of national and local drivers on current approaches to end of life care.

National and local drivers refer to the laws, policies, guidelines, reports, and strategies set by the government or local authorities to shape health and social care practice. In end of life care, these drivers aim to provide clear direction for delivering compassionate, safe, and person-centred care for people who are dying.

At the national level, drivers often take the form of acts of parliament, Department of Health policies, and guidance from recognised bodies like the National Institute for Health and Care Excellence (NICE). Locally, organisations interpret these national drivers and form their own procedures to meet the needs of their communities, guided by local partnerships and resource availability.

By understanding both levels, care workers provide support that is up to date, evidence-based, and respectful of each person’s needs and choices.

National Drivers Shaping End of Life Care

The End of Life Care Strategy (2008)

The Department of Health published the End of Life Care Strategy with the aim to improve the quality of care delivered to adults at the end of their life, irrespective of diagnosis. This strategy introduced the idea that anyone approaching the end of life should have their needs identified, assessed, and planned for. It focuses on:

• Choice and control for people at the end of life
• Early identification of individuals nearing death
• Coordination across services
• Support for families and carers
• Training for health and care staff

The strategy brought attention to the gaps in care and reinforced the need for person-centred approaches.

The NICE Guidance on End of Life Care

NICE offers detailed evidence-based recommendations for health and social care professionals. Important documents include “Care of dying adults in the last days of life” (NG31), which provides guidance on:

• Recognising when a person might be dying
• Communicating sensitively with people and families
• Managing pain and other symptoms
• Involving the individual as much as possible in decisions
• Providing emotional and spiritual support

NICE guidance helps maintain consistent and high standards throughout the country.

The Five Priorities for Care

This document replaced the Liverpool Care Pathway and set out clear expectations for care in the final days and hours of life. The Five Priorities are:

• Recognising dying
• Communicating and involving the person
• Involving family and others important to the person
• Exploring wishes and preferences
• Delivering care with compassion

These priorities highlight the shift from a medical “one size fits all” approach to a more holistic and respectful style.

NHS Long Term Plan

The NHS Long Term Plan pushes for all people to have choice and control over their care, especially at the end of their life. It stresses support in the community, rapid response services, and out-of-hours options to help people stay in their preferred place of care, such as home.

Legal Frameworks

Several laws shape good practice in end of life care:

• Mental Capacity Act 2005 protects the rights of people who may lack capacity to make decisions, allowing for advanced decisions and best interest decisions.
• Human Rights Act 1998 ensures dignity, privacy, and respect for family life.
• Equality Act 2010 requires services to be free from discrimination.

These laws mean care must respect each individual’s wishes and protect vulnerable people.

Local Drivers and Strategies

Local Commissioning

Local commissioning groups, like Integrated Care Boards (ICBs), identify needs within their area and plan how services will meet them. In end of life care, ICBs:

• Map local needs and resources
• Choose which services to fund
• Sponsor training and service development
• Lead on joint initiatives with social care

Commissioning ensures that care reflects the community’s needs, culture, and demographics.

Organisational Policies

Care providers, such as NHS Trusts, hospices, and care homes, create their own policies. These interpret national guidelines into practical actions. For example, an organisation may have:

• Protocols for advanced care planning
• Procedures on recording wishes about resuscitation
• Recording and sharing information securely
• Protocols for pain management
• Steps for family involvement and bereavement support

Staff have a responsibility to follow these so care is safe and consistent.

Education and Workforce Development

Local drivers include training programmes that reflect national standards, but adapted for local needs. Examples are:

• Multi-disciplinary training on communication skills
• Workshops on managing symptoms
• Shadowing opportunities for less experienced staff
• Simulation exercises on delivering bad news
• Joint sessions delivered by hospices and community teams

These ensure the workforce feels confident and supported.

Multi-agency Partnerships

Locally, partnerships between health, social care, voluntary sector, and primary care help coordinate care for individuals and families. Partnership working supports:

• Seamless transition between hospital and home
• Shared access to care plans
• Out-of-hours support
• Support for religious and cultural needs
• Fast-tracking funding for urgent care at home

These partnerships mean everyone is working to shared goals for the person at the centre.

Local Public Health Initiatives

Some local authorities run public awareness programmes to increase understanding about end of life care, encourage earlier conversations about wishes, and challenge stigma. These initiatives include:

• Information leaflets in GP surgeries
• Community events and forums
• Bereavement cafes
• Social media campaigns

This increases the likelihood that people’s preferences are known and recorded before a crisis.

Analysis of the Impact of National and Local Drivers on Current End of Life Care Approaches

National and local drivers have shaped current approaches in several key ways. Their impact can be seen in practice, attitudes, and outcomes for people who are dying.

Promoting Person-centred Care

One key impact is the move towards truly person-centred care. National guidance and local policy both emphasise listening to people’s wishes, involving them in decision making, and respecting their dignity. For example:

• More people now create Advance Care Plans
• Individuals can record “do not attempt resuscitation” wishes
• Emotional and spiritual needs are routinely considered

This represents a huge mindset shift for many professionals. It recognises that each person’s experience of death is unique.

Earlier Identification and Planning

Drivers have also encouraged earlier identification of people who may be approaching the end of life, leading to earlier conversations and planning. The Gold Standards Framework, Hospice UK’s work, and local training have made this the norm.

This means:

• More time to explore wishes and fears
• Better pain and symptom control
• Fewer unnecessary or distressing hospital admissions

Early planning also supports family members to feel prepared and less isolated.

Improving Symptom Control

National policies outline how vital it is that no one dies in pain or distress. NICE guidance has encouraged the adoption of clinical tools for pain assessment and management. Local protocols provide access to specialist advice (from palliative care teams or hospices) quickly and flexibly.

This means better outcomes for comfort, with more people achieving “a good death”—free from unnecessary suffering and agitation.

More Choice over Place of Care and Death

The combination of NHS policy and local coordination now makes it easier for people to express where they want to be cared for in their final days. Wherever possible, services work to support people to die in their preferred setting, often at home or in a care home.

There are more community nursing teams, rapid equipment delivery, and coordinated social care packages as a result. This supports greater dignity and helps meet families’ expectations.

Raising Standards and Reducing Poor Practice

Before unified national and local guidance, there were many stories of poor care at the end of life—pain not controlled, lack of communication, or distressing scenes for families. Since the End of Life Care Strategy and subsequent guidance:

• Most services must evidence high quality care
• CQC (Care Quality Commission) inspects against national standards
• Organisations introduce audits and reflect on practice
• Complaints and feedback help identify and address gaps

Improvements in training, leadership, and organisation-wide learning now hold all staff to account.

Equality and Inclusion

Policies like the Equality Act have made services better able to meet the needs of people from a wide range of backgrounds. Some adaptations seen in practice:

• Providing translated care plans and information
• Respect for religious or cultural practices around dying
• Better access for people with learning disabilities or dementia

This gives everyone the same right to comfort and respect, which was not always the case before.

Better Support for Families and Carers

Many drivers now expect organisations to support those close to the dying person. This may be through information, respite, counselling, or practical help.

Local partnerships mean family members can contact someone if they feel overwhelmed, and post-bereavement support is often available.

Challenges and Limitations

While the impact is mostly positive, there are challenges:

• Funding pressures may limit how much choice is available, especially in very rural or deprived areas
• Differences between GP practices or care homes may mean standards are not always consistent
• Workforce shortages sometimes mean delay in care or lack of continuity
• Some groups, like the homeless or people with multiple complex needs, may be harder to reach

Being aware of these means that workers can advocate for change and play a part in quality improvement.

Practical Examples of National and Local Drivers in Action

• A person with terminal cancer meets with their GP and nurse to develop an Advance Care Plan, documenting their wish to remain at home wherever possible, with pain relief provided by community nursing
• A hospice team organises training for nursing home staff, based on local data showing gaps in end of life care for older residents
• A district nurse refers to local guidance to arrange fast-track funding for a hospital discharge home for someone in the last days of life
• A home care agency ensures all staff complete online learning in communication and symptom management as part of their induction
• Local palliative care partnership offers evening drop-in advice for carers worried about someone’s pain control

Each example demonstrates policies turning into real improvements for people and families.

Final Thoughts

National and local drivers have changed the culture and practice of end of life care. Instead of a fragmented and sometimes uncaring system, there is now a dynamic focus on dignity, choice, and comfort. Legislation and policy set the standards, while local strategies make these standards work in real situations.

By staying aware of these drivers, care workers put values into practice. Everyone who is dying deserves to feel heard, respected, and safe. Your understanding and use of these drivers directly improves care at a time of great importance. Through ongoing learning and teamwork, you can continue to help people achieve a good end of life experience, wherever they are.