The Royal College of Physicians (RCP) has issued a new policy position urging government and health leaders to transform end-of-life and palliative care across the NHS and social care.
It calls for a cultural shift, both in healthcare and wider society, towards earlier recognition of dying, open conversations, personalised planning and better integration of care for people with progressive life-limiting conditions.
The RCP is asking the government to:
- Launch a public awareness campaign about end-of-life and palliative care
- Fund professional education and improvement to support better end-of-life care planning and delivery
- Commission a national strategy, including a service framework, common dataset and aligned workforce planning.
Dr Hilary Williams, RCP clinical vice president. said: ‘Doctors of all career grades and specialties need the skills – and, vitally, the time – to recognise when a person is approaching the end of their life. Too often, that recognition happens only in the final days or weeks, and often in acute care settings. We can and must do better.
‘Real change will only come when we value continuity of care, the involvement of experienced decision-makers, and we can give clinicians the time to have honest conversations with patients and families about what lies ahead.’
Currently, most patients nearing the end of life experience a healthcare system focused on curative treatments, despite 70% dying from predictable long-term conditions. Many families feel unprepared, yet timely, supportive discussions can improve care choices and quality of life.
Research shows that the last year of life costs the public £22 billion, mostly in hospital-based care, yet palliative care is often underused and poorly coordinated.
The RCP highlights missed opportunities to identify patients earlier, inadequate training in end-of-life care and the under-provision of specialist palliative services, which suffer from workforce shortages and regional inequities. Social care’s key role, especially in homes and care facilities, remains under-recognised and under-resourced.
The RCP advocates integrating palliative care into all settings, with shared patient information and collaboration across specialities. It also urges a broader approach to advance care planning, such as the ReSPECT process, to replace narrow DNACPR-focused discussions.
Without a shift in attitudes towards palliative care, and better integration of health and social care systems, the RCP warns that quality end-of-life support will remain inconsistent. It stresses that dying well is a shared responsibility, requiring commitment from policymakers, professionals, and society alike.
Dr Suzanne Kite, president of the Association for Palliative Medicine said: ‘We urgently need a national strategy to ensure that everyone has access to the high quality palliative care that they need, wherever they are, as early as necessary, around the clock.
‘Opportunities for patients, families and professionals to talk honestly about what matters in the final months and weeks of life must be embedded in care, and we need systems, training and public conversations that support this.’
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