New commissioning guidance for Scottish health and social care partnerships

Eilidh Macdonald, Hospice UK’s Policy and Advocacy Manager for Scotland, writes about Scotland’s new commissioning guidance and how it applies to end of life care.

There is much to welcome in the Scottish Government’s new Strategic Commissioning guidance for Health and Social Care Partnerships (‘Partnerships’). The Guidance should provide local decision makers with direction to ensure their commissioning strategies prioritise people living with terminal and life shortening conditions. However, it is for guidance only, and as such is limited in its power: it is not statutory and does not contain specific direction around the commissioning of palliative and end of life care.

The new guidance was promised as part of the Scottish Government’s national framework to ensure everyone who needs palliative care has access to it: the Strategic Framework for Action on Palliative and End of Life Care  (the ‘Framework’). The genesis of the Framework was the imperative to address palliative and end of life care needs now and in the future, driven by demographic changes, and evidence highlighting the many thousands of Scots missing out on palliative care right now.

The Framework vision is nothing short of universal access by 2021. It is ambitious, and it is absolutely what we should be aiming for. Access to palliative care, like hospice care, can be the difference between staying at home or repeated and traumatic admissions to hospital; it can mean loved ones being able to be a wife, a son, a sister again rather than a carer on the edge of collapse; it can mean that people can really focus on what matters to them in the time they have left.

This new guidance for Partnerships should be an important component of realising that vision, guiding local decision making when commissioning services to meet the needs of people living with terminal, life-shortening and chronic, deteriorating conditions.

It is the realisation of a specific Framework commitment which recognises the importance of the role of Partnerships’ commissioning approaches and states that commissioning plans should “reflect the importance of, value and specific contributions of palliative and end of life care in delivering the national outcomes for health and social care”. It is this principle, framed within the urgent need to widen access to care, which guided Hospice UK’s briefing for Partnerships on prioritising Scots who need such care in Strategic Commissioning Plans and practice published last year.

This new guidance is important as it should mean better coordinated care that reaches more people. As well as providing policy and service information, it signposts decision makers to partners and resources.  It is particularly strong in a number of ways. It:

• contains many examples of the innovative, diverse and critical work hospices do across the health and social care landscape;
• recommends a named lead for palliative and end of life care within Partnerships;
• emphasises the importance and impact of anticipatory care planning, linking with the realistic medicine agenda;
• highlights the need to work closely with hospices when commissioning services;
• mentions the role hospices do and could play in workforce development and training;
• discusses the need to ensure processes for transitioning between care settings are clear.

However, the guidance risks missing the urgency with which we need to address unmet need for children and adults, and could have a stronger focus on bereavement support; tackling barriers to equal access; co-production; and hospice-led community care which accounts for 80 per cent of all hospice care in Scotland.

Because of this, as the guidance acknowledges, it is important Partnerships utilise other resources, coming from public and third sectors. Complimenting the guidance with resources such as hospice expertise, will ensure priorities are pursued effectively and decisions are co-produced with delivery partners, and people at the centre of care.

Government has the right vision, but it is now largely over to Partnerships, working with local providers, to transform experiences for thousands of people in need right now, and in the years to come. As Hospice UK’s commissioning briefing for Partnerships highlighted, it is  no small task and if it is to have any chance at all, Partnerships must understand and genuinely collaborate with the incredible resources around them to get palliative and end of life care to everyone in need.