Looking at palliative care ambitions for Scotland, there is no doubt that the Scottish strategic framework for action on palliative and end-of-life care has a bold vision. For example, the strategy asserts that, by 2021, everyone living in Scotland who requires palliative care will have access to it (Scottish Government, 2015). Now that we are in 2021, a lens on Scotland seems timely, to see if the vision has been achieved. In doing so, we can also learn lessons to improve accessibility to palliative care services for those in England.
First, it is worth looking at the fundamental pillars of the strategy and how these were implemented to include both adults and children (Scottish Government, 2015).
In order to ensure successful implementation, it is clear that a range of statutory, independent and third-sector organisations were involved in the delivery of this mission.
The central tenet to successful palliative care is to afford people and their families the opportunity for timely conversations about their care and support towards the end of their life. To do this well, skilled professionals working in palliative care are crucial, as they can identify people's preferences and needs, which can then be honoured when the time comes.
Perhaps it is too early to review the Scottish strategy as we are only half way through 2021. However, given its focus and emphasis, it is clear to see its semblance with some of England's national framework positions, such as the six ambitions listed in Ambitions for palliative and end of life care (National Palliative and End of Life Care Partnership, 2015). Both strategies advocate collaboration, cooperation and involving stakeholders to create the necessary support and improvements to drive palliative and end-of-life care to address individual people's needs. It is timely to review whether the six ambitions were implemented fully between 2015 and 2020 and what impact they have had on those approaching the end of life.
It is also worth reminding ourselves how COVID-19 has challenged both these ambitions and the Scottish Framework. While it is accepted that neither vision was completely derailed, there were elements of significant and forced adaptations to their implementation. For example, COVID-19 meant social distancing was introduced together with personal protective equipment, which created unwanted but a necessary barrier during caring in order to protect patients, but this meant than health professionals could not offer intimate, personalised care. The impact on both patients and health professionals is important to capture as we enter the post-COVID-19 recovery period.
Scottish research activities
It is evident that there was a marked increase in palliative care research studies being conducted in Scotland (Finucane et al, 2018), although only four addressed children's issues. Most of the studies preferred descriptive methodologies as a way of capturing people's experiences and stories of illness and interventions. Researching palliative care is important in order to generate new understanding, so that we can continue to improve care. Finally, it is equally important to recognise that effective palliative care is central for the wellbeing of society at large. Let us continue to learn from each other and generate new evidence to improve access and practice, while offering dignity in life and death.