Assuring good deaths at home

Due to the COVID-19 pandemic, the UK has experienced the highest rate of death in many years. At the same time, there has been a marked change in the place of death, with a 67% increase in deaths at home during the first wave of the pandemic; this was sustained at lower levels during the second and third waves (O'Donnell et al, 2021). The circumstances of these home deaths and the quality of the end-of-life care offered has not been reported, but it is well documented that many primary care consultations became remote rather than face-to-face during the pandemic. This change reflected those occurring in many areas of clinical practice and care delivery, both to minimise infection risk and to maximise limited resources.

Prior to the pandemic, much palliative and end-of-life care was oriented towards supporting people with cancer rather than non-malignant conditions and frailty, despite the growing needs of those with complex multi-morbidities and frailty who are living longer (Polak et al, 2020). The National Institute of Health and Care Excellence (NICE) (2019) guideline provides service and practice recommendations for all those approaching the end of their lives; this is augmented by another earlier guideline (NICE, 2015) which focuses upon best practice provision during the last few days of life, including access to appropriate symptom control through anticipatory prescribing. Bowers et al (2021) have described the challenges of providing end-of-life care during the pandemic, many of which district nurses overcame through their innate flexibility and creativity, to ensure that their clients' needs were given primacy. They also identified opportunities for new ways of working and for nursing roles in the community within end-of-life care, which may become embedded post-pandemic when services have a chance to regroup and reflect upon what worked well and what changes are needed to further enhance the delivery of high-quality care.