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A GOOD DEATH: THE ROLE OF THE LOCAL AUTHORITY IN END OF LIFE CARE

IF PEOPLE want to die in their own homes then housing, be that affordable orrented, must play a much larger role in the delivery of end of life care. It’s ashared agenda in which an enhanced role for housing providers and localauthorities is key to unlocking the door to a system that reflects people’s wishesand not bureaucratic boundaries.

With at least one fifth of NHS spending1 relating to end of life care and large amounts ofdata to support the claim that end of life patients often access GP and acute services whengreater support at home would meet the needs they present to doctors with, the potential fora significant improvement in the quality of care alongside savings is self-evident.

But that requires a different way of working. We must overcome the difficulty of silo-workingand separate budgetary streams that only serve as barriers to delivery.

The survey results are reflective of the debate going on within the sector. There is a concernthat existing schemes will not be able to cope in the future. But equally there is also realoptimism with three quarters of respondents seeing a role for councils in commissioning anddeveloping end of life services.

Within Health and Wellbeing Boards local authorities have a leadership role both in raisingawareness of the end of life care agenda and promoting new ways to increase levels ofhome care which can deliver better outcomes for patients and savings for the taxpayer.

As a major social landlord and the UK’s largest provider of care and support services wehave used our experience and expertise to make practical arrangements and choices whichhave allowed individuals to remain in their own homes for as long as possible. Workingtogether with local authorities care providers now have the opportunity to make sure thesame opportunity is shared more widely.

Rachael ByrneExecutive Director of Care and SupportHome Group

Forewords

1 Dying for Change, Charlie Leadbetter and Jake Gardner, Demos (2010)

WE DON’T talk much about dying. Despite it being one of the few universalelements of the human experience we tend to shy away from it as a topic ofdiscussion. Our fears, let alone our hopes or expectations of dying are rarelyaired. Often it is seen as the province of religion or poetry rather than of public policy.

This report is part of a wider effort to change this. We know, as this research points out, thatpeople do in fact have strong preferences about how and where they die, but few of us areable to realise them. For instance two-thirds of people would prefer to die at home but onlytwo out of ten actually do. A majority of respondents to this research thought that theircouncil’s existing arrangements for end of life care would be inadequate for the future, andless than four in ten were confident that people could effectively plan their end of life care.

Why do we fail so abjectly to give people the deaths they want? This may not seem like anobvious question for local government, but only because we have to a large extentmedicalised our view of the end of life. This too is odd: there is, after all, no cure for death.As this report shows many of the factors that affect the quality of people’s deaths: goodhousing, integrated social care, support to stay in their homes, fall within the purview of localauthorities.

At LGiU we believe that the role of good local authorities is increasingly to help people buildthe resilience and capacity to manage their own well being throughout their life course.Dying may not be the part of the life journey we most want to think about, but we must notneglect it. That’s why it’s so important that local authorities consider the findings of thisreport so that they can give people more choice about how they spend their final days.

Jonathan Carr-West Policy DirectorLGiU

4 The role of the local authority in end of life care LGiU

Our survey of local authorities showed that:

l Six out of 10 local authorityrespondents thought that theirexisting end of life carearrangements would not be sufficient in future.

l Four out of 10 thought that Healthand Wellbeing Boards should leadon end of life care in future.However, only three out of 10 saidthat their shadow Health andWellbeing Boards had identified endof life care as a priority.

l Progress made on end of life carevaried considerably across thecountry, but 60 per cent ofrespondents said that their authorityintended to develop their role inpromoting better end of life care infuture.

There were three main conclusions from the findings:

l There is a need for more work toraise awareness in local governmentin relation to end of life care. Oursurvey results suggested a level ofuncertainty and confusion about theagenda among a significantproportion of council respondents.

l There are opportunities for localauthorities to take greater ownershipof end of life care. Councils have animportant role to play in deliveringand commissioning services, and incoordinating partners locally, butsome responses suggested that thehealth service is still regarded asholding primary responsibility for endof life care.

l Housing could still be betterconnected into this agenda. Lessthan a quarter of respondentsagreed that housing works closelywith social care on end of lifeprovision, despite its often crucialrole in supporting quality of lifeoutcomes.

SummaryThis report considers the role of local authorities in end of life care. While the healthsector has taken a strong lead role on this agenda in recent years, the engagement oflocal authorities has been more mixed. Nevertheless, many of their core services,including social care and housing, are important components of a high quality approach toend of life care. In the context of major reform to the framework of health and social care,councils are considering how they can move forward with the agenda.

5LGiU The role of the local authority in end of life care

Research shows that 70 per cent of adultswould like to be cared for and die in theirown home.2 But the great majority of us stilldie in hospital. Neither are future projectionsfor this matter encouraging. In 2008, leadingacademics forecast that demographic trendscould lead to 90,000 more people dying ininstitutions by 2030, with fewer than one in10 dying at home by 2030. More recentresearch has been cautiously encouraging,suggesting a slow reversal of this trend.3Nevertheless, it will be difficult for progressto keep pace with our rapidly increasingannual number of deaths, which is expectedto rise by 17 per cent from 2012 to 2030.

These figures have urgent implications forboth the quality and cost of care, and raisereal questions about the role of housing inthe provision of end of life care, as well asthe integration of health and social care inthis area.

Despite this, media attention of end of lifecare issues has been strongly focused onissues of assisted dying and, more recently,the Liverpool Care Pathway. Less publicattention has been given to broaderquestions of quality in end of life care, andthe integration of health, social care andhousing.

The issue

Progress to dateIn health circles, there has been a strongemphasis on end of life for several years.The Department of Health launched its 10-year End of Life Care Strategy in July 2008,followed by a Palliative Care Review in June2011. Palliative care pilots based on therecommendations of the review are nowunder way in 11 areas of the country.

Nevertheless, end of life care is not theconcern of the health sector alone. Localauthorities also have a key part to play,through their provision of social care. In theirbroader role as place shaper, they alsoprovide local leadership and are importantplayers in bringing together public servicesin a locality.

And of course their increasingly prominentrole in housing is vital to this agenda. Inmany cases simple adaptations and supportcan help people to remain in their own

homes for longer, and councils can play animportant role in ensuring that health, socialcare and housing are all equally engaged indelivering end of life care.

The need for better local authorityengagement is recognised in the work of theNational End of Life Care Programme(NEoLCP), which has promoted betterintegration between health and social care indelivering end of life care. So far their workhas included:

l Establishing a framework for socialcare at the end of life: SupportingPeople to Live and Die Well (2010).This sets out an agenda to addressthe role of social care in thecommissioning and provision ofquality end of life care.

l Appointing social care leads within

2 NatCen survey on attitudes towards dying, death and bereavement commissioned on behalf of the Dying Matters coalition (July-September 2009)

3 Reversal of the British trends in place of death: Time series analysis 2004–2010, Higginson (2010)

NEoLCP to promote the importanceof social care within end of life carework.

l Running road shows and test sitepilots to focus on the objectives ofthe framework for social care.

Local authorities have responded positivelyto the programme. A 2011 evaluation ofNEoLCP’s work showed that authoritiesvalue the support around integration ofhealth and social care, though health wasstill largely seen as leading in this area.4 Thenext steps for the Programme are toencourage councils to name their own socialcare leads who will progress the work locally,and to establish a new focus on the role ofhousing in end of life care.

Social care and housing has also beenconsidered a key part of other organisationsand charities who seek to improve palliativeand end of life care. For example, theNational Council for Palliative Care’s recentreport in conjunction with the National CareForum notes that “we need to buildcompassionate communities which supportpeople to grow older and die in thecommunity. This requires clever use ofhousing and neighbourhood design,

a long-term vision and partnership workingacross all sectors”. However, while there areseveral individual examples of innovativework among local authorities, practice on theground has been mixed.

With this in mind, now is a good time toconsider how councils are responding to theend of life care agenda.

l What level of awareness of end oflife care priorities is there nowamong local authorities?

l Are elected members familiar withwork around end of life care?

l What level of involvement is therefrom housing departments?

l What level of involvement is therefrom social care departments?

l What do local authorities regard astheir role in this agenda? Do theysee this changing in future?

l What level of integration with healthhas already been achieved, and howwill the reform of health and socialcare affect this work?


The LGiU undertook a national onlinesurvey of local authority officers and electedmembers, focusing on their understandingof the end of life care agenda, theirperceptions of the challenges andopportunities in this area and theirrelationships with other key agents in thepublic and voluntary sectors.

The survey received 135 responses,representing 91 out of 152 upper tierauthorities. Of these, 75.9 per cent were

officers (of whom 21 were directors, 35were heads of service and 27 were third tiermanagers), and 24.1 per cent werecouncillors (of whom 14 were cabinetmembers and 14 were overview andscrutiny chairs).

Just over three quarters represented adultsocial care departments, a fifth were frompublic health, and the remainder was from amixture of housing, children’s services andpolicy departments.

Research findings

4 The National End of Life Care Programme: evaluating the Programme’s work to support and promote the integration of social and health care, University of Nottingham (2011)


Key findingsl 60 per cent of respondents thought that their existing end of life care

arrangements would not be sufficient in future.

l Four out of 10 respondents thought that Health and Wellbeing Boardsshould lead on end of life care in future. However, only three out of 10 saidthat their shadow Health and Wellbeing Boards had identified end of lifecare as a priority.

l 40 per cent of respondents reported that their authority had a lead officerfor end of life care. Just over half had a local plan for end of life care, eitheron their own, or jointly with health.

l Less than a quarter or respondents agreed that housing and social careworked together on end of life care.

l 60 per cent of respondents said that their authority intended to developtheir role in promoting better end of life care.

The current position

There was evidently a level of concernamong local authority respondents with thecurrent systems of end of life care, perhapsreflecting uncertainty about the wider fundingof social care, and also about the changesbrought about by health reform. We askedpeople to agree or disagree with thefollowing statements:

l Our existing end of life carearrangements will be sufficient forthe future.

l Service users and their families inthis locality are able to plan andcontrol their end of life care.

Sixty per cent of respondents thought thattheir existing end of life care arrangementswould not be sufficient in future.

Just over a third of respondents said thatservice users and their families were able toplan and control their end of life care.However, the majority were more

ambivalent, with 35 per cent neitheragreeing or disagreeing, and 28.6 per centdisagreeing completely.

These results raise a series of interestingquestions regarding progress against thisagenda, which we will address here.

Who leads on end of life care?

There is currently some uncertaintyregarding the leadership of the end of lifecare agenda at a local level. The NHS wasstill regarded as the lead organisation forend of life care in the largest proportion ofresponses.

While there was evidence of joint workingbetween health and local authorities, withjust over 20 per cent holding a shared leadfor end of life care, the Primary Care Trust(PCT) was still identified as the lead body injust under half of the responses.

This reflects the strong lead taken by theDepartment for Health in end of life care,and the work of the NEoLCP, but it raises


potential concerns for the future of this work in the context of a shift away fromPCTs to Clinical Commissioning Groups(CCGs).

Taking this into consideration, we askedlocal authorities, who they thought shouldcoordinate end of life care in future. Justover 40 per cent identified Health andWellbeing Boards, suggesting it is widelyregarded as a shared agenda betweenhealth and the local authority.

However, 37.6 per cent said CCGs shouldtake the lead in coordinating work in this area.This may imply that for many, end of life careremains a health issue, potentially raisingconcerns that councils do not have sufficientownership of the agenda in some localities.

The division illustrated by this findinghighlights a level of uncertainty andconfusion in local government regarding theownership of the end of life care agenda,and their role within it. It raises important

questions about how we exercise democraticcontrol over the process in future.

Local authorities have a key role to play inend of life care, through their provision ofrelevant services in social care and housing,and in drawing together local partners on theissue. There is evidently a need for moreclarity in some areas of the country.

Is end of life care a priority forlocal authorities?

To establish how local authorities regardedthe end of life care agenda, we asked them:

l if they had a lead officer for end oflife care in their authority;

l if the authority had a policy or planfor end of life care; and

l whether or not their shadow Healthand Wellbeing Board had identifiedend of life care as a priority.

The local authority

The PCT

GPs

Hospitals

Hospices

Charities such as Age UK

Shared responsibility betweenthe council and the healthservice

No overall lead – different partners commission differentparts of the service

Don’t know

Other (Please specify)

11.8%

22.5%

12.7%

2.0%1.0%

2.0%

48.0%

Chart 1: Who currently leads the commissioning of end of life care in your locality?


The local authority

Health and Wellbeing Boards

CCGs/GPs

Hospitals

Hospices

Charities such as Age UK

No overall responsibility required


2.0%37.6%

4.0%

9.9%

4.0%42.6%

Chart 2: Who do you think should have overall lead responsibilityfor coordinating end of life care in your area in future?

Yes – the council has apolicy/plan

Yes – the council and healthhave a shared policy/plan

No – the council has nopolicy/plan but the healthservice has one

No – there is no policy/plan

Don’t know

15.6%

6.4%

23.9%

15.6%38.5%

Chart 3: Does your council have a plan for supporting end of life care development?


The picture was varied: over 40 per cent ofauthorities had a lead officer for end of lifecare in their area, but 30 per cent did not,and a further 30 per cent did not knowwhether or not a lead had been appointed.

The majority of respondents reported havinga plan for end of life care. In just under 40per cent of cases this was a joint planbetween the council and the health service.

In 15.6 per cent of cases the council hadtheir own plan. However, a further 22 percent indicated that the council did not have aplan, and 23.9 per cent did not knowwhether or not there was a plan.

It is encouraging that there are so many jointhealth and social care plans focusing on thisarea of work; further research into thecontents of these plans, and the way inwhich other council services such ashousing have been incorporated would be ofvalue.

However, it is also clear that a significantproportion of authorities still do not have aplan, suggesting this agenda has not beenidentified as a priority, and perhapscontinues to be regarded as the

responsibility of health. Without sufficientbuy-in from all relevant partners it will bedifficult to make further progress on thisagenda.

32.7 per cent of respondents reported thattheir Health and Wellbeing Board hadidentified end of life care as a priority, butroughly 30 per cent had not, and theremaining respondents did not knowwhether or not it had been identified as a priority.

This reflects the recent findings of researchundertaken by the National Council forPalliative Care, which has found that only 38(46%) of 83 newly created Health andWellbeing Boards with public strategies haveconsidered the needs of dying people.5

How well integrated is end of lifecare?

We asked respondents to agree or disagreewith two statements on the integration of thisarea of work.

l The health service works closelywith the council on shared provisionof end of life care.

The health service works closelywith the council on sharedprovision of end of life care

Housing and social care workclosely together on shared provision of end of life care

0% 10 20 30 40 50 60 70 80 90 100%

Chart 4: To what extent do you agree with the following statements?

Neither agree nor disagree Disagree Strongly

DisagreeStronglyagree Agree

Per cent

2.2

20.9 42.9 31.9

1.1

2.2

9.9 47.3 30.8 11.0

5 What about end of life care: Mapping England’s Health and Wellbeing Boards’ vision for dying people, National Council for Palliative Care (2012)


l Housing and social care workclosely together on shared provisionof end of life care.

Housing was clearly less integrated into endof life provision than health and social care.While nearly 60 per cent agreed, or stronglyagreed that health worked closely with thecouncil on end of life care, less than aquarter agreed that housing and social careworked together on this agenda.

However, when we later asked respondentsto identify the top barriers to better end of lifecare, only 23.8 per cent regarded housing’slack of integration as a barrier.

This suggests that the vital role played byhousing in delivering high quality end of lifecare is less recognised than the role of healthand of social care services. Housing is anessential part of the end of life care agenda.Many unnecessary hospital admissions couldbe prevented by a more integrated

assessment of housing need alongside thoseof health and social care for example.

What are the barriers to betterend of life care?

When asked to identify the challenges forend of life care provision, respondentsidentified the following barriers as their topthree choices:

l poor coordination between healthand social care (54.8 per cent)

l the need for better training in end oflife care among frontline staff (46.4per cent)

l a lack of leadership (26.2 per cent)

Interestingly a lack of political will was notwidely regarded as a prominent issue. The concern regarding coordination betweenhealth and social care is of particular

Poor coordination between health and social care

The need for better training in end of life care among frontline staff

A lack of leadership

Low levels of engagement from housing

Unwillingness to discuss end of life care on part of service users

Low levels of engagement from health

A lack of political will

0% 10 20 30 40 50 60 70 80 90 100%

Chart 5: In your view, what are the biggest barriers to theprovision of better end of life care, if appropriate?

Per cent

26.2

46.4

54.8

23.8

19.0

14.3

3.6

relevance given that more than 60 per cent ofrespondents agreed that health worked closelywith social care on end of life care in anearlier question. This suggests that althoughthere is partnership working, other factors,such as the difficulty of aligning budgets, arepreventing traction on this agenda.

Several people identified their own barriers to better end of life care, whichperhaps shed some light on thiscontradiction.

l Availability and flexibility within themarketplace. Lack of specialistcommissioned services.

l Lack of knowledge, information andunderstanding on behalf of serviceusers and family carers across health and social care.

l Need to raise awareness amongstgeneral public about end of life care.

l Lack of healthcare capacity – it isless staff resource intensive ifpatients are maintained in a hospitalor care home setting. Resources willneed to transfer accordingly.

l Better training is required for frontlinestaff employed by care homes anddomiciliary care agencies.

l There is a willingness and appetite to work together but with adult socialcare unable to provide financialresource, influence is limited.

l Professional jealousy andprotectionism.

l Out-dated working practices andemployment contracts i.e 9-5 Mon toFri services and lack of out-of-hoursspecialist provision; service gaps; aculture of paternalism and not allowingreal choice and risk-taking; underlyingpower and accountability issues.

What is the role of the localauthority in future?The context in which services are deliveredis changing rapidly as a result of reform inthe sector. With this in mind, we askedrespondents what they regarded to be themost important roles of the local authority inend of life care in future.

These results reflect a broader shiftoccurring across local government, andparticularly in social care, where mostauthorities have moved towards assessing,commissioning and monitoring, rather thandirectly delivering services.

More than three quarters regard‘commissioning and developing services’ asan important part of their responsibility inthis area. Less than half, however, wouldregard coordinating partners as an aspectof their role. This perhaps reflects theprominent role health has taken in thisagenda to date.

We would argue however, that one of themost important roles a local authority canplay, is in bringing together the wide range ofpartners and interests from across the public,private and voluntary sectors, to promotebetter coordination and awareness of theissues that must be overcome.

In their position as place-shaper in a localarea, a council has an important role inpromoting the importance of the agenda, ingenerating debate and developing sharedunderstanding.

A number of respondents wrote individualresponses to this question, including thefollowing:

“Being in partnership with health havinga shared vision and also responding touser feedback.”

“To ensure that end of life care isembedded in all existing services.”



Commissioning and developing services

Monitoring the quality of end of life servicesAssessing for support

Awareness raising

Training and education for care staff

Providing political leadership

Coordinating partners

Collating data


Holding an end of life register

No role in this agenda

0% 10 20 30 40 50 60 70 80 90 100%

Chart 6: What do you regard as the council’s role inend of life care? Please tick all that apply.

Per cent

60.7

64.0

67.4

60.7

56.2

46.1

21.3

11.2

9.0

77.5

Yes

No

Don’t know

12.4%

25.8%

61.8%

Chart 7: Does your council have plansto develop its role in end of lifeprovision in future?

“We would see social care working with health provision in the support ofan End of Life Care Pathway.”

“All the above should be a jointresponsibility with respective lead commissioners within the twoCCGs we are directly working with. It should be everybody’s business to ensure the wishes of people at end of life are respected and acted upon. Local authority cannot directly influence health staff, etc.”

Encouragingly more than 60 per cent ofrespondents said their authority had plans todevelop its role in end of life provision in thefuture, perhaps reflecting the move towardsgreater partnership working between healthand social care as a result of Health andWellbeing Boards.

The local context for end of life care variessignificantly from one authority to another.Some have established programmes of workin partnership with health services, whileothers have yet to act on this agenda. Thefindings of our survey illustrate three broadareas of work for councils in reviewing endof life care.

1) Raise awareness

There is clearly still scope to further raise theoverall level of awareness of the issuesassociated with end of life care in localgovernment.

The majority of respondents to the survey hadsome level of formal responsibility for socialcare, either as an officer, cabinet member oroverview and scrutiny chair, but more than athird of respondents did not know if end of lifecare was a priority for their Health andWellbeing Board. Around a quarter did notknow whether or not they had an end of lifecare plan and 30 per cent did not know if theyhad a lead officer for this area of work.

There was no clear dominance from eitherofficers or councillors in terms of knowledge.Nearly half of councillors responding did notknow if their authority had a lead officer forend of life care, as opposed to a quarter ofofficer respondents. But 40 per cent ofofficers did not know if their Health andWellbeing Board had identified end of lifecare as a priority, as opposed to 25 per centof councillors.

2) Take ownership

The results indicate that councils arebeginning to take a more prominent role inan area that has previously been primarilyled by health. That more than 60 per cent ofrespondents report that they plan to developtheir role in end of life provision isencouraging.

However, around 40 per cent ofrespondents identify CCGs as the leadpartner for end of life care in future, ratherthan Health and Wellbeing Boards. Thissuggests that many still regard end of lifecare as being first and foremost an issue forhealth. The work of lead officers, andelected members will be to raise the profileof the local authority as an equal partner tohealth in this agenda.

There is some level of contradiction withregard to the relationship between socialcare and health. While nearly 60 per centagreed, or strongly agreed that healthworked closely with the council on end of lifecare, ‘poor coordination between health andsocial care’ was seen as the top barrier tobetter end of life care. This may reflect thechanging relationships in this area as aresult of health and social care reform.

3) Integrate housing

Less than a quarter of respondents agreedthat housing works closely with social careon end of life provision, despite its oftenpivotal role in quality of life outcomes forpeople in receipt of care.

A recent pilot project delivered on behalf ofauthorities in Tyne and Wear by HomeGroup, has brought together housing, healthand social care services to make practicalarrangements for individuals to enable themto remain in their own home for as long aspossible. As well as reducing unnecessaryhospital admissions, and supporting betterquality of life for individuals, it has alsoshown that savings can be made byintegrating housing with health and careservices.

The renewed initiative from local authoritiesoffers new opportunities for a joined upapproach that draws in health, social careand housing.


Recommendations


Conclusion

Case study: Tom, client of a Good Deathprogramme, 2011“I’m 38 years old, married, with a two-year-old daughter and I have terminalbone cancer. Cancer Connections, part of Macmillan Cancer Support, referredme to the Good Death project just after I was terminally diagnosed whilst inhospital with an infection.

The hospital weren’t willing to discharge me as my home had six leaks in theroof, making the property damp and unsuitable for me to live in, especially asI was very poorly at the time.

I own my property but because I was unwell and without work, I was unable tokeep up with repairs or pay someone else to undertake the works for me. All I wanted to do was go home and be with my wife and young daughter as Iknew I had little time left.

Home Group worked with my family to access funding, including a grant fromMacmillan, which meant the roof could be fixed and I could return home to myfamily.

Without this support, I guess I would still be in the hospital.”

As we face the long-term challenge of anageing population at a time of shrinkingfinancial resources, it is vital that we get endof life care right. Failure to do so will result inspiralling costs for the public sector, andmore importantly, a human cost for all of uswho want to reach the end of our lives withdignity and control.

Getting it right will require good leadership,and effective coordination of local agenciesworking in this field. Councils have a crucial

part to play, both in their position asproviders and commissioners of services,and in their broader role as place-shapersand coordinators in the local area.

This research shows that progress has beenmade in some areas of the country, but thatthere is further still to go in developing a fullyintegrated approach to end of life care thatdraws in the expertise in health, social careand housing to deliver joined up,personalised services.


Bibliography

Independent evaluation of NEoLCP social care Phase 1 test sitesCentre for Housing Policy, University of York (January 2012)

End of Life Care Strategy – promoting high quality care for all adults at the end of lifeDepartment of Health (July 2008)

Where people die (1974-2030): past trends, future projections and implications for carePalliative Medicine, 22:1, 33-41. Gomez B, Higginson IJ (2009)

Dying for ChangeLeadbetter, Charlie and Gardner, Jake, Demos (2010)

A 2030 Vision: building communities and environments to support people to live and die wellNational Council for Palliative Care and National Care Forum (2012)

What about end of life care: Mapping England’s Health and Wellbeing Boards’ vision fordying people National Council for Palliative Care (2012)

Supporting people to live and die well: A framework for social care at the end of lifeNHS National End of Life Care Programme (July 2010)

TEST (Training, Engagement, Services, Transferability and sustainability): Supportingpeople to live and die well NHS National End of Life Care Programme (May 2012)

Social Care Workstream ReportNHS National End of Life Care Programme (November 2011)

The route to success in end of life care – achieving quality for social workNHS National End of Life Care Programme and the College of Social Work (July 2012)

Evaluating NEoLCP’s work to support and promote the integration of social and health care,Nottingham University of Nottingham (February 2012)

WebsitesHome Group’s Good Death programme:http://www.homegroup.org.uk/news/Documents/A%20Good%20Death.pdf

National End of Life Care Intelligence Network – Local authority profileshttp://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/la_profiles_2012.aspx

National End of Life Care Programme: http://www.endoflifecareforadults.nhs.uk/

The National Council for Palliative Care: www.ncpc.org.uk

Dying Matters: www.dyingmatters.org

22 Upper Woburn PlaceLondon WC1H 0TB020 7554 [email protected] November 2012

The LGiU is an award winning think-tank and localauthority membership organisation. Our mission is to strengthen local democracy to put citizens incontrol of their own lives, communities and localservices. We work with local councils and other public services providers, along with a wider networkof public, private and third sector organisations. The LGiU convenes the Children’s Services Network(CSN), which provides policy briefings, reports andevents for children’s services professionals.

www.lgiu.org.uk

Based in Newcastle, Home Group is one of the UK’sleading providers of affordable and supportedhousing. Through our Stonham brand the group isBritain’s largest provider of care and support services.Working in over 147 local authorities we provide highquality services which support 30,000 individuals togain and maintain independence each year.

www.homegroup.org.uk

Report author: Lauren Lucas,Policy Manager, LGiU