People with advanced liver disease have complex end-of-life needs. Palliative care provision for these patients is often poor, with no clear national guidance for end-stage liver disease. This article describes a pilot project (n=20) conducted to assess the impact of early hospice intervention on patients' wellbeing and experience. Patients remained under acute hospital management and were seen by the hospice's specialist nurse practitioner on a monthly basis and referred into hospice services as needed. Monthly measurements of symptoms and wellbeing were taken using the Palliative care Outcome Scale (POS) and Palliative care Outcome Scale-symptoms (POS-s). Findings showed that this model of care addressed previously unmet holistic care needs, with timely interventions appearing to improve overall outcome despite deteriorating health. Indications that a shared care pathway could reduce the length of stay and cost of paracentesis, as well as the number and length of hospital admissions, led to the implementation of a more formal, larger-scale study, which is currently in progress.

The UK Department of Health's (2008) End of Life Care Strategy highlighted the need for greater public awareness around planning and the choices available as people approach the end of their life. Despite efforts to 'normalise' death and dying and recognise that they are an inevitable part of life, a taboo persists and open communication about these issues is often limited or restricted to periods of crisis. Translating national policy into meaningful local dialogue requires creative interventions that are adaptable to each community. This article explores these key themes and reports on the responses of the first 304 people to complete an end-of-life survey as part of local engagement with the general public in South West Essex regarding issues around death and dying.

This article will outline the achievements of a project group as they translate the recommendations set out in the UK National Institute for Health and Clinical Excellence (NICE) guidance on spiritual care provision in clinical practice (NICE, 2004). It was evident that there was an opportunity to offer a comprehensive, competency-based course that developed recognition of the spiritual care needs of patients with cancer and their carers. A two-day experiential programme was devised that included role play, the evidence base, theory and fun, resulting in the acquisition of tacit and explicit knowledge. The course was based around the following tenets: Spiritual issues are broader than religious ones and include a quest for meaning in the illness, resolution of old conflicts and integration of past life experiences (Barraclough, 1994). We cannot know others except by knowing ourselves (Carrither, 1992). It is hoped that by providing holistic training that stimulates the growth of an individual's spirituality and allows them to identify their spiritual needs, we can increase understanding, awareness, confidence and knowledge in ways that can have a real application within the workplace, enabling spiritual care provision to become realistically integral to care.

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The contemporary challenges associated with addressing diversity, ethnicity, equality and accessibility in today's healthcare economy, sometimes lead to a reactive response where service providers strive to apply these concepts in practice. This article describes establishing a group that could engage with the broadest spectrum of the local community in ways that would make a lasting and meaningful difference to the local population, including how individuals and groups engage with and access palliative care services. The Valuing Local Diversity in Palliative Care Group was formed in May 2006. The group, whose membership is composed of statutory and voluntary services and members of various community groups, has promoted some innovative and creative partnerships.