Ambitions for palliative and end of life care: mapping examples of use of the framework across England

Abstract

Background Since 2015, the Ambitions for Palliative and End of Life Care: a national framework for local action has provided guidance for care within England and beyond. Relaunched in 2021, the Framework sets out six Ambitions which, collectively, provide a vision to improve how death, dying and bereavement are experienced and managed. However, to date, there has been no central evaluation of how the Framework and its Ambitions have been implemented within service development and provision. To address this evidence gap, we investigated understanding and use of the Framework. Methods An online questionnaire survey was conducted to identify where the Framework has been used; examples of how it has been used; which Ambitions are being addressed; which foundations are being used; understanding of the utility of the Framework; and understanding of the opportunities and challenges involved in its use. The survey was open between 30 November 2021–31 January 2022, promoted via email, social media, professional newsletter and snowball sampling. Survey responses were analysed both descriptively, using frequency and cross-tabulations, and exploratively, using content and thematic analysis. Results 45 respondents submitted data; 86% were from England. Findings indicate that the Framework is particularly relevant to service commissioning and development across wider palliative and end of life care, with most respondents reporting a focus on Ambition 1 (Each person is seen as an individual) and Ambition 3 (Maximising comfort and wellbeing). Ambition 6 (Each community is prepared to help) was least likely to be prioritised, despite people welcoming the focus on community in national guidance. Of the Framework foundations, ‘Education and training’ was seen as most necessary to develop and/or sustain reported services. The provision of a shared language and collaborative work across sectors and partners were also deemed important. However, there is some indication that the Framework must give more prioritisation to carer and/or bereavement support, have greater scope to enhance shared practice and mutual learning, and be more easily accessible to non-NHS partners. Conclusions The survey generated valuable summary level evidence on uptake of the Framework across England, offering important insights into current and past work, the factors impacting on this work and the implications for future development of the Framework. Our findings suggest considerable positive potential of the Framework to generate local action as intended, although difficulties remain concerning the mechanisms and resources necessary to enact this action. They also offer a valuable steer for research to further understand the issues raised, as well as scope for additional policy and implementation activity.

Small Steps, Big Vision: using multi-stage qualitative research to develop a grab-and-go guide to support utilisation of the Ambitions for Palliative and End of Life Care framework

“…However, its understandability was questioned, and concerns raised regarding the Framework’s limitations as non-mandatory guidance, as well as potential to increase inequalities nationally. Our recent survey of PEOLC providers [ 14 , 15 ] found a similar pattern of understanding. Although the Framework was endorsed as a validation of the importance of PEOLC and statement of excellence in provision, uncertainty over how this excellence might be achieved was evident.…”

“…Stage 1 involved 17 in-depth case study interviews with participants who had used the Framework in local service development. Participants were identified from the previous mapping survey [ 14 , 15 ] and/or invited by the research team, purposively selected for diversity in terms of locality, setting and type of work undertaken. Interviews were selected for the case study component to enable participants dedicated, confidential time to discuss the Framework, their service/practice, and other issues they considered relevant to implementing policy/guidance or service development.…”

“…In addition, concerns were raised that differential uptake of the Ambitions would exacerbate local-level inequalities in provision. Our survey [ 14 , 15 ] also demonstrated a clear desire from practitioners for support to help address identified challenges, particularly concerning implementation of the Ambitions.…”