By Dr. Suzanne Kite, MbCHB, BMedSci, MA, FRCP
President, Association for Palliative Medicine
The Leeds Teaching Hospitals Trust
ORCiD: https://orcid.org/0000-0002-3297-1042
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The long awaited National Health Service (NHS) 10 yr plan for England has been published (1), and reactions and commentaries across the health and social care sector have been posted. There is broad support for the strength of commitment to the NHS, and the scale of ambition, particularly in prevention, digital innovation, and the shift from hospital to community. This is tempered by realism, with those who have been around a while commenting that they have seen much of this before, wondering what will be different in the approach taken this time, and questioning what has been learned from prior experience. There is concern about the scale of reorganisation of health and social care, and the capacity of the system to absorb this in times of such financial constraint and workforce challenge.
As expected, it is a high level document with little specific detail on individual specialisms, other than primary care. The palliative care community had hoped for more, particularly in light of the widespread consensus that palliative care services fall far short in availability, accessibility and quality for current population need, let alone for sustainability and resilience in the face of demographic changes. Whilst regrettable, this is familiar territory and we are skilled at looking within national policy for hooks on which to hang our service ambitions.
So, what can we draw from the NHS 10 year plan for palliative care? How does it align with our ambitions?
We know that we need to act on the evidence that end of life care is often fragmented, access and provision inequitable, and provided by under-resourced and overstretched services. The recognition and communication of deterioration or dying often comes late or not at all. The hidden costs for patients and families for being cared for at home are huge (2).
The shift from hospitals to neighbourhood-delivered healthcare is the backbone of the plan, with neighbourhood hubs promising opportunity for full integration of community palliative care, and with specialist palliative care advice supporting generalist services. Compassionate communities, third-sector partnerships, and social prescribing could really come into their own here, with opportunities for networks of volunteers to be developed and supported within and alongside statutory services. Closer adjacencies of health and social care offer the promise of greater impact on meeting people’s end of life care needs, and addressing the hidden costs of being cared for and dying at home.
The recommendations of the Commission on Palliative and EoLC provide a comprehensive road map of what is needed (3), however the following thumbnail from Prof Fliss Murtagh provides a succinct guide:
‘To meaningfully shift care from hospital to community, we must radically improve early identification of deteriorating health, invest in truly integrated and relational community care, ensure 24/7 crisis support, and improve communication so that people can plan and make informed choices about their care.’ – Professor Fliss Murtagh, ‘Time to focus on the blue dots’, RCP June 2025 (3)
The focus on prevention offers several opportunities for palliative care. The earlier involvement of specialist palliative care prevents and reduces distress. Risk stratification within primary care, to identify people needing continuity of care, should support better identification of population need and onward referral to palliative care services. Shared care records, as and when IT interoperability can be sorted out, will support future care planning.
The operating model is of devolution of commissioning and oversight from the centre to integrated care boards (ICBs), the geographies of which may be redrawn. This continues the trend of recent years, and we have seen that this reduces the likelihood of national strategies in favour of principles to be implemented more locally. This trend has been accompanied by a very variable appetite for the commissioning of palliative care services by ICBs. A major source of variability across ICBs has arisen as a direct result of historical budgets where those who have funding continue to receive it, and those who don’t have funding face monumental uphill struggles. Provider organisations will no longer sit on ICBs, and vigilance will be required to ensure that the voices of clinicians and the third sector are heard. Multi-year financial settlements will however be very welcome by hospices in particular.
The very essence of palliative care is the workforce. A national workforce review is coming later in the year, however the lack of specificity in the 10-year plan on training and retention does not reassure. A heavy reliance on digital innovation to reduce the size of the workforce appears optimistic. 1000 new specialty training posts are promised, but the detail on allocation is awaited. The Association of Palliative Medicine (APM) will be reviewing national guidance on workforce in palliative care, and will continue to support ways of increasing and developing the workforce.
There are areas to watch. Understanding proposed developments and funding within primary care, the ICBs, and regions will be crucial. The discussion on making the greatest impact possible with Continuing Healthcare funding and personal health budgets will continue. As always, learning from each other and from what is working elsewhere is vital and the APM will continue to support shared learning, including dissemination of evidence from research into changes in practice.
The greatest challenge, however, will be finding ways for palliative care to be a sufficient priority, within a sea of priorities, to attract the headspace and air-time for committed and sustained commissioning, and the managerial oversight to ensure that service improvement happens. National drivers here would be invaluable, as well as dedicated ringfenced money – neither of which are indicated in the 10 year plan, and for which the APM will continue to strive.
In conclusion, the 10 year plan does provide a sense of how services could better meet the needs of those living with frailty and long-term conditions, however there is considerable work yet to be done in imagining and realising how specialist palliative care will fit in the new landscape. An implementation plan for the NHS 10-year plan is awaited in the coming months, and it may still be possible to shape this. The APM will continue to fight for a national strategy for palliative care, with funding, not least to mitigate the impacts of implementation of any assisted dying legislation. Clearer service specification, and benchmarking of quality and accessibility of palliative care services must be developed.
If you are interested in learning more about the work of the APM or the benefits of becoming a member visit www.apmonline.org
References
- DHSC 10 Year Health plan for England: fit for the future (3 July 2025) 10 Year Health Plan for England: fit for the future – GOV.UK
- Royal College of Physicians (July 2025) ‘Time to focus on the blue dots’: an RCP workshop discussion on the NHS shift from hospital to community | RCP
- Finlay, I., Richards, M., Maskell, R., et al. (2025). Palliative Care and End-of-Life Care: Opportunities for England (Volume 2), The Commission on Palliative and End-of-Life Care, 2025. Commission on Palliative and End-of-Life Care
Declaration of interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am the President of the Association for Palliative Medicine of Great Britain and Ireland.