Letters

3which states ‘Almost half of complaints about NHS services related to acute hospitals. Of these, 54 per cent related to the care given at the end of life’, citing a report from the Healthcare Commission 4 as the primary source. However, I cannot locate specific data or a supporting reference within that report. This figure on hospital complaints regarding end of life care, which has been cited widely, should therefore not be taken as representative until more definitive data are confirmed. I highlight this repeated citation of a potentially misleading statistic to emphasise the need for urgent work to ensure that future strategic developments in palliative and end of life care are supported by accurate, timely and useful data that will drive improvements in the quality of care. While there has been significant progress made to enhance awareness of palliative care in recent years, the problems with reliable implementation of the Liverpool Care Pathway act as a reminder that the development of action plans, resources and guidance will not lead to the pace and scale of improvements that will be required in the future. Living and Dying Well 5 has not delivered all the changes needed – a new approach to support change will be required, supported by implementation and improvement science, informed by unprecedented levels of national dialogue about care preferences when cure is no longer an option and models of care that address the medicalisation of death and dying. 6 A different approach to support change will, I believe, provide the conditions for a more sustainable system within which physicians can connect more readily with their professional values and deliver change that will see high quality palliative and end of life care be delivered for more people, more often and more consistently. The Scottish Government will be publishing a Strategic Framework for Action for Palliative and End of Life Care later this year to support this. The framework will set out objectives and priorities to guide our collective focus, link with national clinical strategic priorities and connect this work more explicitly with the vision beyond 2020 for health and social care in Scotland. All of this will be linked with the Scottish Government’s strong track record of emphasising assets, co-production and improvement, including the links to The 3-Step Improvement Framework for Scotland’s Public Services. 7