End of Life Care Together


Existing organisations with an interest in ensuring the provision and quality of end-of-life care in Highland have been meeting for several years under the auspices of the Highland Palliative and End of Life Care Leadership Group.

This group has two aims:

  • To highlight and prioritise key issues around end-of-life care delivery
  • To identify key improvement strategies for end-of-life care

As part of this second aim, it was proposed that a collective partnership form with a focussed aim of improving palliative and end-of-life care for everyone across the Highlands in their last 12 months of life.

This led to the formation of the End of Life Care Together partnership. The founding partners were Highland Hospice, NHS Highland, Marie Curie and Macmillan.

This partnership has established a three-year service development and quality improvement project led by a dedicated Clinical Program Manager and Clinical Lead.

An Innovative Approach

This is a novel collaboration with organisational lead from Highland Hospice, who are investing £1.5m in developing the project, and with NHS Highland providing strategic focus. The collective partnership are committed to delivery of the project, investing resource, capacity and time with an aim to prove that a successful and cost effective model of care delivery can be developed.

The initial three-year project is being carried out with embedded evaluation to demonstrate the value of the innovative approach and with the aim of ensuring the long-term sustainability of the model.

There is commitment across the partnership to take the learnings from the initial three years and establish a service going forward that improves equity and service provision for those in the last year of life across the whole region.

Key Aspects of the Service

The project has a multi-faceted, population approach to service improvement taking into account health, social care, voluntary, and community supports that enable optimal availability and access to community resources for those in the last year of life.

This involves:

  • screening and better identification of those at risk of dying in the next year
  • a single electronic plan of care with read and write accessibility across health and social care providers, and with patient / family access
  • a coordinated helpline accessible to patients, families, carers and professionals
  • an increase in the provision of community care whether this be through structured statutory services or through community and voluntary supports

The aim is to simplify access to support while increasing the quality of community resource for this population.

Based on Best Practice

Although unique to Scotland, the End of Life Care Together partnership have based their project on work undertaken elsewhere in the UK, including:

The My Care Choices Register in North Essex

The Coordinate My Care Urgent Care Plan in London

Making Contact

For further information, please contact Michael Loynd, Macmillan Clinical Programme Manager, End of Life Care Together by email at michael.loynd1@nhs.scot.

Palliative Care Helpline

Our palliative care advice and support helpline will soon be available 24/7. You can find out more here.