Background Despite 500,000 deaths p.a. in England and Wales, the National Nurse Consultant Group (Palliative Care), National End of life Programme and Department of Health identified inconsistencies and disagreement about the care of the adult who has died.

Aim To produce nationally, multi-professionally agreed guidance, that (A) was sensitive to roles/responsibilities of health/social care professionals (B) offered clarity ensuring consistency of care and appropriate training.

Methodology Using a consensus approach, four rounds of decision making occurred (Jones et al 1995). The National Nurse Consultant Group (Palliative Care) provided advice on the only clinical benchmark The Royal Marsden Guidelines (Dougherty and Lister 2008) (round one). The guidelines and advice were broken into statements. Fifty national stakeholder organisations were invited to comment, provide evidence or identify aspects of care not covered. Thirty-five organisations responded. Statements were amended where there was consensus or legal guidance (round two). The second round demonstrated areas of little evidence or consensus for example, containing leakage, identification, or preparation of the deceased. A national stakeholder event discussed these issues (third round of consensus) and outcomes were incorporated and re-circulated (round four of consensus). Over one hundred individuals representing national organisations took part in ‘Guidance for staff responsible for care after death (last offices)’, issued in April 2011, with the endorsement of the Royal College of Nursing and the Royal College of Pathologists. Feedback is that the guidance is welcomed and well received.

Conclusion Consensus methodology is helpful and systematic in developing national guidance when the evidence base is disparate and poor, as it draws together professionals enabling debate of clinical knowledge (as source of evidence) and illuminates benchmarks for clinical quality.