The changing patterns of disease and growth in demand for palliative care services will necessitate new approaches to service provision at end of life. As demand and expectations for good palliative care increases, resources will need to be allocated efficiently while maintaining high-quality and effective outcomes. To achieve this, reforms will be needed at multiple levels. Service delivery models and interventions will be needed that ensure end of life services are organised and supplied based on population need rather than local interest. Robust methods for measuring consumer and carer experience and outcomes of end of life care will also be required to enable tracking of performance over time to inform local and national improvements. Such reforms will depend on sustained efforts to build and enhance the capacity of all relevant sectors in health and human services to provide quality palliative care, as well as efforts to develop the community’s capacity to participate effectively in decisions about end of life care.