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Using a public health approach to improve end-of-life care: results and discussion of a health needs assessment undertaken in a large city in northern England
  1. Kathryn Ingold1 and
  2. Fiona Hicks2
  1. 1Department of Public Health, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  2. 2Department of Palliative Care, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  1. Correspondence to Kathryn Ingold, Department of Public Health, c/o Leeds Teaching Hospitals NHS Trust, Trust Headquarters, St James’ Hospital, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK; kathryn.ingold{at}


A detailed health needs assessment (HNA) for end-of-life care (EoLC) services was led by public health in Leeds to inform a commissioning strategy. To answer the question: are we delivering the best possible EoLC services within the resources available? Mixed methods were used with three approaches: epidemiological, corporate and comparative. More people from deprived communities die in hospital. 18% of people who die each year are on a palliative care register, reflecting a lack of recognition and planning for EoLC given that 75% of people who die need EoLC. Over 100 staff, patients and carers were interviewed and over 200 staff returned questionnaires. Staff highlighted concerns about capacity of services; pressure on out-of-hospital care; problems at physical and electronic interfaces between services; suboptimal hospital discharge; need for earlier recognition of the EoL stage for patients. Patients and carers stressed the importance of communication, coordination and continuity of care; full involvement in care planning; honesty and support for the bereaved; an advocate for patients and families; accessible information; improved urgent care; integrated team working; pain relief, dignity and respect. Issues from comparator sites included the need for sustainable leadership for change, lack of interoperability between IT systems; building advance care planning into working culture; gaps in psychological services, bereavement and pastoral support; integration within all clinical areas; lack of district nurses; few investment opportunities; getting home care support right; concerns about 111; incentives for general practitioners to deliver EoLC; variability in service and the Liverpool Care Pathway controversy. Ethical approval was not sought as the HNA was undertaken as a service evaluation. Local policy is that ethical approval is not required for service evaluation.

  • palliative care
  • public health
  • needs assessment

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