End-of-life care services are typically funded and delivered by a mix of organisations from the NHS, local authorities and the voluntary sector as well as by independent agencies and through individual means (informal or family carers).

Given the growing complexity of and demands on end-of-life care services, commissioning in this area is likely to be one of the more challenging tasks facing the new clinical commissioning groups. Commissioners need to be aware of and understand the options they have for funding end-of-life care at a local level. However, little is known about what works in the commissioning and provision of end-of-life care. This paper seeks to address this – highlighting current barriers in funding and commissioning as well as the opportunities commissioning offers.

The particular issues that make end-of-life care so important for commissioners include:

• demographic changes are leading to an increase in the number of deaths but also to the number of people living with complex and co-existing diseases
• the government’s end-of-life care strategy emphasises that end-of-life care is a local commissioning priority
• the fact that several monitoring and incentive programmes are aimed at improving the quality of care.

Using objective information and interviews with a small group of commissioners, managers and clinicians the paper outlines issues around the current commissioning of end-of-life care including funding and the existence of a range of different contract arrangements and outlines the difficulties facing commissioners – for example, difficulties in defining end of life, calculating costs, specifying expected outcomes.

The coalition government has continued to emphasise personalisation of care (and patient choice), clinically led commissioning and integration of care. Drawing on the available evidence and the interviews on these topics, the paper looks at examples, what is already known and what lessons commissioners can learn.

Rachael Addicott, Jenny Hiley. Issues facing commissioners of end-of-life care (PDF). King’s Fund, 29 Sep 2011.