Is end-of-life care a priority for policymakers? Qualitative documentary analysis of health care strategies

BACKGROUND: Prioritisation of end-of-life care by policymakers has been the subject of extensive rhetoric, but little scrutiny. In England, responsibility for improving health and care lies with 152 regional Health and Wellbeing Boards. AIM: To understand the extent to which Health and Wellbeing Boards have identified and prioritised end-of-life care needs and their plans for improvement. DESIGN: Qualitative documentary analysis of Health and Wellbeing Strategies. Summative content analysis to quantify key concepts and identify themes. DATA SOURCES: Strategies were identified from Local Authority web pages and systematically searched to identify relevant content. RESULTS: In total, 150 strategies were identified. End-of-life care was mentioned in 78 (52.0%) and prioritised in 6 (4.0%). Four themes emerged: (1) clinical context – in 43/78 strategies end-of-life care was mentioned within a specific clinical context, most often ageing and dementia; (2) aims and aspirations – 31 strategies identified local needs and/or quantifiable aims, most related to the place of death; (3) narrative thread – the connection between need, aim and planned intervention was disjointed, just six strategies included all three components; and (4) focus of evidence – where cited, evidence related to evidence of need, not evidence for effective interventions. CONCLUSION: Half of Health and Wellbeing Strategies mention end-of-life care, few prioritise it and none cite evidence for effective interventions. The absence of connection between need, aim and intervention is concerning. Future research should explore whether and how strategies have impacted on local populations.