The state of UK palliative care - time for change at scale and pace.

After 60 years of development, palliative care services are fully embedded in local communities, raising awareness, delivering care and often also relying on local fundraising. Specialist palliative care teams are integrated within primary and community care services, as well as acute hospitals. Palliative care is shown to be cost effective, improving patient experience and reducing acute hospital bed days, saving money for the health service as long as patients access services early enough to make a difference. Unfortunately across the country, services are patchy with significant inequalities due to a lack of universal funding, clear outcomes and accountability. The likely implementation of Assisted Dying Bills brings to a head the likelihood that services that assist people to die will be available on the NHS, but not those services assisting people to live. The specialty is ready to embrace the shifts to community-based, preventative care driven through technological change. Palliative care has always been innovative and agile, focused on problem solving, relationship building and personalised care. Political leadership now could truly unlock the care of those towards the end of their life. A fully funded palliative care service with a clear national service framework backed by clear outcome measures could transform the quality of palliative and end of life care, offering patients real choice and true 'cradle to grave' care. With that in place, palliative care is ready to respond at a scale and pace not previously seen.