Looking back, looking forward: the evolution of palliative and end-of-life care in England

Palliative and end-of-life care in England has undergone some remarkable transformations across the course of less than half a century and can be seen as a useful case study with which to understand international trends and challenges. This paper examines some of the long term influences which led to the emergence, for the very first time, of an End-of-Life Care Strategy in England. It revisits the critical contribution of Cicely Saunders to the development of a theoretical framework for palliative care before examining the gradual and as yet incomplete transformation of ‘palliative care’ into ‘end-of-life care’ which is occurring internationally. The paper then turns to examine two key challenges in contemporary end-of-life care, looking at how these are being addressed in England and forecasting the possible direction of travel in the future.