A view from the sharp end Achyut Valluri Consultant in Acute Medicine Ninewells Hospital, Dundee

Improving shared decision-making within the multidisciplinary team 1 Addressing the knowledge/experience gap our doctors in training have with difficult conversations 2 Developing the role of patient liaison / advocate that our Healthcare Assistants often take on 3

We need to support people at home or other settings when admission is not in keeping with their wishes / of “overall benefit”  ensure purposeful admissions for those with advanced disease and acute events ensure good end of life care is delivered when it's needed link to fast track discharge, when wished, for community- or Hospice-based EoLC provide a space in the system for those who choose hospital

We need from policy-makers Hospital-based Palliative Care services Anticipatory Care Planning Better Training for Grief and Bereavement Care Hospital-based Palliative Care services In-reach support Dedicated specialist unit Health and Social Care partnerships Dynamic discharge planning Access to community-based resources to achieve a whole system approach at the front door of the hospital all centred around person/family’s needs/hopes/wishes + reality