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

3. Improving shared decision-making within the multidisciplinary team1
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

4. 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

5. 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