Authored by Ian Binks, UK&I Business Development Director

In October’s budget, the government promised more than £2 billion to upgrade NHS technology, making it fit for the future and helping to address three critical shifts: moving from analogue to digital, hospital to community care, and sickness to prevention.   

One powerful way to support these goals is by delivering truly connected care. This ensures patients receive the right support at the right time and that all health and social care professionals are working from the same information, creating a unified approach to patient care. This is particularly important for those with complex or sensitive needs, such as during end-of-life care planning.   

For care planning to have a meaningful impact, information must flow seamlessly across the health system. End-of-life care planning is a prime example of how connecting care can improve care delivery during an incredibly stressful time by enabling patients to document their wishes regarding treatment, interventions, and comfort measures.   

But where is the best place to host these plans to make the most impact? In this article, I explore why investing in a care planning solution that integrates seamlessly into the shared care record is essential to delivering the care patients deserve and helping set our systems up for the future.  

Transforming end-of-life care 

Traditionally, advance care plans have been captured on paper or stored in standalone systems, making them difficult to access. This can lead to inconsistent care, unnecessary hospital visits, and treatments that don’t reflect the patient’s wishes. However, making them available within the shared care record changes everything and can transform how end-of-life care is delivered. Here’s why:   

  1. Centralised access for all providers  

The shared care record connects information from hospitals, GP practices, social care, and community services. Hosting end-of-life care plans here ensures every authorised professional involved in a patient’s journey can instantly access the most up-to-date plan.  

  1. Improved emergency care  

In critical moments, such as when an ambulance crew is called, instant access to a care plan allows responders to act in accordance with the patient’s wishes—for example providing treatment at home and avoiding unnecessary hospitalisation.  

  1. Reducing stress for families and loved ones  

Families don’t need to worry about carrying around a paper form and gain peace of mind knowing that the patient’s wishes are documented and followed, reducing stress and uncertainty during emotionally challenging times.  

  1. A foundation for patient empowerment  

Looking to the future, integrating care plans from shared care records into the NHS App is a critical next step. This will allow patients to view and update their end-of-life care plans in collaboration with their care team, ensuring that plans remain accurate and reflect their evolving needs and preferences.  

  1. Prepared for a connected future  

As the NHS moves toward a fully interoperable system, the shared care record ensures healthcare providers are ready to align with initiatives like the national record locator service. This will make end-of-life care plans accessible and actionable no matter where the patient is in the country, creating truly connected care.  

Devon & Cornwall Care Record leading the way  

In Devon and Cornwall, end-of-life care plans, known as Treatment Escalation Plans (TEPs), have been digitised and held within the Devon and Cornwall Care Record since August 2022. The new Electronic Treatment Escalation Plans (eTEPs) help ensure the patient’s treatment goals are clearly developed, understood, and accessible to all members of the care team.  

Prior to eTEPs, the region faced challenges with its existing paper-based processes, including a lack of visibility as to where the TEP was located, poor data quality, illegible handwriting, and multiple and conflicting plans for patients. This led to risk-averse behaviours in escalation situations, poor health outcomes, and additional pressures on the system.   

By introducing the digital solution accessible within their shared care record, they are reducing unnecessary emergency admissions, making better use of their acute capacity, alleviating pressure on primary care, improving the patient experience and minimising distress for patients and their families.   

As of December 2024, 18,796 eTEPs have been created with 47,691 views of the existing eTEPs, and the number is growing daily. User feedback has been overwhelmingly positive, with users describing the solution as immediately game-changing, making the often-difficult task of affecting behavioural change relatively easy.   

My call to action 

Taking Devon & Cornwall as a great example, the NHS can move one step closer to delivering its commitment to building a more connected health service by embedding advance care planning into the shared care record. Furthermore, integrated care planning directly impacts the three critical shifts by moving from analogue to digital, enabling care in the community rather than the hospital where appropriate, and focusing on prevention rather than sickness.   

The benefits are clear: reducing demand on services, improving the patient experience and empowering care teams to make better decisions. This investment not only maximises the value of current digital infrastructure but also lays the groundwork for a health service fit for the future.   

Now is the time to act. By integrating care planning into the shared care record, we can create a healthcare system that is connected and truly patient-centred. Let’s take the next step in building a seamless, compassionate future for care delivery.