Relieving pain is at the core of medicine. There have been enormous advances in controlling pain and other symptoms that affect people at the end of their lives. Yet thousands in Scotland who could benefit from palliative care are not receiving it.

Relieving pain is at the core of medicine. There have been enormous advances in controlling pain and other symptoms that affect people at the end of their lives. Yet thousands in Scotland who could benefit from palliative care are not receiving it.

According to an Audit Scotland review of palliative care services, this is largely due to the lack of a national strategy on access to good quality care. The availability of effective care for people with incurable conditions varies widely, from area to area and according to patients' circumstances. Those over 75 or suffering from conditions other than cancer are much less likely to receive this care. Specialist terminal care has tended to be concentrated on cancer patients, but assumptions that they are the largest group to benefit from it are woefully misplaced. Cancer accounts for 30% of deaths, but cancer patients receive 90% of palliative care. Better access to specialist services for patients with other chronic illnesses who are nearing the end of their lives is urgently required, particularly if we are to meet the needs of the growing number of people suffering from dementia and chronic obstructive pulmonary disease (COPD).

Audit Scotland has calculated that only 12% of people with potential palliative care needs had these identified and recorded by their GPs. That is partly because of the way palliative care services have developed, with much of the pioneering work carried out by charities caring for cancer patients (half of the £59m spent on specialist palliative care services last year came from the voluntary sector). The extent to which health boards buy in services from the charities varies widely, contributing to the uneven nature of provision.

Advances in treatment have tended to overshadow those areas of the health service that provide care rather than cure. Yet improving the quality of life of people with chronic illnesses makes an enormous difference to patients and their families. As lead cancer clinicians have pointed out, quality of life during and after treatment is what matters. According to the Scottish Government, palliative care should be available to anyone suffering from a life-threatening illness from diagnosis onwards. Audit Scotland has revealed how much still needs to be done. Better coordination and communication between different parts of the NHS and other providers, allied to a fair system for referring patients to services, must be the priorities for the palliative care action plan due this autumn.