Currently, around 56% of people die in hospital, 20% at home, 20% in nursing or residential homes and 4% in hospices. Yet surveys suggest that the majority of people would prefer to be supported to die in their own homes. We note the recent economic analysis which Marie Curie has produced of the potential cost benefits arising from a shift towards more patients dying at home and recommend that the Department assesses this carefully. We welcome the fact that the Government is considering legislation to grant extra rights to carers and recommend that it provides for a period of paid leave for them. We recommend that the Department reviews the place of domestic support within the spectrum of social care services and ensures that people's needs for domestic help are adequately met. We were concerned to note the variation in the criteria for continuing healthcare between Strategic Health Authorities and recommend that national criteria for continuing care should be developed. Many of our witnesses drew our attention to disputes between health services and those providing personal social care for the terminally ill. Unseemly arguments about who should pay for different elements of a care package are especially abhorrent in palliative care, and we call for an integrated structure in the delivery of care. We also seek the inclusion of hospices or specialist care units in the ambit of the Community Care (Delayed Discharges etc.) Act to ensure that higher priority is not attached to other patients in dealing with delayed discharges.

We note a wide range of inequities in the current provision of services. There exists inequity by geographical area, where need and provision are not well matched; inequity by patient group, with particular problems in services dealing with patients in transition from children's to adult services, older people, patients with complex needs, and patients from black and minority ethnic communities; and most fundamentally, inequity by disease group, with cancer being by far the commonest disease for which patients receive palliative care. We call on the Government to consider what more can be done to inform Primary Care Trust commissioning of palliative care by issuing clearer guidance on preferred models of care, and to obtain better data on where services are provided and where they are needed. We hope that the forthcoming National Service Framework (NSF) for Children will acknowledge the particular difficulties of the transition from adolescent to adult services. In order to make palliative care services available to a broader range of users we believe it is important that attention is paid to the need for palliative care services in the community. To try to remove some of the 'disease bias' towards cancer we recommend that the forthcoming NSF for Long-Term Conditions should assume responsibility for palliative care in non-cancer conditions and take full account of the recent National Institute for Clinical Excellence (NICE) guidance. It should incorporate the key principles of the NICE guidance as far as possible in order to remove the distinction that is made in the palliative care of cancer patients and of those patients dying from other diseases.

There are significant challenges in raising the skills of healthcare staff, and we urge the Royal Colleges to ensure that training in palliative care becomes part of continuing professional development and to consider making such modules a requirement for revalidation. We recommend that the Department encourages local champions to develop the uptake of proven tools for addressing the needs of those receiving palliative care, which would also promote better communication between health professionals, carers and patients. We also recommend that the Government urgently reviews the regulatory inconsistencies in palliative care services.

Turning to resources, we applaud the ambitious goal the Government has set to double the number of palliative care consultants by 2015; shortfalls in other relevant staff will also need to be addressed. We welcome the additional £50 million the Government has directed to the development of specialist palliative care services. The Treasury's cross-cutting review has set a deadline of 2006 by when statutory agencies will be obliged to meet the full costs incurred by the voluntary sector in providing public service. We hope that the fact that the state will bear more of the cost of provision can be used as an opportunity to ensure greater equity of provision.

Finally we believe that the right to a good death should be fundamental and that social attitudes contribute to problems in helping people achieve this. We hope that the Department for Education and Skills will address this area by examining the place of death education within the curriculum and within teacher training.