Each year, more than 500,000 people die across England and Wales – a number projected to rise significantly by 2040. Wales, with its older population profile and large rural communities, faces particular challenges in meeting this growing need. Most people will require some level of palliative care during their lives, yet too many still struggle to access timely, specialist support close to home.
In 2025, Wales saw major developments aimed at improving this picture. The Welsh Government published a new National Service Specification for Palliative and End of Life Care (PEoLC), setting out a clear vision for equitable, person centred care. Health Education and Improvement Wales (HEIW) also launched the All Wales Competency Framework, providing a multidisciplinary standard for the knowledge and skills required across nursing, medicine, allied health professions, pharmacy, psychology and paramedicine.
These are important steps and the changes demonstrate Wales’ intention to deliver more equitable, person centred and data driven PEoLC, while also exposing gaps requiring urgent transformation, but the reality on the ground remains deeply challenging and demand for services outstrips capacity.
Marie Curie Cymru’s Wales at Breaking Point report (2025) highlighted the scale of system strain, revealing that nearly one in five hospital beds in Wales are occupied by people in their final 12 months of life, costing NHS Wales an estimated £1.3m per day. Delays in social care packages are contributing to extended hospital stays, while personal testimonies expose significant gaps in integration between health and social care, particularly in rural areas.
Hospices and community services, which play a vital role in supporting people to die in their preferred place, continue to face financial instability and rising demand. Without sustainable funding and a strengthened workforce, inequities in access will only widen.
The role of nursing staff
Nursing staff are central to delivering compassionate, dignified end of life care in hospitals, care homes, hospices or people’s own homes. But to meet rising need, nurses require protected learning time, adequate staffing and investment in community and specialist services.
While debates continue across the UK about assisted dying, it is vital that everyone has access to high-quality palliative and end of life care. This year’s RCN Congress resolution calls on RCN Council to lobby UK governments to ensure that everyone, in every nation, can access the palliative and end of life care they deserve.
Kiera L Jones, Lead Nurse at Skanda Vale Hospice, said:
"We only have one opportunity to get it right when it comes to end of life care, and the impact of that experience – positive or negative – can have a lasting effect on a grieving family.
“There’s a focus on 'preferred place of care and death' for palliative and end of life patients and if this cannot be honoured, due to pressures on services and resources, then patients are being failed. We need greater investment in end-of-life services to ensure that care provision and standard is equitable across the UK.
“I’m passionate about palliative and end of life care, and I know from experience that in order to continue to provide an excellent standard of care, staff working in palliative and end of life care need the right support, resources and wellbeing services to do this and to do it well."
Emma Saysell, Chief Executive and Director of Nursing at St David's Hospice Care, said:
“Access to palliative and end of life care is an increasing concern, as we know demand for our services will increase significantly over the next two decades.
“Palliative and end of life care nursing is an extremely rewarding area of nursing. Having the skills and qualifications to provide high quality, compassionate care is a privilege.”
Viv Cooper, Head of Nursing, Quality & Safety, and Sam Clements, Associate Director of Nursing & Quality at Marie Curie Cymru, said:
“Almost 1 in 3 people don't get the end-of-life care and support they need. End of life care in Wales needs urgent change to stop more people missing out.
“As the UK’s leading end of life charity, Marie Curie colleagues see daily the impact personalised and compassionate palliative and end of life care can have on people who are dying, and their loved ones. Our staff provide hands-on personal care and emotional support and have open discussions about making end of life plans when it is appropriate. There are gaps in care and the system is under severe pressure which means that too many people spend their final days isolated or in an environment they wouldn't choose to be in.
“Urgent action is needed to ensure better access to care and support in communities across the country. Truly transforming end of life care means making sure people and their families can access the care they need, in the place of their choice at the right time.”
Looking ahead
As Congress debates this important resolution, RCN Wales will continue to champion fair access, sustainable funding and a well supported nursing workforce. With demand set to rise sharply in the coming years, urgent action is needed to ensure that people in Wales can receive compassionate, high quality care at the end of life – wherever they live, and whatever their circumstances. Everyone in Wales deserves high quality care at the end of life; we will continue to press for the investment and action required to make that a reality.
