You can download the NHS confederation paper about cuts in the NHS from 2011 here: http://www.nhsconfed.org/Publications/Documents/Dealing_with_the_downturn.pdf

Of course this is only the NHS managers upping the ante in the budget debates and shroud-waving in advance of having to negotiate with this and future governments , but it contains a lot of suggestions about how the severe reductions in NHS might be managed, so we can see the ideas that are floating around.

There is only one mention of end of life care specifically: the increased costs of new end-of-life drugs is a current cost pressure. The growing proportion of older people in the population is also a cost pressure.

Social care is also mentioned as an issue; because it has had less investment than the politically sexy NHS poor social care is likely to put extra pressure on the NHS. This just proves the point about the stupidity of holding back social care, but politicians never learn that they need to talk up the value of social care, rather than relegating it to an also-ran and moaning about social work.

One feature of the managerial suggestions is to include social care into NHS pathways (that is, fragment it even more and include it when it suits NHS managers).

It does suggest thinking about other providers (that is, possibly voluntary sector hospices) but there are a lot of provisos about maintaining an integrated service and cutting out duplication, which means in reality that there will be pressure to maintain hospital palliative care teams and non-specialist palliative care and stop funding external specialist provision.

There is also a suggestion that home care nursing has no evidence base and ought to be charged for (that is the managers want to make sure their budgets for hospitals are maintained at all costs). This is an active disincentive for carers to carry on caring because they will get no support. There will be families who have no capital (and therefore will not have to pay) who will say: Bung the old biddy in a care home.