The stages of palliative care: what families can expect

The NHS, NICE and Marie Curie do not define a fixed series of numbered stages of palliative care. Palliative care can begin at diagnosis of an incurable illness and continue for years, and end of life care is usually described as the final phase, when death is thought likely within about 12 months. Because “stages” are described differently, this guide sets out the phases most often used.

At a glance

• Marie Curie says palliative care can start at any point after a terminal diagnosis and can run alongside treatment such as chemotherapy or radiotherapy.
• The NHS says end of life care is considered to start when death is likely within 12 months, though this is hard to predict.
• NICE sets out separate guidance for adults in the last year of life (NG142) and for the last days of life (NG31).
• Hospice care is free to use, according to Marie Curie, and you do not need to be dying to be referred.
• “Five stage” models you may see online are not official NHS staging; popular grief models describe emotions, not care.

Are there official stages of palliative care?

No. Marie Curie’s description of palliative care does not describe formal stages, and neither does the NHS. What both explain is a difference in timing:

• Palliative care is care for people with an incurable illness that focuses on comfort. It relieves pain and other distressing symptoms and offers psychological, social and spiritual support to the person and their family. It can begin when a life-limiting illness is diagnosed and can be given alongside treatment.
• End of life care is the form of palliative care given near the end of life, usually when someone is thought to be in their last year.

Our guide to palliative care versus end of life care explains this difference in more detail. You may see articles that describe “five stages” of dying or of palliative care. Be cautious. Popular models of grief describe emotional reactions, not phases of medical care, and not everyone experiences them in order or at all.

Clinicians do use tools to recognise when someone’s needs are changing. NICE guidance on end of life care mentions systems such as the Gold Standards Framework, the Amber Care Bundle and SPICT for flagging people who may be nearing the end of life. The Gold Standards Framework uses red, amber and green coding based on needs: red for the last days of life, amber for deteriorating, and green for decline, instability or advanced disease. It describes this as reflecting changing needs rather than exact timescales.

A practical way to think about the phases

The table below is a plain-language summary of phases that NHS, NICE and Marie Curie material describe. It is not an official staging system, and real life is less tidy. People can move back and forth, and some stabilise for long periods.

What happens early on, and in the long middle phase?

Palliative care is not only for the final days. Marie Curie says it can last for years, and having it does not necessarily mean death is near. It covers symptom management, emotional, spiritual and psychological support, and practical help such as planning for the future and equipment.

Usually a referral is needed from a clinician such as a GP or district nurse, though staff in hospitals, care homes and hospices can arrange it. Palliative care teams can include doctors, nurses, hospice staff, counsellors, social care staff, chaplains and therapists. At home or in a care home, the GP has overall responsibility, with specialist palliative teams offering extra support.

This is a good time to talk about wishes. Advance care planning, powers of attorney and decisions about resuscitation are easier before a crisis. See DNACPR and advance decisions and health and welfare lasting power of attorney.

How is it recognised that someone is approaching the end of life?

The NHS says end of life care covers people with advanced incurable illnesses, frail people with other conditions, people whose existing conditions could suddenly worsen, and people who have had a sudden life-threatening event such as a serious accident or stroke.

NICE guideline NG142 on end of life care for adults says that once end of life is suspected, practitioners should complete and document an initial holistic assessment of the person’s wider wellbeing, not only their medical needs. It also recommends that:

• Carers and other important people in the person’s life are identified and offered support, which is reviewed over time.
• People are offered advance care planning and have a copy of their plan wherever they are, at home, in hospital, a care home or a hospice.
• A healthcare professional is available 24 hours a day, seven days a week, with access to the person’s records and advance care plan, and an out-of-hours advice line and pharmacy access to symptom control medicines.

For help at home, see palliative care at home and end of life care at home. If someone is in a care home, see palliative and end of life care in care homes. Where the person is expected to be in their last weeks or days, fast track NHS continuing healthcare can speed up funding decisions.

What are the last days of life like?

NICE guideline NG31 on care of dying adults in the last days of life sets out what should happen when a person may be dying. Clinicians should gather information on the person’s needs and goals and the views of those close to them, and watch for signs such as agitation, changes in breathing, reduced consciousness and withdrawal. Improvement can sometimes happen, so the picture should be reviewed at least every 24 hours.

The guideline also says that:

• A suitably skilled clinician should explain the situation honestly, without false optimism, and invite questions.
• An individualised care plan should cover goals, preferred place of care, symptom preferences and needs after death, and be shared and updated.
• Support for safe drinking and mouth care should continue, with hydration assessed and decisions about clinically assisted hydration made individually.
• Medicines for likely symptoms such as pain, breathlessness, nausea, anxiety, agitation and noisy breathing can be prescribed in advance.

See signs of end of life in elderly people for what families commonly notice, and comfort care at home for practical ways to help.

Where is care given, who pays and who supports the family?

The NHS says end of life care can be given at home, in a care home, in a hospice or in hospital. Marie Curie says NHS care is free for UK residents, but some services, such as certain social care, may cost money depending on where you live and your finances. Our guides to NHS continuing healthcare at home and the NHS continuing healthcare checker cover the main funding route.

Marie Curie says hospice care is free to use. It is paid for through a mix of NHS funding and public donations. Hospices also support family members, and day services can include counselling, therapies and support groups. Some hospices accept self-referrals, while others need a referral from a GP, district nurse or consultant, and places can be limited. See hospice care at home for what is offered.

Family and carers need support too, including a carer’s assessment under the Care Act. After a death, see what happens when someone dies in a care home and bereavement support for carers.

Frequently asked questions

How many stages are there in palliative care?

There is no official number. The NHS and Marie Curie describe palliative care as starting at diagnosis and end of life care as the final phase, usually the last 12 months. Any “five stage” model is a simplified description, not formal NHS staging.

Does palliative care mean someone is dying?

No. Marie Curie says people can receive palliative care for years, and having it does not necessarily mean death is near. It focuses on comfort and quality of life and can run alongside treatments such as chemotherapy.

How long does the end of life phase last?

It varies. The NHS says it can last a few days or months, and sometimes more than a year. Prediction is difficult, so clinicians review regularly rather than set a fixed timeline.

Is hospice care free?

Yes. Marie Curie says hospice care costs nothing to use and is funded through a mix of NHS funding and public donations. Referrals usually come from a GP, district nurse or consultant, and some hospices accept self-referrals.

Who coordinates palliative care at home or in a care home?

The NHS says the GP has overall responsibility at home or in a care home, with community nurses and specialist palliative care teams adding support. NICE says community care is coordinated by the GP or a member of the primary or community team.

Where to get help next

Start with your GP or district nurse, who can refer to a palliative care team or hospice. Our care search lists local care homes and home care providers, and the care glossary explains unfamiliar terms.

Sources

• NHS: End of life care, what it involves and when it starts
• Marie Curie: Palliative care
• Marie Curie: Hospice care
• NICE: End of life care for adults, service delivery and organisation (NG142)
• NICE: Care of dying adults in the last days of life (NG31)
• Gold Standards Framework: Proactive Identification Guidance

Reviewed by The Care Panel team on 9 November 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.