Access to End of Life Medicines in Care Homes
Policy Position Statement
Date: October 2025
Introduction
The Royal Pharmaceutical Society (RPS) recognises the critical importance of timely access to medicines for the management of symptoms at the end of life.
We are committed to supporting high-quality pharmaceutical care for individuals in care homes, particularly during out-of-hours periods when access to medicines can be challenging.
The RPS supports systems and practitioners that make sure the process of obtaining medicines, including urgent controlled medicines, is as easy and timely as possible.
However, following careful consideration of the available information, the RPS does not support a change in the law to allow care homes to hold anticipatory stock of controlled drugs for the management of end-of-life symptoms at this time.
Background
At its Congress in June 2024, the Royal College of Nursing (RCN) members passed a resolution from its Pain and Palliative Care Forum to lobby governments to amend the law to improve access to controlled drugs in care homes.
Marie Curie, the end of life charity, has convened a working group to discuss challenges within the current care home landscape regarding access to controlled drugs in care homes, following the rollback of changes made during the COVID-19 pandemic to allow repurposing of medication.
The working group is conducting a short survey study, across the four nations of the UK, investigating how care home staff access controlled drugs (CDs) such as morphine and midazolam, for palliative and end-of-life care. The CINCH Study is open to UK-based care home staff, including nurses, care assistants, and managers, to take part.
The subject matter is relevant to the mission and aims of the Royal Pharmaceutical Society (RPS) and both the RCN and Marie Curie are key partner organisations.
Rationale for Position
Patient Safety and Legal Safeguards:
Controlled drugs such as morphine and midazolam require stringent handling, storage, and administration protocols to ensure patient safety and prevent misuse. Current legislation provides essential safeguards that protect vulnerable individuals and uphold public trust in the use of these medicines. Where no registered healthcare professional is present, a change has the potential to increase the risks associated with the management of controlled drugs.
Care homes providing nursing care may hold stocks of certain CDs, but this often requires a Home Office controlled drugs licence—particularly when storing medications not yet prescribed to individual residents. These licensing processes are designed to ensure the safe management of controlled substances and involve thorough checks, including site visits and intelligence assessments, which can take several months to complete.
While these requirements can present logistical challenges, they are essential safeguards.
We are opposed to any loosening of these regulations unless there is clear evidence that such changes are the only or best solution to improving access.
Current exemptions to the licensing process still require that the control and administration of these medicines fall to a registered healthcare practitioner, and we believe this responsibility must remain in place to uphold safety, accountability, and clinical oversight in care settings.
Lack of Sufficient Evidence for Legislative Change:
There is currently insufficient evidence demonstrating that the absence of stocks of controlled drugs (as opposed to individually dispensed medicines, including Just in Case medicines) in care homes results in significant harm to patients.
Furthermore, no permanent legislative changes were enacted during the COVID-19 pandemic, despite increased pressures on healthcare systems, suggesting a high threshold for any future amendments.
A forthcoming resource of interest is a study, conducted by Marie Curie and University of Cambridge, exploring how care home staff in the UK access controlled drugs (CDs) such as morphine and midazolam for palliative and end-of-life care. Once published, the findings will offer valuable insights to inform our policy position.
Alignment with Existing Policy Development:
The forthcoming RPS Palliative and End of Life Care Policy (2025) addresses access to medicines within the current legal framework. This policy will guide our advocacy efforts and support improvements in pharmaceutical care without necessitating legislative change.
Learning from current and best practice
There are examples of good practice across the devolved nations, demonstrating that multiprofessional teams including cross agency working can ensure early identification of people approaching end of life and processes can be put in place to ensure access to medicines is achieved.