Ageing populations are characteristic of many countries. The pattern of disease at the end of life is changing and more people are living with serious chronic circulatory and respiratory diseases as well as with cancer. More people will need help at the end of life, in a social context of changing family structure and wider migration, employment and ageing of potential care-givers. Despite evidence of dramatically increased need for supportive and palliative care, this area has been relatively neglected in health policy and research.