It could mean the difference between a "good death" and a bad one. Where you live in Scotland would now appear to affect the way you spend your final days.

Audit Scotland's report documented the vast differences in levels of palliative care across the country, with the lack of a national coherent approach leaving great gaps in how the sick - and their families - are treated.

Palliative care can boil down to a mere friendly word or the administration of vital pain relief. Increasingly, it is being used earlier after diagnosis to keep on top of chronic conditions in a bid to avoid acute treatment in the future. More than 55,000 people in Scotland die every year, but last year just 12% of them accessed palliative care. Audit Scotland estimates 75% of the population would benefit from this support as they near the end of their life.

PROVISION
Palliative care is rooted in the hospice movement, set up to care for terminally ill cancer patients, but there is a need to include a wider range of illnesses. Around 90% of palliative care patients suffer from cancer, but account for 30% of deaths in Scotland.

The number of those with long-term conditions is rising - dementia patients are predicted to rise 75% over the next 20 years, for example. NHS boards should improve access for people based on need, not diagnosis, Audit Scotland said.

PATIENTS
Where do patients get the help they need? Service is patchy across Scotland. Nine health boards, out of 14, have hospital-based palliative teams but none of them had dedicated beds for patients.

Around 72% of day care places were provided by voluntary hospices, with demand outstripping supply. Around 46% of the district nurses said they had difficulty in accessing these services.

The system does not cope with demand at present.

In 2007, there were 5000 people on the palliative care register. Audit Scotland suggests around 42,000 people a year are in need. The low number could be due to difficulties in identifying when patients need care.

STAFF
Palliative care needs to be joined up between district nurses, GPs, hospices and hospital specialists. One patient could have many different carers but they may not communicate with each other. Sharing information is often slow which hinders continuity of care for patients.

The system could improve if each health board had a single individual to plan palliative care. A lack of out-of-hours service means that some patients are unnecessarily admitted to hospital.

Staff numbers vary greatly too. NHS Highland has 11.2 specialist staff per 100,000 people, Orkney has 22.3. NHS Lothian has 5.1 and Greater Glasgow and Clyde has 7.3.

FUNDING
The latest figures show that £59m was spent on specialist palliative care in hospitals and hospices in 2006/2007. Almost half of this came from the voluntary sector. There are no figures to show how much is spent by GPs and district nurses due to lack of data.

This has left it difficult to plan for the future at a time when preparing for the years ahead is crucial.

WHAT NEXT?
The Scottish Government is due to publish is own palliative care action plan next month and has been told by Audit Scotland that the document must address the inequalities in how people get the support they need.

The experience must be made more seamless for the patient, with staff in place to link up services. A standard assessment criteria is needed to help iron out different standards in care for those with terminal illnesses.