National Audit of Care at the End of Life – First round of the audit (2018/19) report and appendices. England and Wales published

The NHS Benchmarking Network is pleased to publish the National Audit of Care at the End of Life: First round of the audit (2018/19) report: England and Wales.

NACEL is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the last admission leading to death in England and Wales. Data for all elements of the audit was collected between June and October 2018. 97% of eligible organisations participated in the first round of the audit.

The report, together with other audit outputs for participants, will help acute, community hospitals and mental health inpatient facilities to identify good practice and areas for improvement in the care of dying people. The following recommendations are made in the report.

Integrated Care Systems/Commissioners, working with providers, should:

1. Put in place systems and processes to support people approaching the end of life to receive care that is personalised to their needs and preferences.
2. Review capability and capacity within primary care, community services and social care, to provide appropriate care at the end of life, and to support families through to bereavement, with the aim of better meeting people’s needs and preferences.
3. Implement processes to enable rapid discharge to home, care home or hospice, from hospital to die if that is the person’s wish.
4. Ensure adequate access to specialist palliative care in hospitals for holistic assessment, advice and active management.

Trust/UHB Boards should:

1. Promote and support an organisational culture which prioritises care, compassion, respect and dignity as fundamental in all interactions with dying patients and the people who are important to them.

Chief Executives should:

1. Require and support health and care staff to gain competence and confidence in communicating effectively and sensitively with patients and families in the last days and hours of life.
2. Ensure systems are in place to assess and address the needs of the families of dying patients in a timely manner. Specific senior, strategic and operational responsibility is required.
3. End of Life Care Lead (Board member with accountability for end of life care) should:
4. As part of a strong governance framework for end of life care, report annually to the Board with a performance report and action plan.

Medical Directors and Nursing Directors should:

1. Ensure that staff have an awareness of, acknowledge and communicate, as early and sensitively as possible, the possibility or likelihood of imminent death. Ensure that patients who have signs and symptoms that suggest they may be in the last days of life are monitored for changes.
2. Ensure that priority is given to the provision of an appropriate peaceful environment, that maximises privacy, for dying people and their families. Take into account the wishes of dying people and those important to them, to be cared for in a side room.
3. Ensure that patients who are recognised to be dying have a clearly documented and accessible individual plan of care developed and discussed with the patient and those important to them to ensure the person’s needs and wishes are known and taken into account.
4. Ensure that the intended benefit of starting, stopping or continuing treatment for the individual is clear, with documentation of the associated communication with the patient and/or person important to them.
5. Ensure the dying person is supported to eat and drink if they are able and wish to do so.

Northern Ireland also participated in the organisational level audit. The recommendations above are for England and Wales only.

The audit, first undertaken during 2018/19, comprised:

an Organisational Level Audit covering trusts (in England)/Health Boards (in Wales) and hospital/submission level questions;

a Case Note Review completed by acute and community providers only, which reviewed all deaths in April 2018 (acute providers) or deaths in April – June 2018 (community providers); and

a Quality Survey completed online, or by telephone, by the bereaved person.

Sudden deaths, deaths in A&E and deaths within 4 hours of admission were excluded from the audit.

In total, 206 trusts in England and 8 Welsh organisations took part in at least one element of the audit. The number of Organisational Level Audits completed was 302 and Case Note Reviews received, 11,034. The total number of Quality Surveys returned was 790.

For further information, please contact Lindsey Ashley, or call 0161 266 1997.