End of life care report "deeply disturbing"

15 May 2014
A new joint report by the Royal College of Physicians and Marie Curie has highlighted the need for major improvements in the care of people dying in hospitals.

The comprehensive national review looked at the care given to more than 6,500 people who died last year in 149 hospitals. It found just a fifth of hospitals provided specialist end-of-life care seven days a week, ten years after this was recommended.

The report found:

  • One in four bereaved families felt they were not involved in decisions about their loved one's care and did not feel supported during their last two days
  • More than a third of families said the emotional support they received from medical staff was fair or poor
  • Just 45% of patients had been assessed to see if they needed artificial nutrition and 59% for hydration
  • Getting medication for key symptoms including pain and nausea or vomiting varied from 63% to 81%
  • Training in caring for dying people was only mandatory for doctors in one in five hospital trusts and for nurses in 28% of trusts
  • Only 21% of sites had access to face-to-face palliative care services seven days per week, despite a longstanding national recommendation that this be provided
  • Nearly half of trust boards had not discussed care of the dying in the previous year or conducted a formal audit - despite recommendations to carry this out annually

The patients in the report had a mean age of 82, and almost one in four had cancer. Almost half were on the Liverpool Care Pathway or a similar protocol. For the first time, the report included the views of bereaved carers. More than 800 were consulted, providing further insights into how well hospital staff respond to the physical, emotional and spiritual needs of people in their final days of life and of those close to them.

Speaking in response to the report, Claire Henry, Chief Executive of the National Council for Palliative Care and the Dying Matters Coalition, said: “The way we care for dying people says something fundamental about our values as a society, as well as being an acid test for how well the NHS is working, which is why so many of these findings are so deeply disturbing.

"There can be no excuse for hospitals failing to treat people with dignity, compassion and respect when they are dying, at the time that they most need this. It is simply unacceptable that so many dying people appear not to have been told that they are in their last days of life - something our own research shows the majority of people would want to be told about - and that important decisions about artificial nutrition and hydration are not being discussed with them or with their relatives and friends.

"With almost half of us dying in hospital, the care of people who are dying should be core business for the NHS but it sadly appears this is not the case. The challenge now is for hospitals which are not getting it right to learn from those that are.”

Simon Chapman, Director of Public and Parliamentary Engagement at the National Council for Palliative Care and the Dying Matters Coalition, added: “Although some hospitals are providing excellent care to people who are dying and communicating well with them and their families and friends, it’s clear this is not happening in the majority. Little wonder that new research for Dying Matters has found just one in 100 GPs and 6% of the public say that given the choice they would want to die in hospital.

"Alongside urgent action to address these failings and mandatory training for health and care staff in how to talk sensitively to people who are dying and those close to them, we need a national conversation about dying so that health and care staff and the general public become more comfortable in discussing dying and planning ahead. We only get one chance to get it right for people who are dying, so poor care and a failure by hospitals to take end of life care seriously must not be tolerated.”

More

Full report on the provision of care for people dying in hospitals

Executive summary of the report

Millions leaving it too late to discuss dying wishes

The Telegraph: "No one should be denied the right to know that their lives are coming to an end"

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