People's dying wishes are still not granted

Over recent years we have learnt a lot about what works and does not work for terminally ill people and their families. These lessons can help commissioners grapple with the challenge of delivering more, to more people, with less money. 

The Royal College of Physicians’ National Care of the Dying Audit for Hospitals report provides the latest piece in a jigsaw of our understanding of the needs of terminally ill people and their families. It builds on the latest VOICES Bereavement Survey and Marie Curie’s Difficult Conversations.

• More from Marie Curie’s end of life care channel

One year on from Baroness Neuberger’s review of the Liverpool care pathway, the RCP audit provides the first post-Neuberger snapshot of care provided to dying people in hospitals in England. The audit includes reviews of patient case notes, assessments of organisational end of life care capacity and a survey of 858 bereaved relatives.

Perfect alignment

While there is encouraging news in terms of the proportion of patients prescribed medication for the five most common symptoms at the end of life, at 63-81 per cent, and the number who had been assessed five times or more in the last 24 hours of life, 87 per cent, it is the level of variation across the country which is most striking.

‘For some people hospital will always be the right place, for many people it will not be’

Only 21 per cent of NHS hospital trusts provide seven day access to palliative care and just 2 per cent of trusts offer a 24/7, face to face service. Perhaps most disappointingly, the audit shows that in 87 per cent of cases, while healthcare professionals had recognised that the individual was in the last days of life, conversations had only been initiated with 46 per cent of those capable of doing so.

Overall, 24 per cent of bereaved relatives did not feel they were involved in decision making.

The audit adds to the knowledge gained from What We Know Now, a report on end of life care by Public Health England. When asked what they want, people who are terminally ill repeatedly tell us that they want to be pain free, surrounded by family and friends and in the place of their choice in the last days of life.

‘People who are terminally ill repeatedly tell us that they want to be pain free, surrounded by family and friends’

While it is important to acknowledge that for some people hospital will always be the right place, for many people it will not be. By commissioning the right community services, such as those highlighted in the Nuffield Trust’s Impact of the Marie Curie Nursing Service on Place of Death and Hospital Use at the End of Life report, we can ensure that fewer people, with no clinical need to be in hospital, end up there and that we begin to relieve the pressure on hospitals. 

As colleagues from Marie Curie have argued elsewhere on hsj.co.uk, we currently have a perfect alignment of what terminally ill people want and what the system needs. This means that we can deliver more of what terminally ill people and their families want and what the system needs, and help meet the twin challenges of an ageing population and ongoing austerity.

• Find out more about how Marie Curie works with commissioners

Joanne Stradling is divisional general manager for eastern and central England at Marie Curie