Conversations that matter most: improving communication in end of life care (PHSO, 7 July 2026)

Summary

Good end of life care depends on good communication. When patients and families receive clear, honest and timely information, they are better able to face what lies ahead. When communication breaks down, the consequences can last a lifetime.

Since 2020, the Parliamentary and Health Service Ombudsman (PHSO) have investigated complaints about palliative and end of life care services across England. They found that communication is the most common failing - patients not told their diagnosis, families kept in the dark, and vital information lost when people move between services.

This PHSO report draw on the experiences of families and clinicians to set out where communication most often falls short and what needs to change. 

Content

Recommendation 1. The Modern Service Framework should include a detailed strategy to address skills and confidence gaps in communication.

• The Modern Service Framework should include a system-wide strategy to tackle longstanding gaps in confidence and skills in talking about death, dying and palliative care. This should establish communication about the end of life as a core competency across the workforce.
• Clinical education should set the expectation that skilled communication about the end of life is an essential, invaluable part of all healthcare roles. We echo the recommendation of the Commission on Palliative and End-of-Life Care that training on palliative and end of life care should be a mandatory part of undergraduate medical education.
• Mandatory training at postgraduate level in provider settings should include:: psychologically informed elements such as understanding common patterns of distress at the end of life, and core skills for responding to and understanding clinicians’ own anxiety so they are able to stay present and sit with distress; skills practice with feedback and rehearsal of challenging scenarios.
• To be effective, training must be accompanied by ongoing ‘on-the-job’ support. This needs to be understood as an important part of implementation, not an optional add-on to training. For example, providers should consider developing clinical supervision structures that support professionals to increase their skills and confidence while maintaining their own resilience and wellbeing. This reflects the fact that embedding skills into practice, and seeing them valued in the working environment, is important for consistent delivery.  

Recommendation 2. The Modern Service Framework should develop clear outcome measures to assess the performance of end of life care services, centred on patient and family experience.

• Outcome measures should include an assessment of how effectively services communicate with patients and those close to them.
• One consideration in this is the role of large-scale surveys that ask bereaved people about experiences of end of life care for their loved one. The National Audit of Care at the End of Life (NACEL) is extremely valuable as a national comparative audit of the quality and outcomes of care experienced by the dying person. But it covers only the final hospital admission rather than experiences across all settings and at earlier points in the care journey.
• The Modern Service Framework should consider options for a bereavement survey that asks for feedback about the experience of all deaths, including deaths at home, in care homes and in hospices, in addition to those in hospitals. This will be particularly important given the ambitions around shifting care, including end of life care, from hospitals to the community.  

Recommendation 3. Prioritise end of life care in the rollout of the Single Patient Record.

• Dying patients often move between hospitals, GPs, community palliative care teams, hospices and ambulance services. Patient information must be readily accessible across these different settings.
• The Single Patient Record must make sure that important end of life care information – including advance care plans, ReSPECT forms and DNACPR decisions – is consistently accessible and editable across all care settings.
• The Single Patient Record must build on and learn from the important work that has gone before, including the development of Electronic Palliative Care Coordination Systems (EPaCCS).
• Joined up, accessible systems are necessary, but they also depend on the quality of information that goes into them. The Single Patient Record programme must include sufficient investment in training on how patient record systems should be used on the frontline.