End of life care – 2024 State of the Nations report (HQIP, 14 August 2025)

Summary

The National Audit of Care at the End of Life (NACEL) is a comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the last admission to hospital before death. The aim of NACEL is to improve the quality of care of adults (18+) at the end of life in NHS-funded hospital inpatient settings in England, Wales and publicly-funded care in Jersey. The information featured in the State of the Nations Report reflects a validated annual position of care delivered from January 2024 – December 2024,

Content

Based on care delivered from January to December 2024, this report from the National Audit of Care at the End of Life (NACEL) found that 83% of deaths were expected by clinical staff during the final admission and, of these, 84% had an individualised plan of care addressing their needs at the end of life.

73% of bereaved people rated the overall care and support given to themselves and others by the hospital as excellent or good

It also found that 97% of hospital providers have access to specialist palliative care services. Yet, of those providers, 61% have access to a face-to-face specialist palliative care service (nurse and/or doctor) 8 hours a day, 7 days a week. As such, the report recommends that services provide specialist palliative medical and nursing cover face-to-face, 8 hours a day, 7 days a week in addition to a 24-hour, 7 days a week, telephone advice service.

Other key findings include:

• 77% of bereaved people agreed that the dying person received sufficient pain relief during their final hospital admission
• 62% of clinical notes contained evidence of communication about hydration with those important to the dying person, or a reason recorded why not.

In addition to further key findings, this report contains five recommendations for improvement relating to:

1. Hospital improvement plans
2. Access to specialist palliative care services
3. Personalised care and support planning
4. Equitable care
5. Training and support.