NCEPOD: Planning for the end. A review of the quality of care provided to adult patients towards the end of life

Summary

Each year over 600,000 people die in the United Kingdom and many of these deaths occur in hospital, despite the majority of people saying that they would prefer not to die there. Approximately 70% of people die from long-term health conditions that often follow a predictable course, with death anticipated well in advance of the event. The annual number of deaths in the United Kingdom is predicted to rise to 736,000 by mid-2035. Therefore, the provision of care at the end of life must meet the needs of the population.

NCEPOD reviewed the quality of care provided towards the end of life for adults with a diagnosis of dementia, heart failure, lung cancer or liver disease and have made a number of recommendations.

Content

Recommendations

1. Ensure that patients with advanced chronic disease have access to palliative care alongside disease modifying treatment (parallel planning) to improve symptom control and quality of life. 
2. Normalise conversations about palliative/end of life care, advance care plans, death and dying. As a trigger to introduce a conversation which includes the patient and their family/carers, consider: The surprise question “Would you be surprised if this patient died within the next 12 months?” This can be used across all healthcare settings; and/or recurrent hospital admission of patients with advanced chronic disease. 
3. Ensure all patients with an advanced chronic disease are allocated a named care co-ordinator. 
4. Provide specialist palliative care services in hospitals and in the community, to ensure all patients, including those with non-malignant diseases receive the palliative care they need. 
5. Train patient-facing healthcare staff in palliative and end of life care. This training should be included in: undergraduate and postgraduate education; and tegular training for patient-facing healthcare staff.  
6. Ensure that existing advance care plans are shared between all providers involved in a patient’s care.
7. Raise public awareness to increase the number of people with a registered health and welfare lasting power of attorney (LPA) well before it is needed. .