The NHS Benchmarking Network is pleased to publish the National Audit of Care at the End of Life: Second round of the audit (2019/20) report: England and Wales.
The National Audit of Care at the End of Life (NACEL) is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the last admission leading to death in acute and community hospitals in England and Wales. Mental health inpatient providers were included in the first round of the audit but excluded for the second round of the audit. The audit measures progress against the five priorities for care (One Chance To Get It Right, Leadership Alliance for Care of Dying People) and NICE Quality Standards 144 and 13, and NICE guideline NG31. The audit also has links with NHS England & NHS Improvement plans for personalised end of life care and NHS England & NHS Improvement plans for the five ambitions. The second round of the audit, undertaken during 2019/20, comprised: • an organisational level audit covering Trusts in England and University Health Boards (UHBs) in Wales, and hospital/submission level questions. • a Case Note Review which reviewed all deaths in the first two weeks of April and May 2019 (acute providers) or deaths in April and May 2019 (community providers); and • a Quality Survey completed online, or by telephone, by the bereaved person. Data for all elements of the audit was collected between June and October 2019. We are pleased to share that 175 trusts in England and 8 Welsh organisations took part in at least one element of the audit, amounting to 97% of eligible organisations. There are five key messages outlined by the National Audit of Care at the End of Life Year Two. We encourage all organisations to read the full report for the recommendations and findings. Recognising the possibility of imminent death: The possibility that the patient may die was documented in 88% of cases audited. The median time from recognition of death to dying was recorded as 41 hours, compared to 36 hours in the first round of the audit. Individual plan of care: The results suggest that 71% of dying patients had an individualised end of life care plan. This related to patients where it had been recognised that the patient was dying (category 1 deaths). For the 29% of patients who did not have an individualised plan of care, in 45% of these cases, the time from recognition of dying to death was more than 24 hours. Families’ and others’ experience of care: Although most people responding to the Quality Survey felt that the patient and families/others had received good care overall (80% of respondents rated overall care delivered to the patient as outstanding/excellent/good; reported as 75% in relation to the care provided to families and others). However, there remains a gap in identifying the needs of families and others, with one-fifth of families and others responding to the Quality Survey reporting that their needs had not been asked about. Individual plan of care: 80% of respondents to the Quality Survey perceived that hospital was the ‘right’ place to die; however, 20% remarked there was a lack of peace and privacy. Workforce: Although most hospitals (99%) have access to a specialist palliative care service, just over a third of hospitals (36%) lack face-to-face 24 hour specialist palliative care provision (doctor and/or nurse). Thank you to all organisations who participated in the audit. Thanks also to all stakeholders, steering group and advisory group members who contributed to the development of NACEL round two. We are excited to begin delivering NACEL round three, which will audit acute and community hospitals, as well as mental health inpatient providers, in England and Wales. Please direct any queries to Amy Fokinther, Project Coordinator