NHS Reforms Must Support Focus On Compassionate Communication For End Of Life Patients
Patients nearing end of life are being failed by poor, unclear communication that compromises care and compounds grief, according to a new report by England’s Health Ombudsman.
The Parliamentary and Health Service Ombudsman (PHSO) is urging the Government to prioritise improvements to end of life care as part of its NHS reforms.
The report, Conversations that matter most: improving communication in end of life care, highlights widespread failings in the way professionals working in NHS end of life care communicate with patients, families and carers, and between teams and care settings.
In one case, a Trust failed to clearly and promptly inform a man that his cancer had spread and was terminal. He found out by accident from his GP.
The Ombudsman’s newly published five-year strategy has committed to improving communication in public services as a way of rebuilding trust between the citizen and state. Too often, patients and families are not listened to or communicated with clearly. When the patient voice is not heard, opportunities to resolve issues early are lost, avoidable harm can be repeated, and complaints become harder to resolve and learn from.
Ombudsman Paula Sussex CBE said, “For more than a decade, we have highlighted problems with end of life communication. But disturbingly, too many people are still being let down. At their most vulnerable moments, patients and families should be able to rely on care that is clinically effective, compassionate and honest.
“However, our report shows poor communication is causing avoidable distress for those receiving care, their loved ones and the professionals caring for them. Listening to its patients is one of the most powerful tools the NHS has to prevent harm. Patient voice must be at the heart of improvement.
“There needs to be better information-sharing, record-keeping, and training that gives staff the confidence and support to have timely, honest conversations about prognosis and people’s wishes. As the Government pushes forward with its plans to develop a Single Patient Record across the NHS, we urge them to prioritise end of life care as an area for roll out.
“Compassionate communication should be a fundamental part of quality care and it needs to be led by the profession themselves. Patients and families deserve care that is clear, coordinated and empathetic, while professionals working deserve systems that support them to deliver it.”
Communication failures remain the most recurring theme in Ombudsman investigations, and they have repeatedly raised concerns about communication in end of life care, including in its 2015 report, Dying without dignity, and its 2024 report on DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) decisions.
Casework analysed for this new report shows patients, and their families are often left ill-informed about their prognosis, with poor discussions about treatment, care preferences, where they wish to die and who they want involved in decisions about their care.
Families are often not told clearly or early enough that their loved one is deteriorating or approaching the end of life, further adding to their grief after their relative has died.
End of life care can be complex and involve multiple teams and settings such as wards, hospices and care homes. Poor communication between these teams affects continuity of care, delays decision-making and leaves patients and families constantly having to chase for updates.
The Ombudsman spoke to clinicians to understand more about the barriers to good communication. Many described the emotional burden of difficult end of life conversations and the challenges of communicating effectively when faced with time pressures, limited support and access to the right information.
Dr Sarah Holmes, Chief Medical Officer at Marie Curie and consultant in palliative medicine, said: “Deeply troubling but not surprising, this report shows why too many families are left haunted by a loved one’s death. It highlights fragmented care, overstretched staff, and missed chances to recognise — or tell someone — they are dying.
“That is why Marie Curie is partnering with the NHS to embed teams in emergency departments and GP practices — identifying people earlier, supporting staff, and helping families get care plans and conversations sooner.
“These services must be rolled out nationwide. The UK Government’s Palliative and End of Life Care Modern Service Framework could help fix a broken system — but only with a transformation fund to drive joined-up care.
“Change is long overdue. Families saying goodbye do not get a second chance — and successive governments have had too many.”
The Local Government and Social Care Ombudsman will shortly publish a report examining end of life care in the social care sector, highlighting the importance of person-centred care, joined up services and clear, compassionate communication.
