Significant Variation In Standards Of Care For People Dying In Hospitals

The National Care of the Dying Audit for Hospitals led by the Royal College of Physicians (RCP) today reports (Thursday 15 May) significant variations in care across hospitals in England.The audit shows that major improvements need to be made to ensure better care for dying people, and better support for their families, carers, friends and those important to them.

The new audit sampled the care of dying people in hospital, assessing the quality of care received directly by 6580 people who died in 149 hospitals in England between 1 May and 31 May 2013 and questionnaires completed by 858 bereaved relatives or friends, asking about the treatment of their relative, their involvement in decision making, and the support available to them.

Key findings:

• Communication with family and friends about the death of their relative/friend occurred in 93% of the cases, on average 31 hours before their relative or friend died
• Only 21% of sites had access to face-to-face palliative care services, 7 days per week, despite a longstanding national recommendation that this be provided; most (73%) provided face-to-face services on weekdays only
• Mandatory training in care of the dying was only required for doctors in 19% of Trusts and for nurses in 28%, despite national recommendations that this be provided. 82% of Trusts had provided some form of training in care of the dying in the previous year; 18% had not provided any
• 53% of Trusts had a named Board member with responsibility for care of the dying; 47% did not. In 42% of Trusts care of the dying had not been discussed formally at the Trust Board in the previous year and only 56% of Trusts had conducted a formal audit of such care, despite previous recommendations that this be carried out at least annually
• Only 47% of Trusts reported having a formal structured process in place to capture the views of bereaved relatives or friends prior to this audit.

Alzheimer’s Society comment:

‘You should be able to die peacefully, free from pain and in the place of your choice, no matter what condition you have, where in the country you are or what day of the week it is. An Alzheimer’s Society report found that too many people with dementia are not dying in the way they wish or deserve to. With low diagnosis rates of dementia, tragically many people are seeing out their final days deprived of dignity in hospital. People with dementia occupy over a quarter of hospital beds. Palliative care in hospitals must improve so vulnerable people at the end of their lives are better supported.’

Jeremy Hughes

Chief Executive

Alzheimer’s Society