A survey published by the Office for National Statistics has reported significant differences in the quality of care experienced according to the age of patient at death, cause of death and place of death – with hospital care lagging behind hospice care.
Key findings from the National Bereavement Survey 2011, included:
• Seventy five per cent of people reported the overall quality of end-of-life care to be outstanding, excellent or good.
• Hospice care was rated the most positively, with 92% of people rating it as ‘excellent’ or ‘good’.
• Cancer patients and patients under 65 were most likely to rate their care as ‘outstanding’ or ‘excellent’.
• There was a notable variation in dignity and respect, with hospice care coming out top and care in hospitals bottom.
The survey findings will underpin a new indicator for end-of-life care in the NHS Outcomes Framework. Care services minister, Paul Burstow said: “All people, regardless of their age or condition, should get the best quality care at the end of life. The results of this survey will be carefully studied by NHS and social care professionals. It reveals a wide variation in the quality of care across the country. There is more to be done to improve both the way care is co-ordinated for people in their own homes and the quality of care in hospital. “We are already working with hospices, the NHS and social care to pilot new ways of working and put in place a secure funding system to support palliative care. These results will help health and social care to benchmark the care they deliver and learn from the best.” The Government has recently introduced a range of measures aimed at ensuring all patients are treated with dignity and respect. This includes the ban on age discrimination in health and care services, which will be introduced in October 2012, and the creation of an independently chaired Nursing and Care Quality Forum. Responding to the results of the National Bereavement Survey, Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said: “Wherever a person dies, the level of care and dignity should match that offered by the best hospices, which are rightly praised in this survey. We are deeply concerned that not all patients can access this standard of care, particularly if they die in hospital. All NHS staff, whether they are specialists or not, need to be confident that they can deliver good care to people at the end of their lives, and the RCN is supporting nurses to develop themselves in this area. “No patient should have to die in hospital when they would prefer to die at home, simply because specially trained district nurses are not available at all hours in their area. Nurses see too many instances of patients at the end of their life having to come into hospital, often at night and against their best wishes. This obviously causes distress to individuals and families. The NHS needs to sustain investment in this specialist, out of hours care, so that wherever and whenever a person dies, they can be given excellent painrelief, dignity and care.” Imelda Redmond CBE, director of policy and public affairs, at Marie Curie Cancer Care commented: “Hospitals are letting people down at a crucial time and this poor care is leaving behind memories of loved ones being treated with little dignity and respect, and dying in pain. This is simply not good enough… There is no reason why we can’t provide a dignified and respectful death, regardless of setting, location or diagnosis. It is now time to learn from these findings and make improvements. “We want assurance that the Department of Health will continue to monitor the views of bereaved carers, and patients who are towards the end of life. This should be undertaken on a rolling basis and at a scale that allows it to be used as a tool for Clinical Commissioning Groups to be held to account for the quality of end-of-life care they commission in the future.”
