End-of-Life Care fails both dying patients and bereaved relatives, says review

29 May 2014

End-of-Life Care fails both dying patients and bereaved relatives, says reviewEnd-of-Life Care fails both dying patients and bereaved relatives, says review

A new review of health and patient care standards in England has found that the care given to people dying in hospital is insufficient and “deeply concerning.”

In an audit and accompanying review conducted by the Royal College of Physicians and Marie Curie, research showed that just one fifth of the hospitals reviewed provided specialised end-of-life care for seven days of the week; this is despite the fact that the recommendation for daily end-of-life care should have been implemented within hospitals ten years ago. Furthermore, communication with families and those in palliative care was singled out as particularly poor.

Current mortality rates in England show that 500,000 people die each year, with half of that number in hospital. The review specifically looked at the end-of-life care for over 6,500 people who died last year in 149 hospitals.

This end-of-life care covers care during the final stages of life, a phasing out process which can involve the withdrawal of medication, food and necessary fluids. It appears, however, that this care is failing to provide necessary support to families and bereaved relatives.

Over 800 bereaved relatives were asked for their views which 75% of them stating they only felt supported during their loved-one’s final two days of life.

Some of the other key findings were that:

Less than half of the patients had been assessed to see if they needed artificial nutrition with 59% being assessed for hydration

There was a strong variation-between 63% to 81%-in the receipt of medication for key symptoms like pain, vomiting, respiratory difficulty and agitation

Compulsory training for the doctors relating to end-of-life care for patients was only required in 19% of the trusts reviewed and for 28% of the nurses in those trusts

Less than half of the trust boards reviewed had not even discussed care of dying in the last 12 months even though recommendations showed such reviews should be carried out annually.

Dr Kevin Stewart, who led the review, said: "Although some aspects of care are good, I am deeply concerned that some hospitals are falling short of the excellent care that should be provided to both dying people and those important to them.

"It is disappointing that hospitals don't seem to recognise this as an important issue, not just for those experiencing this in their own lives, but the wider public."

Patients Association chief executive Katherine Murphy added the issue was "extremely upsetting and distressing".

"Many of our callers feel very guilty for not having done enough for their loved ones and hearing about poor quality of care for their relatives at the end of their life in hospitals will only add to their guilt of and the feeling of helplessness."

Care and Support Minister Norman Lamb said: "All patients should be receiving high quality and compassionate care in their last days of life - there can be no excuse for anything less.

"Deeply concerning"

"This report shows evidence of very good care but I am seriously concerned about the variations in care, and improvements are needed in the way some clinicians communicate with patients and support families. I am determined this should improve."

If you have been unhappy with the degree of care provided by a hospital or trust in the case of a loved one who has passed away, our specialist teams can help you make a complaint to the relevant authorities and to help improve the communication between clinicians and patients and support families.