End of life care / National Audit Office.

  • Great Britain. National Audit Office.
Date:
[2008], ©2008
Catalogue details

Licence: Open Government Licence

Credit: End of life care / National Audit Office. Source: Wellcome Collection.

    10/64 (page 8)
    a The wishes of people approaching the end of their life are not always conveyed to those who need to know. Such data should ideally be captured in the Summary Care Record; but until it is fully operational, the Department through the national End of Life Care Programme should support PCTs and strategic health authorities to develop protocols to help capture, document, and share accurate patient information on preferences. This information should be regularly updated and shared with all providers across the health, social care, independent and voluntary sectors who influence decisions concerning where and how patients receive care. There are significant gaps in the education and training curricula for health and social care professionals. The Department should work with the relevant professional bodies to ensure that all trainee doctors, nurses, allied health professionals, and registered social care staff receive an appropriate level of training in the delivery of end of life care. Few care home staff have sufficient training in providing end of life care. The Department should strengthen the existing standards against which care homes are assessed to include a requirement to demonstrate that staff have received such training, including: communication skills; how to avoid unplanned emergency admissions; the provision of adequate pain management; and treating all residents with dignity and respect. d The Gold Standards Framework, Liverpool Care Pathway and Preferred Priorities for Care provide a framework for improving the delivery of end of life care, including identifying the point at which it should begin. Little is known, however, about the direct patient benefits associated with their use. The Department should commission clinical evaluations to determine whether their use results directly in better quality care for patients. For example, the planned survey of bereaved carers may be appropriate in the evaluation of the Liverpool Care Pathway and aspects of the Gold Standards Framework and Preferred Priorities for Care. END OF LIFE CARE Commissioning end of life care services is complex and there is a limited understanding of the national picture of demand and supply of end of life care services. The Department should provide more information and, as appropriate, guidance to assist PCTs to meet end of life care needs and allocate resources more efficiently and effectively by building on the evidence from our work. The guidance should apply the World Class Commissioning Framework which was launched in December 2007 and aims to improve the way health and social care services are commissioned. f Advance care plans seek to make clear a person’s wishes in anticipation of a gradual deterioration in their condition, which may result in a loss of capacity to make decisions or to communicate their wishes to others. PCTs should encourage providers to develop care plans, including advance care plans, for those who wish to have one, and review and update them as necessary. A lack of coordination between services or a single point of contact can lead to frustration for patients and carers. PCTs should commission effective coordination of end of life care services through a single point of contact for patients and carers, including access to advice and Carers’ Assessments. PCTs generally contract with independent hospices on an annual basis leading to uncertainty in planning and sometimes financial pressures. PCTs should work with independent hospices to develop three year contracts, based on commissioned services and levels of activity, to enable hospices to better plan the use of resources. These contracts should be in accordance with the existing guidance on how the Government and the voluntary sector should work together. Hospitals will continue to have an important role to play in end of life care but these services do not always meet the needs of patients and carers. PCTs should use the World Class Commissioning Framework to commission end of life care services from hospitals to meet the needs of patients and carers. They should obtain assurance from hospitals on whether staff have received sufficient training; there is suitable inpatient accommodation including private, dedicated space for consultations for patients, their relatives and carers; and there are timely and effective discharge planning arrangements.