A report by The Royal College of Physicians found that end of life care in NHS hospitals is not good enough. Only 16 out of the 142 hospitals in England offer face-to-face palliative care specialists 24/7.
This is something that is supposed to be provided in all hospitals.
It is two years since the first review, which followed the scrapping of the Liverpool Care Pathway. This was a one-size fits all approach to palliative care. Since then there has been a focus on individual care.
Although the report found improvements in all areas, there were still some concerns highlighted.
In around 3,000 notes there was no evidence that the patient’s ability to eat or drink had been assessed on the last day of their life.
In 55% of cases there was no evidence that the dying patient had been supported to drink in their last 24 hours.
One of the main concerns the researchers had was that many doctors did not have full access to on-site palliative care specialists for their patients in the evenings and at weekends.
At 26 NHS Trusts there was no record of any face-to-face specialist, palliative care involving doctors at any time.
Dr Kevin Stewart, medical director of the RCP’s Clinical Effectiveness and Evaluation Unit, said: ”It is encouraging that there have been sustained improvements in many aspects of the care of those dying in hospitals in the last couple of years, especially when the NHS as a whole has been under such pressure in this time. We recognise that much of this is as a result of a lot of hard work by front line clinicians. However, we are disappointed that there are still major deficiencies in the provision of specialist palliative care at nights and weekends by many Trusts; patients and their families deserve the same level of service whatever the day of the week.”
One of the recommendations made in previous reports was that those important to the patient were kept informed during their last stages of care. However, the report found that only 38% were informed of the patient’s needs.
Looking at 9,000 patient notes, researchers found no evidence that suggested do-not-resuscitate decisions had been discussed with relatives or friends in 18% of cases.
NHS England, one of the agencies that commissioned the report, welcomed the improvements but said there was more do be done.
A spokesperson from NHS England told the BBC: “Although this audit presents a snapshot of end-of-life care within NHS hospitals, there are clear variations in the support and services received – and there are areas where improvements must continue to be made.”