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Themed review of end of life care

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What is end of life care?

End of life care (EOLC) is the care experienced by people who have an incurable illness and are approaching death. Good EOLC enables people to live in as much comfort as possible until they die, and to make choices about their care. It is about providing support that meets the needs of both the person who is dying and the people close to them, and includes management of symptoms, as well as provision of psychological, social, spiritual and practical support.

End of Life Care covers the care received by people who are likely to die in the next 12 months, as well as care in the last days and hours of life, and care after death, including bereavement support for families and loved ones.

Barriers to good care

There is evidence of huge variation in the quality of end of life care that people receive, both across services, geographically and between different groups of people. CQC is addressing this in a number of ways.

As part of our new approach to inspection, EOLC is included as one of the eight core services we routinely inspect in acute hospitals, and it is also incorporated in our inspection approach in the other settings where it is delivered.

One of the recommendations of More Care, Less Pathway (the review of the Liverpool Care Pathway) was that CQC also review end of life care provision across sectors. CQC has made a commitment to respond to this recommendation through its membership of the Leadership Alliance for the Care of Dying People, which is taking forward the response to the review and the panel's recommendations.

The Alliance is committed to implementing "a consistent approach to caring for dying people across England, to ensure that everyone who is in the last days and hours of life, and their families, receive high quality care, tailored to their needs and wishes and delivered with compassion and competence".

Five new Priorities for Care have now replaced the Liverpool Care Pathway (LCP) as the new basis for caring for someone at the end of their life. The new approach recognises that in many cases, enabling the individual to plan for death should start well before a person reaches the end of their life.

Five new Priorities for Care

The new Priorities for Care mean that:

  • The possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care are made in accordance with the person's needs and wishes, and these are reviewed and revised regularly by doctors and nurses.
  • Sensitive communication takes place between staff and the person who is dying and those important to them.
  • The dying person, and those identified as important to them, are involved in decisions about treatment and care.
  • The people important to the dying person are listened to and their needs are respected.
  • Care is tailored to the individual and delivered with compassion – with an individual care plan in place.

The aim is to promote a stronger culture of compassion in the NHS and social care – one that puts people and their families at the centre of decisions about their treatment and care.

One chance to get it right

The new priorities have been created by a coalition of 21 organisations known as the Leadership Alliance for the Care of Dying People (LACPD), of which CQC is a part of. The priorities form part of the Alliance’s overall response – called One Chance to Get it Right – to an independent review of the LCP led by Baroness Neuberger.

End of life care themed review

Our thematic activity programme gives us the opportunity to develop our understanding of joined up, integrated end of life care as people experience it, and to understand why particular groups of people have a less positive experience. The work will bring together existing sources of evidence about quality of care and geographical variations, as well as using the findings of our own inspections of end of life care in different types of service.

Our evidence shows that people from particular groups experience end of life care which is of poorer quality and does not always meet their needs. This is why we are focusing our review on the following priority groups in particular:

  • People with a diagnosis other than cancer
  • People aged over 75
  • People with dementia; People from BAME groups and
  • Other groups of people who may have specific needs, such as people with mental health needs, people with learning disabilities, people who identify as LGBT, people who are homeless, prisoners, travellers and gypsies

During the review, we want to develop our understanding of the barriers which prevent people from receiving good quality and joined-up end of life care.

We will identify examples of good local practice that others can learn from. The review will also identify the actions that need to happen nationally so that the inequalities in end of life care services can be addressed.

The findings will be published in the Autumn of 2015.

The overview of the project is available below.

Inequalities and variations in of end of life care PDF | 289.61 KB

Last updated:
27 October 2014