In the National Care of the Dying Audit for Hospitals, which analysed the deaths of 6,580 patients in 149 NHS hospitals in May, experts from the Royal College of Physicians and the Marie Curie Palliative Care Institute found that the care provided to dying patients was “unacceptable”.
In many circumstances, healthcare professionals had recognised that the patients were dying but failed to inform the patient about this. Less than half (46%) of the dying patients who were still capable of conversation were told that they were in the final days of life. However, communication with families and friends was recorded in 93% of cases and on average, these discussions occurred 31 hours prior to death.
A number of dying patients were also overlooked in clinical discussions as only 17% of the surveyed patients were informed that they were evaluated to determine if they needed artificial nutrition.
Bereaved relatives and friends were also affected by the poor quality of care with 24% claiming that they did not feel involved in the decisions for the patient’s care and treatment. 37% also said that the emotional support given to them by the healthcare team was only fair or poor.
The audit also found that a fifth of the hospitals fail to give special training to their medical staff who care for dying patients. Only 19% of the trusts require mandatory training on how to care for dying patients for doctors, and 28% for nurses. Furthermore, it revealed that only a fifth of the hospitals have specialist palliative care staff working on weekends.
As a result of the findings, the audit recommends that hospitals should provide a face-to-face specialist palliative care service from at least 9am to 5pm, seven days per week. It also suggests that education and training in care of the dying should be mandatory for all staff caring for dying patients. This should include communication skills training, and skills for supporting families and those close to dying patients. It’s also advised that pain control and other symptoms in dying patients should be assessed at least every four hours and medication given promptly if necessary. All interventions should be discussed with the patient where possible and appropriate, and also with family, carers or other advocates.
At Fletchers, we welcome these recommendations. Communication, empathy and training is the key to good care and the NHS needs to take action so people that are dying are treated with the dignity, respect and compassion that they deserve.