End of life care

Each year around half a million people die in England, three quarters of whom do so following a period of chronic illness, such as cancer or heart disease. A report out today by the National Audit Office found that some people approaching the end of their life receive a high quality service, but that there is room for improved coordination between health and social care services in planning and delivering end of life care.

The provision of end of life care is becoming increasingly complex, with people living longer and the incidence of frailty and multiple conditions in older people rising. Information on peoples’ wishes is often not captured or shared and a lack of services to support them at home may lead to unplanned and unwanted admissions to hospital.

In 2006-07, estimated expenditure on specialist palliative care, though only one aspect of end of life care, varied considerably between PCTs from £154 to £1,684 per person who died. While there are no complete data on the total cost of end of life care, we estimate the cost of caring for the 27 per cent of people who die from cancer is £1.8 billion in the last year of their life. The majority of people approaching the end of their life wish to be cared for outside of hospital, so reducing the amount of time they spend there unnecessarily could make resources available to support these people more effectively in their preferred place of care.

Frontline staff often lack training in delivering basic end of life care. Only 29 per cent of doctors and 18 per cent of nurses received pre-registration training in end of life care, and there is a lack of formal training for staff working in care homes. Positive experiences of care were often linked to being treated by staff who understood, appreciated and empathised with the end of life situation.

The Department has raised the profile of end of life care within the NHS and social care services in recent years. In July 2008, it published a strategy to improve the care provided to adults approaching the end of their life by increasing the availability of services in the community and developing the skills of health and social care staff. To support implementation of the Strategy, the Department has committed additional funding of £286 million to PCTs over 2009-10 and 2010-11.

“Good end of life care should mean that people are treated with dignity and respect and, where possible, in their preferred place of care. Some people receive high standards of care in their final weeks, days and hours, but others do not. Organisations responsible for the care of people approaching the end of their life need to improve the planning and delivery of services, particularly support in the community. There is scope to make these improvements by using both existing and planned additional resources more efficiently and effectively.”

Tim Burr, head of the National Audit Office, 26 November 2008

Notes for Editors

  1. Today’s report examines the current provision of end of life care services and identifies the potential for improving their quality. It also highlights the issues that will need to be addressed in the implementation of the Department of Health’s End of Life Care Strategy.
  2. End of life care services seek to identify and meet the needs of both patient and family throughout the last phase of life and into bereavement. They include the management of pain and other symptoms, and provision of psychological, social, spiritual and practical support. In July 2008, the Department of Health published its End of Life Care Strategy which aims to improve end of life care for all adults approaching the end of their life, including support for their families and carers.
  3. Specialist palliative care is an aspect of end of life care delivered by clinicians with specialist training, such as those working in dedicated palliative care units or hospices.
  4. Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk.  Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  5. The Comptroller and Auditor General, Tim Burr, is the head of the National Audit Office which employs some 850 staff.  He and the NAO are totally independent of Government.  He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.


Mark Anderson

PN: 53/08