Advising with empathy and experience

Failings in end-of-life care.

A national review of end-of-life care says most hospitals are failing to provide face-to-face palliative care specialists around the clock.

The review, the first review since the controversial Liverpool Care Pathway was scrapped, shows only 16 of 142 hospital sites in England offer specialists on site 24/7.

The Liverpool Care Pathway was phased out after criticisms it had been misused as a tick-box exercise, leaving some patients without food and water. It has been superseded by a series of guidelines aimed at moving away from a ‘broad-brush’ approach to focus on individual care.

The new report, led by the Royal College of Physicians, shows there have been improvements in all areas including communication with patients and relatives.

But there were still concerns. In 18% of more than 9,000 patient notes, researchers found no written evidence that do-not-resuscitate decisions had been discussed with relatives or friends.

And, in about 3,000 notes, there was no evidence that the patient's ability to eat and drink had been assessed on the last day of life.

But the researchers' main concern was that many patients and doctors did not have full access to on-site palliative care specialists at evenings and weekends.

The majority of hospitals did offer a specialist telephone helpline at all times and 53 of 142 hospital sites offered face-to-face palliative care on Monday to Sunday between 9am and 5pm.

But, for 26 trusts, there was no record of face-to-face specialist palliative care involving doctors at any time.

Study leader, Dr Sam Ahmedzai, said: "We know that most front-line doctors and nurses giving end-of-life care do it to a very good standard but problems arise when things start to go wrong and this often happens out-of-hours in the middle of the night and at weekends.

“Then doctors and nurses who are inexperienced need to be able to access palliative care specialists. Without this, patients with complex problems may not get the care they need.”

NHS England, which commissioned the review, welcomed the improvements, but said it was clear that more could be done.

A spokesperson added: "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."