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Survey finds improvement in nursing care for end of life patients

Nursing care for dying patients has improved with more relatives reporting their loved ones were treated with dignity and respect, according to results from the latest national survey.

However, the National Survey of Bereaved People – published yesterday by the Office for National Statistics – also revealed ongoing shortcomings in hospital care and variations in service quality for people nearing the end of life.

“Sadly, hospitals are still lagging behind when it comes to providing quality end of life care”

Jonathan Ellis

The survey, commissioned by NHS England, gathered the views of 22,220 people on the quality of care provided to a friend or relative in the last three months of life.

It found some promising progress in the quality of nursing care since the survey was first undertaken in England in 2011. For example, there was a higher proportion of relatives reporting that nurses “always” treated patients with dignity and respect.

The results for 2013 found hospice nurses were most likely to live up to this standard, with 86% of people reporting these nurses “always” treated loved ones with dignity and respect – up from 81% in 2011.

Only about half of respondents – 51% – said hospital nurses always treated patients with dignity and respect – the lowest proportion among different types of nursing and medical professional involved in end of life care. However that had increased from 48% in 2011.

Meanwhile, 28% said hospital nurses treated patients with dignity and respect most of the time, 19% said it happened some of the time and just 3% said “never”.

In comparison, 78% of survey participants reported community and district nurses always treated their loved ones with dignity and respect, while that was 63% for care home staff.

The survey – also known as VOICES (Views of Informal Carers – Evaluation of Services) – was this year commissioned by NHS England.

Overall, it found the quality of care had not changed much between surveys in 2011, 2012 and last year.

Quality of care was rated significantly lower for people who died in a hospital compared to those dying at home, in a hospice or care home.

Just a third of people – 35% – who said they wanted to die at home got their wish.

Meanwhile, the 2013 results also showed a drop in the quality of co-ordination of care for those dying at home, with 42% of people reporting services worked well together – down from 45% the previous year.

The National Council for Palliative Care said it was “disappointing” to see no overall improvement in care quality in the last few years and stressed the need for much greater consistency across different types of settings.

National Council for Palliative

Claire Henry

“Despite some encouraging progress, particularly in the dignity and respect shown by nurses, it’s hugely concerning that many people are still being failed when they are dying,” said the council’s chief executive Claire Henry.

“Once again end of life care in hospitals is clearly falling short – something which should be a particular concern given almost half the people in the survey died in hospital,” she added.

Jonathan Ellis, director of policy and advocacy at Help the Hospices, said: “This research shows the highest ratings yet for hospice staff over the survey’s last three years.

Help the Hospices

Jonathan Ellis

“Sadly, hospitals are still lagging behind when it comes to providing quality end of life care,” he said. “It is vital they invest in more training and support for doctors and other healthcare professionals to tackle this.

“Many hospices are working in partnership with hospitals through educational initiatives such as the QELCA programme to help raise standards of end of life care,” he added.

Readers' comments (2)

  • To give quality end of life care needs time - time to truly get to know the patient and their family and loved ones where possible. Time is a commodity in very short supply on the acute wards - a nurse will be expected to deliver high quality end of life care, while juggling the needs of the other patients assigned to his/her care that shift. Having worked in a hospice and district nurse setting I feel qualified to comment on this matter. I now have returned to the acute sector, where even finding a side room for a dying patient can be almost impossible as they are all full of patients with infections of one sort or another. Yet again, I feel this is pointing the finger at nurses for not doing their job well enough - nursing a dying patient on an acute ward demands skills challenging any health care professional.

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  • michael stone

    Anonymous | 12-Jul-2014 8:51 am

    I've not yet read the new one, but previous VOICES, from memory, acknowledged that one of the problems is that acute hospitals are often not where many patients should end their lives: it is well understood that the enviroment of acute hospitals is problematic for EoL Care.

    One of the problems, is inappropriate transfer of the dying from the community to acute hospitals.

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