The BMJ Awards 2017: Palliative and Hospice Care

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1563 (Published 28 March 2017) Cite this as: BMJ 2017;356:j1563
  1. Nigel Hawkes, freelance journalist
  1. London, UK
  1. nigel.hawkes1{at}btinternet.com

Nigel Hawkes reports how the shortlisted teams have focused on identifying patients’ priorities and preferences at the end of life

My care choices

Patients approaching the end of life are not always recognised as such by their GP surgeries. In north east Essex, a survey showed that only 35% of patients who died were on a palliative care register and only 20% had their choice of where to die documented. Even where wishes were known, they were not shared, says Karen Chumbley, clinical director of St Helena Hospice in Colchester who was appointed in 2015 after more than a decade as a GP.

The plan for improvement was based around a register, My Care Choices, and a hospice advice and support line, Singlepoint, which is available 24 hours a day, seven days a week for anyone believed to be in the last year of their life. Primary care was commissioned to identify people, and the hospital, mental health trust, and care homes were engaged to make sure that as many patients as possible were included.

“Deaths in hospital, which were above the east of England average at 49%, have fallen to 43%, representing more than 220 deaths a year,” Chumbley says. “A third of people who died in the area last year had their choices recorded, and three quarters of those who have recorded choices die in their place of choice. Over 6000 have used the register since it started.

“We’d like to do more. Academic papers say that 70% of deaths are predictable, but unless there’s a huge change in national culture I don’t think we’ll ever capture more than 50%. The practice where I worked tried really hard, and got 50 to 60%. That may be the best we can hope for.”

Cross-setting consistent anticipatory prescribing guidance

The dying do not …

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