Intended for healthcare professionals


Hospices still outperform hospitals on quality of care at end of life

BMJ 2015; 351 doi: (Published 09 July 2015) Cite this as: BMJ 2015;351:h3776
  1. Ingrid Torjesen
  1. 1London

Bereaved people in England rate the care provided by hospitals at the end of their relative’s life lower than that provided by hospices, care homes, and services in the community, show the results of a survey published by the Office for National Statistics.1

Overall, 75% of bereaved people rated the quality of care of their relative or friend in the last three months of life as outstanding, excellent, or good and 10% as poor, found the annual national survey of bereaved people, VOICES (Views of Informal Carers—Evaluation of Services).

However, quality of care was rated lower when the patient died in hospital than when they died in other settings: 69% of bereaved people whose relative or friend died in a hospital rated the care as outstanding, excellent, or good, compared with 83% where the death occurred in a hospice, 82% in a care home, and 79% at home.

Ratings of fair or poor quality of care were higher, across all care settings, among people living in the most deprived areas (30%) than among those in the least deprived (21%).

Furthermore, a third (33%) of relatives and friends of patients admitted to hospital at some stage during the last three months of their life reported that the hospital services did not work well with GP and other services outside the hospital. Hospital staff were also less likely to be rated as “always showing dignity and respect”: the proportions were 59% for hospital doctors and 53% for hospital nurses but 88% and 85%, respectively, for doctors and nurses in hospices.

When asked whether a patient who had died in hospital had died in the right place, 73% of bereaved people thought that they had, despite only 3% saying that the person had wanted to die in hospital.

Claire Henry, chief executive of the National Council for Palliative Care, said, “The NHS was set up to care for people from cradle to grave, but it’s clear that end of life care isn’t being given priority everywhere—something which is simply unacceptable. That’s why there needs to be strong national and local leadership, improved training and support for health and care staff, and an unwavering commitment to putting people who are dying first and providing coordinated services which meet their needs and choices.”

Where pain relief was relevant, it was reported as being provided “completely, all of the time” during the last few months of life most often for patients who died in hospices (64%) and least often for those who died at home (18%). Eight per cent of people cared for at home did not have their pain relieved at all.

The survey also found that 13% of bereaved people did not believe that the patient’s need for food or nutrition was met in the last two days of life, 11% did not agree that there was adequate support for the patient to receive fluids, and only 10% thought that pain relief was sufficient during that time.

In terms of the quality of communication between health professionals and relatives, friends, or carers in the last two days of life, 86% of bereaved people said that they had understood the information provided by health professionals, but 16% said that they had not been given enough time to ask questions.


Cite this as: BMJ 2015;351:h3776


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