FAQs
Are there any barriers to getting people to identify their preferred place of death?
There is a lack of discussion in society about death and dying. Death is an uncomfortable subject for many people, with little active discussion in society about what constitutes a ‘good death’.
Only around one third of the general public have discussed with anyone how they would like to die. In a poll of over 1,000 people conducted for Endemol UK, 67% of people over 65 years had prepared a will, while only 51% had discussed how they would like to die.
Nearly four out of five people say that they would wish to be told when they were dying, but it is not clear how many actually are told. In the poll conducted for Endemol UK, only 34% of the general public reported that they had discussed their wishes for how they would like to die. Even among those over 65 years, the figure was only 51%. Further, 42% of bereaved relatives did not know the patient’s preferred place of dying while 66% had never discussed death with the patient.
How does London compare to the rest of the country in terms of the number of deaths in hospital?
In London, 66% of deaths occur in hospitals, compared with a national average of 58%.
The Department of Health’s national End of Life Care Strategy refers to six stages of care. What are they?
- Identification of patients who are entering the final stages of their lives, and early discussions
- Assessment and care planning
- Coordination of individual patient care
- Delivery of high quality care in different settings
- Care in the last days of life
- Care after death
These stages are commented on and expanded on in our End of Life Care Good Practice Guide.
What is the Liverpool Care Pathway and why is it important?
The focus of care in the last days of life should be to maintain a person in their preferred place of care, managing symptoms and meeting any spiritual needs the person and their carer(s) have. The Liverpool Care Pathway is a standardised approach to care for people in the last days of life, and is currently the main guidance used to support the management of dying people.
What is the Gold Standards Framework?
The Gold Standards Framework has been developed to provide health professionals with an evidence based approach to improving the care for patients nearing the end of life. It is concerned with helping people to live well until the end of life and includes care in the final years of life for people with any end stage illness in any setting.
What is a Discharge to Preferred Place of Care Notice?
People sometimes die in hospital when they have previously expressed wishes to be cared for at home but they are not discharged from hospital in a timely manner. A Discharge to Preferred Place of Care Notice has been specifically proposed as part of the London work on end of life care, with the aim of managing the discharge of patients from hospital more efficiently. It places a requirement on hospitals to identify patients who need an urgent discharge and a responsibility on community services to ensure that this discharge happens. The Discharge to Preferred Place of Care Notice is incorporated as a standard for commissioners.
How much does end of life care cost nationwide?
It is difficult, if not impossible to calculate the cost of end of life care in England, according to the Department of Health’s End of Life Care Strategy. However, the strategy does note that the key elements of expenditure are:
- Hospital admissions
- Hospices and specialist palliative care services
- Community nursing services
- Care homes
There is widespread agreement that these resources are not being used as well as they might be.
