Analysis

Poor end of life care is clear theme in ombudsman’s report

A report from the parliamentary and health service ombudsman on ‘dying without dignity’ makes disturbing reading

A report from the parliamentary and health service ombudsman on ‘dying without dignity’ makes disturbing reading.

The cases covered include a young man with cancer, nearing the end of his life, who was transferred to a palliative care unit. It took almost 12 hours for his increasing pain to be treated. Even then, extra relief was prescribed only after the patient’s distraught mother contacted the hospital’s emergency department. Eventually, a surgical doctor wrote the prescription. The man died two days later.

Recurring theme

For three quarters of the half million people who die in England each year, death is not sudden. Many receive palliative care in their final weeks and days. But ombudsman Dame Julie Mellor says that end of life care is a ‘recurring and consistent’ theme in the cases of complaint she is asked to consider.

A number of themes emerge from the report, many of which lie within the sphere of influence of senior nurses. They include poor communication, poor symptom control and inadequate care planning, with hospitals and GP practices, for example, often failing to liaise.

In another case outlined in the report, a patient learned that he had cancer only from his discharge note. In another, a terminally ill 82-year-old woman was denied her wish to die at home because of poor, unco-ordinated planning.

Upsetting

RCN professional lead in end of life care Amanda Cheesley describes the report as upsetting. ‘I have talked to a lot of senior nurses in palliative care since it was published and we’re all dispirited by it.’

Communication between staff remains a significant problem, she says. ‘Insufficient information is being given at handover and people are making assumptions that things have happened when they haven’t.’

She adds: ‘There is also an issue here about good leadership and ensuring your staff know their roles and what you expect from them.

Difficult conversations

‘As a senior nurse, I would also want to make sure people are confident in holding difficult conversations and that everyone knows what’s going on, not just certain people.’

Ms Cheesley expresses surprise that some complaints have been escalated to the ombudsman when they could have been handled locally, without necessarily admitting responsibility. ‘Sometimes that means putting your hand up and saying “We will try to make sure this doesn’t happen again”.’

New open-access resources on the RCN website will help all nurses, not just those in specialist teams, drive up standards in end of life care, she says.

The ombudsman’s report offers a number of learning points for the NHS. The first focuses on better recognition and acknowledgement of approaching death so that important conversations can take place to determine the patient’s preferences, which can then be taken into account when care plans are prepared.

Daniel Allen is a freelance health writer

More information

Dying without Dignity

RCNi’s online collection of information on end of life care

 

 

 

 

 

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