Hospitals are “falling short” on caring for dying people in their final days and hours, a new review has found.
There are “significant” variations in care provided by hospitals across England, according to the National Care of the Dying Audit for Hospitals.
Around half of all deaths in England occur in hospital.
But experts have said that major improvements are needed to ensure better care for terminally ill people.
And more needs to be done to support patients’ families, carers and their friends.
Many medics are failing to communicate properly with dying people or their loved ones and hospitals “do not recognise this as an important issue”, the authors said.
The audit, led by the Royal College of Physicians and Marie Curie Palliative Care Institute Liverpool, concluded that all staff who care for dying patients need to be specifically trained in the care of dying patients - particularly in communication skills.
Researchers assessed the quality of care received by 6,500 people who died in 149 hospitals across England between May 1 and May 31 last year.
They also questioned 850 bereaved relatives and friends and assessed services available in each organisation.
For most patients, healthcare workers realised they were in their last days of life, but less than half of patients capable of discussion were informed of this.
It appeared that dying people were also left out of clinical discussions. Seventeenper cent of patients were told they were being assessed to see if they needed artificial hydration or nutrition, according to the research. One in five were asked about their spiritual needs.
Meanwhile, 24 per cent of bereaved loved ones said they did not feel as though they were involved in decisions about care or treatment.
Some 37 per cent reported that the overall level of emotional support given to them by the healthcare team was fair or poor.
And a quarter said they did not feel adequately supported during the last two days of their loved ones’ life.
When the researchers assessed the hospitals, they found that mandatory training in care of the dying was only required for doctors in 19% of hospital trusts and for nurses in 28%.
The authors made a series of recommendations to improve the care of dying patients.
They said hospitals should provide a face-to-face specialist palliative care service from at least 9am to 5pm, seven days a week.
Decisions about care of dying patients should be made by multidisciplinary medical teams and discussed with the patient or their family where appropriate.
All hospitals should also audit their care of dying patients and they should have a designated board member responsible for palliative care.
Dr Kevin Stewart, chair of the audit’s steering group and clinical director of the RCP’s clinical effectiveness and evaluation unit, said: “Although some aspects of care are good in hospitals in England, I am deeply concerned that some hospitals are falling short of the excellent care that should be provided to both dying people and those important to them.
“In particular, communication with patients and their families is generally poor.
Care and support minister Norman Lamb said: “All patients should be receiving high quality and compassionate care in their last days of life - there can be no excuse for anything less.
“This report shows evidence of very good care but I am seriously concerned about the variations in care, and improvements are needed in the way some clinicians communicate with patients and support families.
“I am determined this should improve.”