1st April 2016

Thoughts on End of Life Care Report

We were pleased to read that The Royal College of Physicians biannual report on end of life care in NHS hospitals, issued this week, acknowledges that there have been improvements although it also identifies that there is still much more that needs to be done.

Reading the report it feels as if the College are implying that this is an NHS issue. I do not believe it is. The hospice movement contributes £1bn worth of palliative and end of life care each year to our country and, most importantly, is the quality marker for high standards of end of life care. It is my view that NHS acute and community trusts should widen their horizons and work much more closely with their local hospices. No new expensive initiatives re-inventing the wheel are required by the NHS; just an expansion of such partnership working between NHS hospitals their local hospices. Good examples of this already exist.

Here in Worcestershire we are working in close partnership with Worcestershire Acute Hospitals NHS Trust both through daily liaison with the hospital’s own palliative care teams, but also in the way that St Richard’s has delivered the St Christopher’s Hospice “Quality End of Life Care for All” training package to NHS Ward Managers. Once back in their hospitals, after spending four days at the hospice, they are able to combine that learning with their own processes around caring for patients who may be at risk of dying in the near future, and so deliver better end of life care on the wards.

At the National Council of Palliative Care Conference last week at Keele University it was noticeable how the theme of the need for better communications was repeated, and is again highlighted in this report. Here there is a fundamental problem. There has been investment by the NHS in the past in excellent communications skills training for senior doctors. However, it is frequently junior doctors in hospitals who show inadequate communications skills when talking to end of life care patients and those important to them. This ability to communicate properly with all patients is a basic skill required for all doctors for all aspects of healthcare, not just end of life. I believe that there is a shortcoming of medical schools at universities and that student doctors should learn effective communications skills at the very start of their careers.

At St Richard’s we have the privilege of helping to train student doctors from Birmingham University, but we only see them for one day. The amount of time that those students have in their five years of training for palliative and end of life care is very small indeed. Yet death will eventually come to every one of the patients they will see throughout their careers. It is no surprise to me that junior doctors demonstrate inadequate communications skills in hospitals if they are inadequately trained and are unsure of the subject matter in the first place.

In summary, it is a shame that the College’s report did not recommend specifically that NHS Trusts should work more closely with their local hospices and that the syllabus of junior doctors’ training should be reviewed to include more end of life care and communications skills training. Such partnership working is working well in Worcestershire and we are proud of the excellent compassionate care that, as a whole healthcare team, we provide for those at the end of their lives.

Mark Jackson, Chief Executive

Read the full report Royal College of Physician’s End of Life Care Audit England 2016