National Audit of Care at the End of Life (NACEL)

Supplier info

Name: Debbie Hibbert
Org: NHS Benchmarking Network
Phone: 0161 266 2072
Website: National Audit of Care at the End of Life

HQIP contact

Vivien Dunne

The audit is focusing on the quality and outcomes of care experienced by those in their last admission in acute, community and mental health hospitals throughout England and Wales. Outputs from this project will be of interest to those who receive, deliver and commission care, so will have a far-reaching audience.

The scope of the NACEL will now include the following elements:

  • A case note review of inpatients in hospital in the last few days and hours of life.
  • An organisational level audit covering service models, activity, workforce, finance quality and outcomes
  • The development and administration of an innovative Carer Reported Measure
  • The development and administration of a Staff Reported Measure
  • Topics for periodic, time-limited ‘spotlight’ audits

NACEL will be an independent piece of work, but will also build on previous audits, with services being assessed against the Leadership Alliance for the Care of Dying People’s Five Priorities of Care, CQC domains and Nice national guidance and quality standards. Both carer and staff views will be included in the audit for the first time.

Additional information on all HQIP-commissioned projects is available on the NHS Trusts page, which includes the recommendations repository, infographics compendium, 9 month publication schedule, impact report, and National Clinical Audit and Enquiries Directory. For further information about this project, please contact the project team directly using the contact details listed in the ‘Supplier Info’ section above.

2021 data collection – In this period of excess deaths, it is more important than ever to understand the care patients are receiving and the experience of those important to the dying person. NACEL did not run in 2020 due to the Covid-19 pandemic. If NACEL were to be delayed further, this would mean another year with no national data on the quality and experiences of end of life care in England and Wales.

The NHSEI guidance (26-01-2021) still stands and the importance of clinical audit activity is highlighted although not mandated: ‘Clinical audit: Given their importance in overseeing non-Covid care, clinical audits will remain open. This will be of particular importance where there are concerns from patients and clinicians about non-Covid care such as stroke, cardiac etc. However, local clinical audit teams will be permitted to prioritise clinical care where necessary – audit data collections will temporarily not be mandatory.’

To make this an appropriate and manageable process for Trusts/Health Boards in the current circumstances the following guidance applies for the current round of the NACEL audit.

Guidance for Acute and Community Trusts/Health Boards 2021

(note: Data collection period runs from 1 June to 8 October 2021, covering deaths in April and May)

No Component Requirement
1 Organisational Level Audit: Collecting data about governance, policies and specialist palliative care teams Trusts/Health Boards should aim to participate where this is possible, in line with NHSEI guidance.
2 Case Note Review:

  • Number of reviews = 40 (less than this would not provide meaningful results)
  • The 2021 audit is based on the significantly shorter 2019 ‘light touch’ version
  • Consideration was given to delaying the audit period however, this would mean shifting the data collection period into winter 2021/22, which may be an even more difficult time than summer 2021

 

Trusts/Health Boards should aim to participate where this is possible, in line with NHSEI guidance.

3 Quality Survey:  Feedback from bereaved relatives and staff

Optional

This element is optional if Trusts/Health Boards can provide assurance that they are covering this in some other way by listening to bereaved carers and taking into account their feedback.

4 Staff Reported Measure: Feedback from members of staff

Optional

Some Trusts/Health Boards may wish to better understand the experience of their staff and their skills/training for care of the dying.

 

Guidance for Mental Health Trusts/Health Boards

The Mental Health Spotlight Audit will go ahead as planned, which is supported by the NACEL Mental Health Clinical Lead.

No Component Requirement
1 Organisational Level Audit: Collecting data about governance, policies and specialist palliative care teams Mental Health inpatient providers should aim to complete all 4 elements of NACEL, in line with NHSEI guidance
2 Case Note Review: Collecting data about delivery and quality of care Mental Health inpatient providers should aim to complete all 4 elements of NACEL, in line with NHSEI guidance
3 Quality Survey:  Feedback from bereaved relatives and staff Mental Health inpatient providers should aim to complete all 4 elements of NACEL, in line with NHSEI guidance
4 Staff Reported Measure: Feedback from members of staff Mental Health inpatient providers should aim to complete all 4 elements of NACEL, in line with NHSEI guidance

 

 

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