The National Audit of Care at the End of Life (NACEL) examines the quality of care provided to adults in the last days of life during their final hospital admission across England, Wales, and Jersey. This report includes data from 19,705 case note reviews and 5,994 surveys of bereaved people.
The sustainable delivery of high quality end of life care requires ongoing review and continuous improvement to ensure compassionate and appropriate treatment
The report shows encouraging improvements in several aspects of care. Eighty-four per cent of patients were recognised as being likely to die during their final admission, providing opportunities for timely care planning and support. Documentation of hydration reviews in the last days of life increased to 82%, while 86% of people expected to die had an individualised plan of care addressing their end of life needs. Bereaved people also reported positive experiences, with 77% rating the care and support provided to the dying person as excellent or good.
While overall access to specialist palliative care remained stable at 97% of hospital providers, the proportion offering face-to-face specialist nursing and/or medical support seven days a week increased to 64%, up from 61% in 2024. The proportion of patients reviewed by a specialist palliative care or end of life care team during their final admission increased from 47% in 2022 to 58% in 2025.
The report also highlights areas requiring further attention. Fewer than half of patients had documented evidence of participating in personalised care and support planning conversations, while assessments of spiritual, religious, and cultural needs were recorded in only 49% of cases. Findings also revealed differences in care according to ethnicity, with poorer outcomes observed where ethnicity was not recorded. As a result, this report recommends further national research into inequalities in end of life care and stronger system-level oversight of provider quality improvement plans to support equitable, high-quality care for all people approaching the end of life.
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