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Select committee inquiry

Dying without dignity inquiry

Closed

Public Administration and Constitutional Affairs Committee · Opened 21 July 2015 · Closed 25 October 2017

2 recommendations · 6 conclusions
Inquiry on parliament.uk ↗

What the inquiry looked at

“This short inquiry looked at 'Dying without dignity', the PHSO's May 2015 report, which highlights six key themes seen in the PHSO's casework involving end of life care: Not recognising that people are dying, and not responding to their needs Poor symptom control Poor communication Inadequate out-of-hours service Poor care planning Delays in diagnosis and referrals for treatment The Committee held a single evidence session focusing on the report's findings and on the actions being taken to address the issues raised in the report. Dying without dignity report”

The committee's words, from the inquiry page on parliament.uk ↗.

What it found

In the committee's words, from the summary of 1st Report - Follow-up to PHSO Report: Dying without dignity ↗

Failings in the care provided to people as they approach the end of their life can result in needless pain and suffering. In Dying without dignity, the Parliamentary and Health Service Ombudsman identified systemic issues affecting the quality and delivery of end of life care and used case studies to show how patients—and those close to them—had been affected by poor care. We welcome the report, which concluded that the NHS needed to improve in a number of areas and recommended that the report’s findings be used to inform a new approach to end of life care.

Witnesses told us that they were aware of the issues raised in the report and that the focus must now be on implementing change. We agree. We want good quality, timely and compassionate care to be available to all those who need it at the end of their life. In this Report, we outline the key areas in which we expect to see significant and fast-paced improvements. These are:

• culture, behaviour and training;

• the provision of integrated, 24/7 palliative and End of Life Care (EOLC) services; and • leadership and commissioning.

We also invite the Government to set out how it will ensure that the necessary improvements to end of life care provision are delivered.

We highlight the need to ensure that progress can be assessed objectively and suggest that clear targets for improvement are needed to enable such assessments. Comprehensive monitoring and reporting of progress against targets will also be required, and the Government must set out where responsibility for improving and monitoring end of life care lies.

What the government said

The government responded on 8 February 2016.

Summary written by Accountability Index from the government's response.

The government welcomes the Committee's emphasis on leadership, compassionate care and training, and sets out existing and planned work by NHS England, the CQC and Health Education England to improve end of life care.

  • On round-the-clock services, the government says "We agree fully with the need for better access to round-the-clock, high quality palliative care" and says it is committed to a seven day NHS.
  • NHS England is "soon to publish" an end of life care commissioning toolkit and a service specification for specialist palliative care, to help local commissioners provide around-the-clock specialist services.
  • On accountability, the government says the Department holds NHS England to account through the NHS Mandate and NHS Outcomes Framework, and that it is developing with NHS England a CCG Assessment Framework with ratings of all CCGs.
  • On measurement, the government says it "will continue to monitor progress" and hold NHS England, the NHS TDA, the CQC and HEE to account, while NHS England is "reviewing and developing" new metrics for end of life care.

Read the government's response ↗ Read the report ↗ Report an error

How the inquiry ran

Each dot is a dated item listed on this page, from the inquiry's opening on 21 July 2015 to its close on 25 October 2017.

  1. Oral evidence 15 Sep 2015
  2. Report 29 Oct 2015
  3. Government response 8 Feb 2016

What it recommended 2 recommendations · 6 conclusions

1We cannot overemphasise the importance of the right kind of leadership in achieving improvements in...
Concluded (the committee's words)
We cannot overemphasise the importance of the right kind of leadership in achieving improvements in palliative and end of life care. Leaders must ensure that all staff receive the necessary training and support, and that compassionate care is valued and encouraged. This can be achieved only through leadership by example, with leaders demonstrating that care and compassion are valued at every level of the organisation. Systems should also be in place to enable organisations to learn from mistakes and complaints.
2The National Council for Palliative Care has suggested that “commissioners and providers should stop thinking...
Concluded (the committee's words)
The National Council for Palliative Care has suggested that “commissioners and providers should stop thinking in terms of ‘out of hours’ services and start designing services that meet people’s needs ‘at any time of day and night’”. We agree. It is vital that good quality palliative and end of life care services are available wherever and whenever they are needed. Successful examples of integrated, round-the-clock services from across the UK must be replicated more widely so that all end of life care patients can receive the care they need when they need it.
3Senior leaders and commissioners must give end of life care provision greater priority and take...
Concluded (the committee's words)
Senior leaders and commissioners must give end of life care provision greater priority and take the decisions and actions needed to improve services at a faster pace.
4We support the Health Committee’s recommendations on leadership in its End of Life Care Report.
Concluded (the committee's words)
We support the Health Committee’s recommendations on leadership in its End of Life Care Report. We also highlight the role of commissioners in improving end of life care services, and stress the need to hold both commissioners and senior leaders to account regarding their actions to improve palliative and end of life care. We note the Government’s response to the Health Committee’s recommendations and its commitment to ensuring that services are well-led. We are pleased to note that the Government’s response identifies key figures at the Department of Health and NHS England who will have responsibility for driving forward improvements in end of life care. However, we would like to see more detail on how the Government will ensure that senior leaders, commissioners, trusts and service providers are held to account.
5We understand that the Government is unwilling to use legislation to drive improvements in end...
Concluded (the committee's words)
We understand that the Government is unwilling to use legislation to drive improvements in end of life care, but it must now set out how it will ensure that necessary improvements will be achieved.
6We welcome the Ambitions framework and hope that the collaborative approach it advocates will bring...
Concluded (the committee's words)
We welcome the Ambitions framework and hope that the collaborative approach it advocates will bring significant improvements to end of life care. However, the slow pace at which improvements in end of life care have been achieved is not acceptable. We support the Ambitions framework and have identified specific areas in which we expect to see improvement at a faster pace, namely: • culture, behaviour and training; • the provision of integrated, 24/7 palliative and EoLC services; and • leadership and commissioning.
7We highlight the need to ensure that progress can be assessed objectively and suggest that...
Recommended (the committee's words)
We highlight the need to ensure that progress can be assessed objectively and suggest that clear targets for improvement are needed to enable such assessments. Comprehensive monitoring and reporting of progress against targets will also be required, and the Government must set out where responsibility for improving and monitoring end of life care lies.
8We recommend that, as a matter of priority, the Government should set out: • how...
Recommended (the committee's words)
We recommend that, as a matter of priority, the Government should set out: • how the effectiveness of measures to improve end of life care will be monitored and by whom, including key monitoring targets, time scales and indicators; and • how any inconsistencies and sluggishness in implementing the framework will be remedied.

Evidence

Oral evidence sessions 1