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Appendix

• Technical Appendix >

Resources

• Resource List >

The End of Life Pathway

A good death

1
This chapter (based on the work of the End of Life CPG – full report available at www.yorksandhumber.nhs.uk) sets out the action we should take to improve the care people receive at the end of their life.

2
The quality of care we provide to people nearing the end of their lives suffers as a result of a disinclination to talk about death and dying across society as a whole which is in turn reflected within our NHS organisations. There is often reluctance amongst health professionals to initiate discussions about people's preferences for end of life care.

The Case for Change

3
Approximately 50,000 people die each year in Y&H - 56% of our deaths are in hospital which is close to the national average of 58%. In addition:

• Approximately 18% of patients die in care homes in England, in Y&H this is 19%.
• Just over 4% of patients across England die in hospices, in Y&H this is approximately 5%.
• On average in England around 18% of patients die at home, this is approximately the same in our region.
• There is significant variation across Y&H with regard to place of dying, possibly reflecting the nature of rural and urban localities and the distribution of services.

4
We know that this does not reflect people's preferences:

• Almost 60% of our patients indicate a preference for dying at home.
• 24% of our patients would prefer to die in a hospice.
• Around 40% of our patients do not get their wish to die at home, and a further 19% do not get their wish to die in a hospice.
• Approximately 20% of our patients would prefer to die in a hospital or care home (or setting other than home or hospice); however approximately 70% die in such settings.

5
Patients told us that the longer they can be at home the better.

"I do think it is more comforting and less stressful".

6
As well as not meeting people's wishes at the end of their lives, there are other reasons for change. These include:

• Poor coordination, which leads to delay in setting up packages of care to meet people's health and social care needs.
• Suboptimal delivery of care in hospitals, care homes and the community when measured against known standards of good practice.
• Problems which can occur with verification and certification of death, viewing the body at mortuary and with return of the person's property to their family.

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