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Who's at risk and why?

Adults :: End of life :: Who's at risk and why?

The National Audit Office's report on end of life care suggests that approximately 40% of patients dying in acute hospitals do not have medical needs requiring hospital stay.[1] In Medway, this equates to about 435 people annually. The report suggests that people approaching end of life and their families are at a difficult time and may be at risk of poor end of life experience if their needs are not being met because they are in an inappropriate setting at the time and therefore not receiving the right and appropriate level of care and support. This issue is exacerbated for patients with a non cancer diagnosis. Early recognition of end of life is particularly problematic for patients with non cancer diagnosis as traditionally, end of life services have been provided to only cancer patients.

Around half a million people die each year in England. The majority of these deaths occurres in people over 65 following chronic illnesses related to long term conditions such as cancer, heart disease, renal disease, liver disease, chronic respiratory disease, neurological diseases including dementia.[2] This implies, that the proportion of anticipated deaths from a long term condition can be estimated. However, comparison with the number of patients registered on the Quality Outcomes Framework (QOF) palliative care register indicates that patients are not currently being identified in the last year of life. This suggests that adults diagnosed with chronic long term illness nearing the end of life, are at risk of not gaining access to optimal end of life care.

The Royal College of General Practitioners published the Prognostic Indicator Guidance in 2008.[3] This was to assist GPs identify patients who would most likely require end of life care in the coming year and thus provide through the QOF palliative care register, a more realistic estimate of need.


[1]   National Audit Office. End of Life Care 2008; National Audit Office. .
[2]   Department of Health. National End of Life Strategy - promoting high quality care for all adults at the end of life 2008; Department of Health.
[3]   Royal College of General Practitioners. Gold Standard Framework Prognostic Indicator Guidance, Revised version 5 2008; Royal College of General Practitioners. Gold Standards Framework (GSF) Centre, Walsal. .