News and Comment

‘Quality of death’ – national success vs local variation

Wednesday 7 October 2015


Most of us are familiar with the concept of ‘quality of life’ when thinking about a neighbourhood, city, or country. ‘Quality of death’, on the other hand, isn’t something we regularly talk about. However, a recent report has been in the news this week for doing just that.

The latest Quality of Death Index has been released comparing the quality of provision around care for those at the end of life in 80 different countries.

Happily, if that’s the right word, the Index ranks the UK as highest in the world for its quality of death, citing comprehensive national policies, extensive integration of palliative care into the NHS, and strong hospices as reasons behind this.

Certainly in our own work we have come across many examples of good practice, and innovative and effective approaches. Most recently at OPM we were able to visit Trinity Hospice, as part of our current evaluation of the Wandsworth Care Coordination Centre, to see what ‘quality of death’ can really mean in practice.

From our research we’ve found that key ingredients to this include:

  • Joined-up working between professionals and services
  • Clear pathways to enter end of life care
  • Consistent guidance and frameworks, with good monitoring of whether they are being adhered to
  • Specialised training for professionals involved
  • A holistic approach to people’s needs at end of life
  • Clear quality standards

However, although it’s great news the UK ranks top in the Quality of Death Index, the authors acknowledge that there’s clearly still room for improvement, which is reflected in our own research, as well as recent case reports from the Parliamentary Health Service Ombudsman.

For instance, the nature of the service landscape for end of life care, which the Index doesn’t take into account, is something we have found to be an important factor in influencing how a person spends the last months and weeks of their life. Often, many different services from across health and social care can be involved in a person’s last days. Where these work in a joined-up manner it can make a huge positive impact, but where this is not the case, people can experience delays, poor communication, and inadequate care.

All too often there can also be huge variability between and even within different areas for how easily people can access end of life care, the nature and quality of care they receive, what location they spend their last weeks in, and, not least, whether they have to pay anything for it.

Perhaps what we need is something similar to the Quality of Death Index for within the UK, to make clear the wide range of experiences people are having in different parts of the country. Of course, this idea would still need a lot more development to make sure it supports improvement rather than just singling out areas for criticism. But done successfully, this would enable us to better identify and share the excellent practice that we know is happening in many areas already – and ultimately improve our quality of death even further.