This summary indicator includes 6 questions on discussions regarding how much the patient wished to be involved in decision making and how involved the patient was in decision making: Is there documented evidence about the extent to which the patient wished to be involved in decisions about their care?; Is there documented evidence in the notes that the dying person had their capacity assessed to be involved in their end of life care planning?; Is there documented evidence within the final admission of a discussion with the patient by a senior clinician regarding whether to continue or stop life-sustaining treatment offering organ support such as assisted ventilation, implanted defibrillator, renal dialysis?; Is there documented evidence within the final admission of a discussion with the nominated person by a senior clinician regarding whether to continue or stop life- sustaining treatment offering organ support such as assisted ventilation, implanted defibrillator, renal dialysis?; Is there documented evidence that a discussion with the patient regarding Cardiopulmonary Resuscitation (CPR) was undertaken by a senior clinician?; Is there documented evidence that the Cardiopulmonary Resuscitation (CPR) decision was discussed with the nominated person(s) by a senior clinician?

All 6 questions have the response options of: Yes; No but reason recorded and/or N/A; No and no reason recorded. The maximum possible score for this summary indicator is 6. A response option of 'Yes' or 'No but reason recorded and/or N/A' for each of the six questions received 1 point in the summary score method. A response option of 'No and no reason recorded' received a score of zero.

Hospices are excluded from participating in the National Audit of Care at the End of Life (NACEL) program. All non-NHS acute sites and community hospital providers of adult inpatient care in England and Wales were ineligible to take part in the audit. Deaths which were classed as "sudden deaths" were excluded from the Case Note Review as part of the National Audit of Care at the End of Life (NACEL) program. These were deaths which were sudden and unexpected; this included, but was not limited to, the following: all deaths in Accident and Emergency departments, deaths within 4 hours of admission to hospital, deaths due to a life-threatening acute condition caused by a sudden catastrophic event, with a full escalation of treatment plan in place. Other deaths excluded include: Deaths of patients aged under 18, Suicides, Maternal deaths.

None

The national and hospital-level summary scores are not stratified. The proportions of response options to the five individual data collection questions that are contained within this summary indicator are reported with stratifications for 'All deaths', 'Category 1' deaths and 'Category 2' deaths and by audit year. Category 1 is defined as: It was recognised that the patient may die - it had been recognised by the hospital staff that the patient may die imminently (i.e. within hours or days). Life sustaining treatments may still be being offered in parallel to end of life care. Category 2 is defined as: The patient was not expected to die - imminent death was not recognised or expected by the hospital staff. However, the patient may have had a life limiting condition or, for example, be frail, so that whilst death wasn't recognised as being imminent, hospital staff were "not surprised" that the patient died.

Data collected via Case Note Review entered into a bespoke online data entry tool. For the Case Note Review, acute hospital providers are asked to audit up to 50 eligible patients for each submission created on registration (based on the audit period). Community Hospital providers were requested to audit up to 50 eligible deaths (based on the audit period, which the time-frame can differ for acute versus community, depending on the audit round). Audit participants complete an Audit Summary data specification with the following information: the number of people dying in the audit period, excluding deaths within A&E and within 4 hours of admission to hospital; the total number of people dying in A&E within the audit period; the total number of people dying within 4 hours of admission to hospital within the audit period. The NHS Benchmarking Network team process patient level data through the Case Note Review, with the following demographic information collected: date of death, gender, ethnicity, date of admission and primary cause of death.

Public reporting

National Audit of Care at the End of Life (NACEL) program 2022/23 Report: www.hqip.org.uk/wp-content/uploads/2023/07/Ref.-380-NACEL-2022-Summary-Report-Final.pdf National Audit of Care at the End of Life (NACEL) program 2022/23 Appendices and specifications: www.hqip.org.uk/wp-content/uploads/2023/07/Ref.-380-NACEL-2022-Appendices-Final.pdf

Unable to locate full technical specification details. Some details and methods for scoring available here in Appendix 16 (page 34-40): www.hqip.org.uk/wp-content/uploads/2023/07/Ref.-380-NACEL-2022-Appendices-Final.pdf