This summary indicator includes 6 questions on discussions with the nominated person on plan of care, notification of possible and imminent death, side effects of medication, hydration and nutrition: Is there documented evidence that the possibility that the patient may die had been discussed with the nominated person(s)?(aligned with the theme of 'Recognising the possibility of imminent death'); Is there documented evidence that the nominated person(s) was involved in discussing an individualised plan of care for the patient? (aligned with the theme of 'Recognising the possibility of imminent death'); Is there documented evidence that the nominated person(s) were notified that the patient was about to die? (aligned with the theme of 'Recognising the possibility of imminent death'); Is there documented evidence that the possibility of drowsiness, if likely, as a result of prescribed medications, was discussed with the nominated person(s)? (aligned with the theme of 'Individualised end of life care planning - Symptom management'); Is there documented evidence that a discussion about the risks and benefits of hydration options was undertaken with the nominated person(s)? (aligned with the theme of 'Individualised end of life care planning - Drinking and assisted hydration'); Is there documented evidence that a discussion about the risks and benefits of nutrition options was undertaken with the nominated person(s)? ('aligned with the theme of 'Individualised end of life care planning - Eating and assisted nutrition').

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 5. Is there documented evidence that the possibility that the patient may die had been discussed with the nominated person(s)?(aligned with the theme of 'Recognising the possibility of imminent death'). For this question, the response options Yes and No but reason recorded and/or N/A received a score of 1; No and no reason recorded received a score of zero in the summary score method. Is there documented evidence that the nominated person(s) was involved in discussing an individualised plan of care for the patient? (aligned with the theme of 'Recognising the possibility of imminent death'). For this question, the response options Yes and No but reason recorded and/or N/A received a score of 1; No and no reason recorded received a score of zero in the summary score method. Is there documented evidence that the nominated person(s) were notified that the patient was about to die? (aligned with the theme of 'Recognising the possibility of imminent death'). For this question, the response options Yes and No but reason recorded and/or N/A received a score of 1; No and no reason recorded received a score of zero in the summary score method. Is there documented evidence that the possibility of drowsiness, if likely, as a result of prescribed medications, was discussed with the nominated person(s)? For this question, the response options Yes and No but reason recorded and/or N/A received a score of 0.5; No and no reason recorded received a score of zero in the summary score method. Is there documented evidence that a discussion about the risks and benefits of hydration options was undertaken with the nominated person(s)? For this question, the response options Yes and No but reason recorded and/or N/A received a score of 1; No and no reason recorded received a score of zero in the summary score method. Is there documented evidence that a discussion about the risks and benefits of nutrition options was undertaken with the nominated person(s)? For this question, the response options Yes and No but reason recorded and/or N/A received a score of 0.5; No and no reason recorded received a score of zero in the summary score method.

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

This measure is also aligned with the National Institute for Health and Care Excellence (NICE) Quality Standards and guidance, including NICE’s Quality Standard 144 and NICE Clinical Guidelines NG31 'Care of Dying Adults in the last days of life.