This summary indicator includes 5 questions based on discussions with the dying person on plan of care, the possibility that the patient may die, side effects of medication (including drowsiness), hydration and nutrition. The 5 questions are: Is there documented evidence that the possibility that the patient may die had been discussed with the patient? (aligned with the theme of 'Recognising the possibility of imminent death'); Is there documented evidence that the patient was involved in discussing the individualised plan of care? (aligned with the theme of 'Individualised end of life care planning - The patient'); Is there documented evidence that the possibility of drowsiness, if likely, as a result of prescribed medications, was discussed with the patient? (aligned with 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 patient once the dying phase was recognised? (aligned with 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 patient once the dying phase was recognised? (aligned with theme of 'Individualised end of life care planning - Eating and assisted nutrition'). All questions include the response options: Yes; No but reason recorded and/or N/A; No and no reason recorded.

A response option of 'Yes' or 'No but reason recorded and/or N/A' for each of the five questions received 1 point in the summary score method. A response option of 'No and no reason recorded' received a score of zero. The maximum possible score for this summary indicator is 5. Questions: Is there documented evidence that the possibility that the patient may die had been discussed with the patient?; Is there documented evidence that the patient was involved in discussing the individualised plan of care?; Is there documented evidence that the possibility of drowsiness, if likely, as a result of prescribed medications, was discussed with the patient?; Is there documented evidence that a discussion about the risks and benefits of hydration options was undertaken with the patient once the dying phase was recognised?; Is there documented evidence that a discussion about the risks and benefits of nutrition options was undertaken with the patient once the dying phase was recognised?.

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.