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<p>In the 2017-18 Mandate to NHS England we asked for the identification of metrics
to assess quality and choice in end of life care. As a result, we will shortly have
in place a new indicator to measure the proportion of people with three or more emergency
admissions in their final 90 days of life, which will help us assess how well patients
with end of life care needs are being supported by local health and care services
out of hospital and in the community. The 2017-18 objective was met and therefore
did not feature in the 2018-19 Mandate.</p><p> </p><p>For 2018-19, the Government’s
Mandate asks NHS England to increase the percentage of people identified as likely
to be in their last year of life, so that their end of life care can be improved by
personalising it according to their needs and preferences at an earlier stage. NHS
England will use the Quality Outcomes Framework to demonstrate such an increase by
looking at the percentage of people who are on the general practitioner register for
supportive and palliative care, and consider expected levels based on local populations
Currently the national English average is 0.37%, it is anticipated this figure will
increase in the 2018/19 period. Further work will also be undertaken to develop indicators
that will enable NHS England to scrutinise the effectiveness of local health economies
in delivering choice and quality in end of life care.</p><p> </p><p>Since 2012 the
National Survey of Bereaved People (VOICES) survey has provided valuable insight into
the quality of care delivered to people in the last three months of their lives, highlighting
variations in the quality of care delivered in different areas of the country and
to different groups of patients. Following publication of the last set of survey results
in June 2016, NHS England held a consultation on the future of the VOICES survey to
seek views on the approach and relevance of the survey to ensure that it remained
fit for purpose. Whilst the response showed that the VOICES survey remained a valuable
tool, key amongst its findings were that the majority of respondents indicated that
the VOICES survey would be more helpful if the sample size were made large enough
to report at a local commissioner level.</p><p> </p><p>Following this, work was undertaken
to revise the survey and consider approaches to a larger sample size and then put
in place arrangements to re-commission the VOICES survey. NHS England has been involved
in discussions with the Office for National Statistics, which collects the death registration
data used to identify survey recipients, about arrangements for access to the data
for the new survey. Changes to the safeguarding arrangements on data-sharing, designed
to ensure any concerns about care raised via the survey can be appropriately investigated,
have resulted in delays to commencing the new VOICES survey. Work is ongoing to resolve
this matter.</p>
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