Advice from NICE aims to improve commissioning for end of life care
NICE has published its guide for commissioners of end-of-life care services, the latest in its series of good practice guides to support commissioners in designing high quality, evidence-based services to improve outcomes for patients and to help the NHS make better use of resources. The guide aims to support local implementation of the Department of Health (2008) End of Life Care Strategy and the NICE (2011) Quality Standard for end of life care for adults, and is aligned with the NHS Outcomes Framework and supports commissioning for Quality, Innovation, Productivity and Prevention (QIPP).
A large proportion of deaths are foreseeable, and a recent estimate suggests that approximately 355,000 people need good palliative and end of life care services every year but around 92,000 people are not being reached. Although 63% of people surveyed stated that home is their preferred place of death, in 2010 many deaths occurred in hospitals (53%) and only 21% occurred in the home with an additional 18% in care homes. Emerging evidence suggests that redesigning local end of life care pathways to enable provision of high quality end of life care can result in more people being able to die in their usual place of residence rather than in hospital, and is at worst cost neutral and has the potential to be a more efficient and effective use of resources.
The guide includes an end of life care commissioning and benchmarking tool to help users determine the level of service that might be needed locally and to help cost and identify potential savings associated with commissioning end of life care services. The commissioning and benchmarking tool demonstrates that in England a 10% reduction in the number of hospital admissions ending in death could potentially result in a saving of £52million. These savings can be invested in alternative, community-based end of life care services.
Dr Bee Wee, President of the Association for Palliative Medicine of Great Britain and Ireland, said: "This guide will help commissioners ensure that more people identified as being at the end of life are offered comprehensive and person-centred care during their last year of life. It provides practical commissioning advice about redesigning services so that people approaching the end of life are able to remain in their preferred place of care, where this is in their best interests, and receive the support and care they need, when they need it."
While the guide for commissioners draws on existing NICE recommendations, it does not constitute formal NICE guidance and is intended as a tool to help the NHS improve patient care through effective commissioning.
Notes to Editors
About the EoLC guide for commissioners
1. The NICE guide on commissioning services for end of life care is available on the NICE website at http://www.nice.org.uk/usingguidance/commissioningguides/endoflifecare/endoflifecareadults.jsp
2. This guide for commissioners uses General Medical Council's definition of end of life: people are 'approaching the end of life' when they are likely to die within the next 12 months. This includes people whose death is imminent (expected within a few hours or days) and those with:
- advanced, progressive, incurable conditions
- general frailty and coexisting conditions that mean they are expected to die within 12 months
- existing conditions if they are at risk of dying from a sudden acute crisis in their condition
- life-threatening acute conditions caused by sudden catastrophic events.
3. Around 455,000 people died in England in 2010, two-thirds of whom were 75 years of age or older. Deaths in England and Wales are expected to rise by 17% from 2012 to 2030. A large proportion of deaths are foreseeable, and a recent estimate suggests that approximately 355,000 people need good palliative care services every year but around 92,000 people are not being reached.
4. Details of all the NICE guides for commissioners published to date can be found on the NICE website at http://www.nice.org.uk/usingguidance/commissioningguides/bytopic.jsp
5. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.
6. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS
7. NICE produces standards for patient care:
- quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
- Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients
8. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.
 Hughes-Hallet T, Craft A and Davies C. (2011) Palliative Care Funding Review; Funding the Right Care and Support for Everyone
 Gomes B, Calanzani N and Higginson I (2011) Local preferences and place of death within regions within England 2010
This page was last updated: 11 January 2012