Using the quality standard

It is important that the quality standard is considered alongside current policy and guidance documents listed in the development sources section.

Quality measures and national indicators

The quality measures accompanying the quality statements aim to improve the structure, process and outcomes of healthcare. They are not a new set of targets or mandatory indicators for performance management.

Expected levels of achievement for quality measures are not specified. Quality standards are intended to drive up the quality of care, and so aspirational achievement levels are likely to be 100% (or 0% if the quality statement states that something should not be done). However, it is recognised that this may not always be appropriate in practice taking account of patient safety, patient choice and clinical judgement and therefore desired levels of achievement should be defined locally.

The quality standard makes use of existing measures and indicators provided by the End of life care strategy: quality markers and measures for end of life care (Department of Health 2009). Users are expected to consider the measures in the context of each quality statement and prioritise those that are most appropriate.

Supplementary NICE quality measures have been developed and are included against each statement where existing suitable measures were not available.

For further information, including guidance on using quality measures, please see how to use quality standards. The standard also highlights where related national quality assured indicators currently exist and measure the quality statement.

Diversity, equality and language

People approaching the end of life should have the opportunity to make informed decisions about their care and treatment, in partnership with health and social care professionals and with their families and carers. Good communication between health and social care professionals and people approaching the end of life and their families and carers is essential and should be sensitive to personal preferences. Treatment and care, and the information given about it, should be culturally appropriate. It should also be accessible to people with additional needs such as physical, cognitive, sensory or learning disabilities, and to people who do not speak or read English. People approaching the end of life should have access to an interpreter or advocate if needed. Workforces involved in end of life care should adopt an agreed, consistent approach and attitude to end of life care that encourages and accepts patient choice, regardless of their own background, culture and views.

People approaching the end of life and their families and carers should have access to the high-quality care described in this quality standard on the basis of need and that takes into account their preferences, regardless of their individual circumstances, including:

  • gender

  • ethnicity

  • disability

  • cognitive impairment

  • age

  • sexual orientation

  • gender reassignment

  • religion and belief

  • culture or lifestyle

  • marriage and civil partnership

  • pregnancy and maternity

  • socio-economic status

  • mental capacity

  • diagnosis

  • choices they make about their care

  • location and setting in which they are receiving care.