NHS England has commissioned a report on “Improving communication between health care professionals and patients in the NHS in England”. This has specifically focused on those interventions which result in a significant positive difference to patient experience while also benefiting patient clinical outcomes and reducing financial demands on the health system.
- NHS England has commissioned a report on “Improving communication between health care professionals and patients in the NHS in England”. This has specifically focused on those interventions which result in a significant positive difference to patient experience while also benefiting patient clinical outcomes and reducing financial demands on the health system.
- This report has now been completed and has demonstrated that the evidence for achieving all these benefits, including reduction in overall expenditure to the NHS, is most compelling in interventions relating to end-of-life care. These benefits can be realised by improving communications relating to conversations about patient choices regarding medical interventions, care and support wishes and preferred place of death.
- There are many potential benefits to the early introduction of end-of-life care planning in a patient’s treatment. These approaches can improve quality of life and mood, reduce the use of aggressive care at the end of life, improve clinicians’ documentation and delivery of patient’s preferences including place of death, improve pain management, reduce emergency hospital admissions and even extend life expectancy of certain groups. These conversations not only have the potential to improve patient experiences but also lead to more effective use of resources and generate cost savings to the system as a whole.
- Conversations around prognosis and end of life can be challenging for both the doctor and the patient but vitally important for improving patient experience. The evidence suggests that most patients value these conversations if they are approached sensitively by clinicians with effective communication. However, timely honest conversations about patients’ future that patients wish are not happening routinely. Many physicians do not feel confident to initiate these conversations, to handle prognostic uncertainty or to discuss decisions about care and treatment that balance duration and quality of life.
- Educational research, in particular the iValidate study from Australia, has demonstrated the necessity for specific in-depth staff training approaches using experiential techniques and simulated patients to achieve changes in the ability of staff to hold these conversations, and for these improvements to impact patient care and patient outcomes.
- The report has recommended that NHS England introduce staff training for goals of care conversations with patients presenting in Acute Medical Units and Surgical Assessment Units in those at risk of dying in the next 12 months because of progressive illness or frailty, or at risk of serious clinical deterioration and death during this presentation. This represents approximately 30% of all acute hospital admissions.
- These conversations, held within 48 hours of patient admission involve providing patients with information about their condition and treatment options, and giving them the opportunity to have their values, goals, priorities and treatment preferences heard, respected and recorded by clinical staff.
- This report presents the evidence for a substantial return on investment. For each Trust in the NHS on average an expenditure over 4 years of £413,000 would lead to savings of £8,847,000, equivalent to a 20-fold return on investment. These savings would primarily accrue via a reduction in total bed days per year.
- The recently published NHS Long-Term Plan has committed to the following: “With patients, families, local authorities and our voluntary sector partners at both a national and local level, including specialist hospices, the NHS will personalise care, to improve end of life care. By rolling out training to help staff identify and support relevant patients, we will introduce proactive and personalised care planning for everyone identified as being in their last year of life. A consequence of better quality care will be a reduction in avoidable emergency admissions and more people being able to die in a place they have chosen.”
4th December 2019