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Recommendations published to combat inequalities in end of life care

Patients should have a named care co-coordinator to ensure their end of life wishes are respected, according to a report which revealed that end of life patients are not always getting good quality care.

It is one of a series of recommendations to combat inequalities in end of life care. The Care Quality Commission's (CQC) report published today, A different ending: Addressing inequalities in end of life care, revealed the needs of some communities were not being considered. One-in-three CCGs have not assessed the end of life needs of their local populations including vulnerable people, older patients and those with a learning disability, mental health problem or a progressive illness other than cancer.

The CQC said: “In many cases a lack of understanding of people's needs is still preventing people from receiving good end of life care.”

The needs of the homeless, gypsies and travellers and people with a learning disability who are often excluded from wider health services are not always considered by commissioners, the report found.

A lack of understanding from services and staff had also affected some lesbian, gay and transgender patients and people from black and minority ethnic (BME), the report found.

The CQC highlighted the work of care coordinators in Erewash near Nottingham who are attached to GP practices to help plan tailored services.

It also called for “early and ongoing conversations” with patients about their wishes. It pointed out it can be “challenging” to communicate well about end of life care and said commissioners and providers should ensure staff have good communication skills and the support to met individual's needs.

The CQC said a lack of appropriate commissioned services means“people may end up dying in hospital when they would have chosen to be cared for somewhere else.” Some patients with terminal illnesses other than cancer “seem left out in the cold” and were not getting appropriate end of life care, relatives told the CQC.

The report revealed that some patients with dementia were slipping through the cracks, with just under half of health and care professionals considering their communication needs.

The CQC's chief inspector for general practice Professor Steve Field said while outstanding care was offered to people across the country “one person that does not get this is one person too many.”

The Royal College of Nursing's professional lead for end of life care Amanda Cheesley said: “There is only ever one chance to get death right and while it can be more challenging to ensure the right support for people who may be without a settled home, or have other specific needs, no one should be denied the opportunity for a 'good' death.”