Quality standard

Quality statement 4: Out-of-hours care

Quality statement 4: Out-of-hours care

Quality statement

Adults approaching the end of their life and their carers have access to support 24 hours a day, 7 days a week. [2011, updated 2021]

Rationale

Adults approaching the end of their life may need support from healthcare services at any time. Being able to access support, including specialist palliative care, as soon as the need arises can help to prevent unnecessary distress to the person approaching the end of their life and their carers by preventing unnecessary visits to accident and emergency departments and hospital admissions. It is also beneficial and supportive for carers to know that they can obtain advice at any time of day or night, and this can help to reduce their concerns and anxieties.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Process

a) Proportion of adults approaching the end of their life who have access to a healthcare professional 24 hours a day, 7 days a week.

Numerator – the number in the denominator who have access to a healthcare professional 24 hours a day, 7 days a week.

Denominator – the number of adults approaching the end of their life.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local audits of patient records, local patient and carer experience surveys and bereavement surveys. The National Audit of Care at the End of Life: dying in hospital measures hospital site availability of face to face specialist palliative care services 8 hours a day, 7 days a week, and telephone specialist palliative care services 24 hours a day, 7 days a week.

b) Proportion of adults approaching the end of their life who have access to an out-of-hours end of life care advice line.

Numerator – the number in the denominator who have access to an out-of-hours end of life care advice line.

Denominator – the number of adults approaching the end of their life.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local audits of patient records, local patient and carer experience surveys and bereavement surveys. The National Audit of Care at the End of Life: dying in hospital measures hospital site availability of telephone specialist palliative care services 24 hours a day, 7 days a week.

c) Proportion of adults approaching the end of their life who have access to an out-of-hours pharmacy service that has access to medicines for symptom management in adults approaching the end of their life.

Numerator – the number in the denominator who have access to an out-of-hours pharmacy service that has access to medicines for symptom management in adults approaching the end of their life.

Denominator – the number of adults approaching the end of their life.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local audits of patient records, local patient and carer experience surveys and bereavement surveys.

Outcome

a) Emergency hospital admissions in the 3 months before death.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local audits of patient records and Public Health England's Palliative and end of life care data. The National Audit of Care at the End of Life measures the number of emergency admissions to the hospital / site that the person had in the last 90 days of life.

b) Satisfaction of the person approaching the end of their life, and their carers if appropriate, with the support available.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local patient and carer experience surveys, bereavement surveys and NHS Digital's Personal social services survey of adult carers.

What the quality statement means for different audiences

Service providers (such as hospices, community care, primary care, secondary care and tertiary care) ensure that services are in place to support adults approaching the end of their life and their carers 24 hours a day, 7 days a week. This includes ensuring that a healthcare professional who can access the person's records and advance care plan is available, and that they have access to equipment out of hours, for example, specialist beds and oxygen. It also includes providing an advice line and an out-of-hours pharmacy service with access to end of life care medications.

Health and social care practitioners (such as social workers, mental health clinicians, pharmacists, GPs, specialists and nurses) ensure that adults approaching the end of their life and their carers know about the services that are available to them 24 hours a day, 7 days a week and know how to contact them. They ensure that adults approaching the end of their life and their carers understand how these services can support them. Practitioners can also access the support services to assist adults approaching the end of their life and their carers.

Commissioners ensure that they commission services that are available 24 hours a day, 7 days a week for adults approaching the end of their life and their carers, including an advice line and access to healthcare professionals and pharmacy services.

Adults approaching the end of their life and their carers can access support when they need it. They have access to an advice line, healthcare professionals and a pharmacy service that has medicines to manage their symptoms at any time of the day or night.

Source guidance

End of life care for adults: service delivery NICE guideline NG142 (2019), recommendation 1.12.1

Definitions of terms used in this quality statement

Adults approaching the end of life

Adults in the final weeks and months of life, although for people with some conditions, this could be months or years.

This includes people with:

  • advanced, progressive, incurable conditions

  • general frailty and coexisting conditions that mean they are at increased risk of dying within the next 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.

[NICE's guideline on end of life care for adults, terms used in this guideline]

Access to out-of-hours support

This includes:

  • a healthcare professional available 24 hours a day, 7 days a week, who can access the person's records and advance care plan, and make informed decisions about changes to care

  • an out-of-hours end of life care advice line

  • an out-of-hours pharmacy service that has access to medicines for symptom management in adults approaching the end of their life.

[Adapted from NICE's guideline on end of life care for adults, recommendation 1.12.1]

Equality and diversity considerations

Adults approaching the end of their life and their carers should be provided with information about the services available to them in a format that they can easily understand themselves, or with support, so they can communicate effectively with health and social care practitioners. The information should be in a format that suits their needs and preferences. The information and the services should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate, taking into account the person's level of health literacy. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.