Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what targets have for the 2018-19 mandate to NHS England to increase the proportion of people identified as likely to be in their last year of life.

In the 2017-18 Mandate to NHS England we asked for the identification of metrics to assess quality and choice in end of life care. As a result, we will shortly have in place a new indicator to measure the proportion of people with three or more emergency admissions in their final 90 days of life, which will help us assess how well patients with end of life care needs are being supported by local health and care services out of hospital and in the community. The 2017-18 objective was met and therefore did not feature in the 2018-19 Mandate.

For 2018-19, the Government’s Mandate asks NHS England to increase the percentage of people identified as likely to be in their last year of life, so that their end of life care can be improved by personalising it according to their needs and preferences at an earlier stage. NHS England will use the Quality Outcomes Framework to demonstrate such an increase by looking at the percentage of people who are on the general practitioner register for supportive and palliative care, and consider expected levels based on local populations Currently the national English average is 0.37%, it is anticipated this figure will increase in the 2018/19 period. Further work will also be undertaken to develop indicators that will enable NHS England to scrutinise the effectiveness of local health economies in delivering choice and quality in end of life care.

Since 2012 the National Survey of Bereaved People (VOICES) survey has provided valuable insight into the quality of care delivered to people in the last three months of their lives, highlighting variations in the quality of care delivered in different areas of the country and to different groups of patients. Following publication of the last set of survey results in June 2016, NHS England held a consultation on the future of the VOICES survey to seek views on the approach and relevance of the survey to ensure that it remained fit for purpose. Whilst the response showed that the VOICES survey remained a valuable tool, key amongst its findings were that the majority of respondents indicated that the VOICES survey would be more helpful if the sample size were made large enough to report at a local commissioner level.

Following this, work was undertaken to revise the survey and consider approaches to a larger sample size and then put in place arrangements to re-commission the VOICES survey. NHS England has been involved in discussions with the Office for National Statistics, which collects the death registration data used to identify survey recipients, about arrangements for access to the data for the new survey. Changes to the safeguarding arrangements on data-sharing, designed to ensure any concerns about care raised via the survey can be appropriately investigated, have resulted in delays to commencing the new VOICES survey. Work is ongoing to resolve this matter.