Asked by: Harriet Harman (Labour - Camberwell and Peckham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made the ability of the Government to meet its end of life care choice commitment to babies, children and young people by 2020.
Answered by Caroline Dinenage
In July 2016, the Government set out its commitment to everyone at the end of life in the Government response to the independent Review of Choice in End of Life Care. Our Commitment to you for end of life care set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality and personalisation a reality for all, both adults and children, and to end variation in end of life care across the health system by 2020. On 21 September 2017 we published One year on: the government response to the review of choice in end of life care, an assessment of the progress made in delivering this over the first year. Copies of the Choice Commitment and the progress report can be found at the following links:
www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
www.gov.uk/government/publications/choice-in-end-of-life-care-government-progress
Through the Mandate, we have asked NHS England to deliver the Choice Commitment, and working through NHS England’s National Programme Board for End of life Care with all key system partners and stakeholders, including the children’s end of life care charity Together for Short Lives. In the 2017-18 Mandate we asked for the identification of metrics to assess quality and choice in end of life care. As a result, we 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.
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 lifecare 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. Further work will also be undertaken to develop indicators that will enable NHS England to assess the effectiveness of local health economies in delivering choice and quality in end of life care in line with the Government’s commitment.
NHS England knows that it can be difficult for some commissioners to develop suitable commissioning models for children with palliative and end of care needs, given the relatively small number of children concerned and their geographical spread. NHS England has established a Task and Finish Group to bring together knowledge and expertise in children’s end of life care to consider the development of commissioning models suitable for this vulnerable group of patients. The group met for the first time on 31 May 2018.
Asked by: George Howarth (Labour - Knowsley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to reduce the number of people dying in hospital in areas where there is a high incidence of such deaths.
Answered by Caroline Dinenage
Place of death is an important measure of the quality of end of life care. We know more people would, given the choice and conditions being right, prefer to die at home and fewer wish to die in hospital than is currently the case. However, we also know that preferences can change over time, and that it is important we work to ensure patients receive the right care and support wherever they are being cared for.
Nationally, hospital is currently the most common place of death, with the latest rolling annual data (2016/17 quarter 4 – to 2017/18 quarter 3) showing that 46% of patients (all deaths) died in hospital, but it is important to note this has reduced since 2004 when the figure was 57%. Between clinical commissioning groups (CCGs) the percentage of deaths in hospital ranges from 35% to 63%. Reasons for variation are complex, and in addition to the differences between geographical areas, there are also differences between the conditions people may be dying of at the end of life; between ethnic groups and between deprivation groups.
Public Health England’s (PHE) National End of life care intelligence network collects and publishes data and analysis on services and outcomes for care at the end of life care, including place of death nationally, regionally, by CCG and local authority, and a range of resources to support commissioners to improve delivery of their end of life care services can be found on the Intelligence Network’s website at the following link, including PHE’s ‘What we know now’ series, which examines issues of variation in end of life care:
www.endoflifecare-intelligence.org.uk
On 5 July 2016 we published ‘Our Commitment to you for end of life care’, which set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality, personalised care a reality for everyone. This includes measures to enable personalisation; improve care quality; enhance education and training in end of life care; and encourage the spread of innovative models of care. The commitment sets out that by 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home. On 21 September 2017 we published ‘One Year On: The Government commitment to everyone at the end of life’, setting out the good progress made over the first year in implementing the Choice Commitment. Copies of ‘Our Commitment to you for end of life care’; and ‘One year on: the government response to the review of choice in end of life care’ can be found at the following links:
www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
www.gov.uk/government/publications/choice-in-end-of-life-care-government-progress
We remain committed to improving services and ending variation in end of life care by 2020. Through the Mandate, we have asked NHS England to deliver the Choice Commitment, and through NHS England’s National Programme Board for End of life Care, a range of activity is being undertaken with all key system partners and stakeholders to achieve this. NHS England works to support local commissioners in improving the services they provide, including palliative care, and has recently collaborated PHE and the Care Quality Commission to provide bespoke end of life care support to all sustainability and transformation partnerships.
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 and 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.
Asked by: George Howarth (Labour - Knowsley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking taken to increase the provision of high quality end-of-life care.
Answered by Caroline Dinenage
Place of death is an important measure of the quality of end of life care. We know more people would, given the choice and conditions being right, prefer to die at home and fewer wish to die in hospital than is currently the case. However, we also know that preferences can change over time, and that it is important we work to ensure patients receive the right care and support wherever they are being cared for.
Nationally, hospital is currently the most common place of death, with the latest rolling annual data (2016/17 quarter 4 – to 2017/18 quarter 3) showing that 46% of patients (all deaths) died in hospital, but it is important to note this has reduced since 2004 when the figure was 57%. Between clinical commissioning groups (CCGs) the percentage of deaths in hospital ranges from 35% to 63%. Reasons for variation are complex, and in addition to the differences between geographical areas, there are also differences between the conditions people may be dying of at the end of life; between ethnic groups and between deprivation groups.
Public Health England’s (PHE) National End of life care intelligence network collects and publishes data and analysis on services and outcomes for care at the end of life care, including place of death nationally, regionally, by CCG and local authority, and a range of resources to support commissioners to improve delivery of their end of life care services can be found on the Intelligence Network’s website at the following link, including PHE’s ‘What we know now’ series, which examines issues of variation in end of life care:
www.endoflifecare-intelligence.org.uk
On 5 July 2016 we published ‘Our Commitment to you for end of life care’, which set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality, personalised care a reality for everyone. This includes measures to enable personalisation; improve care quality; enhance education and training in end of life care; and encourage the spread of innovative models of care. The commitment sets out that by 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home. On 21 September 2017 we published ‘One Year On: The Government commitment to everyone at the end of life’, setting out the good progress made over the first year in implementing the Choice Commitment. Copies of ‘Our Commitment to you for end of life care’; and ‘One year on: the government response to the review of choice in end of life care’ can be found at the following links:
www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
www.gov.uk/government/publications/choice-in-end-of-life-care-government-progress
We remain committed to improving services and ending variation in end of life care by 2020. Through the Mandate, we have asked NHS England to deliver the Choice Commitment, and through NHS England’s National Programme Board for End of life Care, a range of activity is being undertaken with all key system partners and stakeholders to achieve this. NHS England works to support local commissioners in improving the services they provide, including palliative care, and has recently collaborated PHE and the Care Quality Commission to provide bespoke end of life care support to all sustainability and transformation partnerships.
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 and 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.
Asked by: George Howarth (Labour - Knowsley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, how Sustainability and Transformation Partnerships plan to measure choice in end of life care in line with his Department's commitment in its 2018-19 mandate to NHS England.
Answered by Caroline Dinenage
Place of death is an important measure of the quality of end of life care. We know more people would, given the choice and conditions being right, prefer to die at home and fewer wish to die in hospital than is currently the case. However, we also know that preferences can change over time, and that it is important we work to ensure patients receive the right care and support wherever they are being cared for.
Nationally, hospital is currently the most common place of death, with the latest rolling annual data (2016/17 quarter 4 – to 2017/18 quarter 3) showing that 46% of patients (all deaths) died in hospital, but it is important to note this has reduced since 2004 when the figure was 57%. Between clinical commissioning groups (CCGs) the percentage of deaths in hospital ranges from 35% to 63%. Reasons for variation are complex, and in addition to the differences between geographical areas, there are also differences between the conditions people may be dying of at the end of life; between ethnic groups and between deprivation groups.
Public Health England’s (PHE) National End of life care intelligence network collects and publishes data and analysis on services and outcomes for care at the end of life care, including place of death nationally, regionally, by CCG and local authority, and a range of resources to support commissioners to improve delivery of their end of life care services can be found on the Intelligence Network’s website at the following link, including PHE’s ‘What we know now’ series, which examines issues of variation in end of life care:
www.endoflifecare-intelligence.org.uk
On 5 July 2016 we published ‘Our Commitment to you for end of life care’, which set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality, personalised care a reality for everyone. This includes measures to enable personalisation; improve care quality; enhance education and training in end of life care; and encourage the spread of innovative models of care. The commitment sets out that by 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home. On 21 September 2017 we published ‘One Year On: The Government commitment to everyone at the end of life’, setting out the good progress made over the first year in implementing the Choice Commitment. Copies of ‘Our Commitment to you for end of life care’; and ‘One year on: the government response to the review of choice in end of life care’ can be found at the following links:
www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
www.gov.uk/government/publications/choice-in-end-of-life-care-government-progress
We remain committed to improving services and ending variation in end of life care by 2020. Through the Mandate, we have asked NHS England to deliver the Choice Commitment, and through NHS England’s National Programme Board for End of life Care, a range of activity is being undertaken with all key system partners and stakeholders to achieve this. NHS England works to support local commissioners in improving the services they provide, including palliative care, and has recently collaborated PHE and the Care Quality Commission to provide bespoke end of life care support to all sustainability and transformation partnerships.
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 and 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.
Asked by: George Howarth (Labour - Knowsley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the (a) extent and (b) causes of regional variation in the proportion of deaths in hospital in England; and if he will make a statement.
Answered by Caroline Dinenage
Place of death is an important measure of the quality of end of life care. We know more people would, given the choice and conditions being right, prefer to die at home and fewer wish to die in hospital than is currently the case. However, we also know that preferences can change over time, and that it is important we work to ensure patients receive the right care and support wherever they are being cared for.
Nationally, hospital is currently the most common place of death, with the latest rolling annual data (2016/17 quarter 4 – to 2017/18 quarter 3) showing that 46% of patients (all deaths) died in hospital, but it is important to note this has reduced since 2004 when the figure was 57%. Between clinical commissioning groups (CCGs) the percentage of deaths in hospital ranges from 35% to 63%. Reasons for variation are complex, and in addition to the differences between geographical areas, there are also differences between the conditions people may be dying of at the end of life; between ethnic groups and between deprivation groups.
Public Health England’s (PHE) National End of life care intelligence network collects and publishes data and analysis on services and outcomes for care at the end of life care, including place of death nationally, regionally, by CCG and local authority, and a range of resources to support commissioners to improve delivery of their end of life care services can be found on the Intelligence Network’s website at the following link, including PHE’s ‘What we know now’ series, which examines issues of variation in end of life care:
www.endoflifecare-intelligence.org.uk
On 5 July 2016 we published ‘Our Commitment to you for end of life care’, which set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality, personalised care a reality for everyone. This includes measures to enable personalisation; improve care quality; enhance education and training in end of life care; and encourage the spread of innovative models of care. The commitment sets out that by 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home. On 21 September 2017 we published ‘One Year On: The Government commitment to everyone at the end of life’, setting out the good progress made over the first year in implementing the Choice Commitment. Copies of ‘Our Commitment to you for end of life care’; and ‘One year on: the government response to the review of choice in end of life care’ can be found at the following links:
www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
www.gov.uk/government/publications/choice-in-end-of-life-care-government-progress
We remain committed to improving services and ending variation in end of life care by 2020. Through the Mandate, we have asked NHS England to deliver the Choice Commitment, and through NHS England’s National Programme Board for End of life Care, a range of activity is being undertaken with all key system partners and stakeholders to achieve this. NHS England works to support local commissioners in improving the services they provide, including palliative care, and has recently collaborated PHE and the Care Quality Commission to provide bespoke end of life care support to all sustainability and transformation partnerships.
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 and 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.
Asked by: Sarah Champion (Labour - Rotherham)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, by what means his Department collects information on the preferences for care for people at the end of life since the discontinuation of the National Survey of Bereaved People (VOICES) after the publication of 2015 data.
Answered by Caroline Dinenage
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, and a timetable for the publication of the next survey cannot be provided at this time.
Finally, there are other means through which personalisation and choice at the end of life are assessed and monitored; for example, through the Care Quality Commission’s inspection regime, which now rates end of life care as a core service, and via the National Audit for Care at the End of Life, commissioned on behalf of NHS England by the Healthcare Quality Improvement Partnership.
Asked by: Dan Jarvis (Labour - Barnsley Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what (a) financial support (b) guidance and (c) training his Department provides to child bereavement services to ensure appropriate support for children and young people.
Answered by Caroline Dinenage
The funding and delivery of National Health Service bereavement services, including the training of staff, is a local matter.
Bereavement care is a key part of the provision of good end of life care as set out in the Government’s end of life care Choice Commitment, published in July 2016. As part of this, Health Education England, in partnership with Skills for Care and Skills for Health, published a refreshed End of Life Care Core Skills Education and Training Framework in March 2017. This aims to standardise end of life care training and education, including around bereavement care. The Government’s Choice Commitment and the framework can be found at the following links:
www.gov.uk/government/publications/choice-in-end-of-life-care-government-response
www.skillsforhealth.org.uk/services/item/536-end-of-life-care-cstf-download
The importance of bereavement care is also reflected in the National Institute for Health and Care Excellence (NICE) Quality Standard on end of life care, and other NICE end of life care guidance, which commissioners should take into account when planning services for local populations. The Quality Standard, which highlights that children may need specific tailored support to help them with bereavement, can be found at the following link:
The Quality Standard draws on a range of evidence, including older Departmental guidance such as When a person dies: guidance for professionals on developing bereavement services, first published by the Department in 2005, and updated in 2011 by the Primary Care Commissioning Service with support from the NHS National End of Life Care Programme and the Bereavement Services Association. The guidance can be found at the following link:
www.pcc-cic.org.uk/sites/default/files/articles/attachments/when_a_person_dies_19_oct_2011.pdf
Asked by: Mohammad Yasin (Labour - Bedford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, for what reason the National Survey of Bereaved people was discontinued; and whether he has plans to collect that data by a different method.
Answered by Caroline Dinenage
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.
Asked by: Mohammad Yasin (Labour - Bedford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, for what reason the commitment to identify metrics to assess quality and choice in end of life care in the Government's mandate to NHS England for 2017-18 was not included in the Government's mandate to NHS England for 2018-19.
Answered by Caroline Dinenage
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.
Asked by: Mohammad Yasin (Labour - Bedford)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what progress has made on the commitment in the mandate to NHS England for 2017-18 to identify metrics to assess quality and choice in end of life care.
Answered by Caroline Dinenage
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.