CCG-commissioned review looks at deaths within 30 days of care

More than a third of patients who died within a month of leaving Shropshire’s main hospitals received “poor or very poor” care, a review suggests.

Niche Health and Social Care Consulting looked at a sample of patients who passed away between January and June last year and identified cases where their wishes were “not respected”, and others where care was delayed or planning and documentation were inadequate.

Out of a subgroup of 124 cases within the sample, 42 per cent received “good or excellent” care while 38 per cent received “poor or very poor” care.

A report summarising the review will be presented to the Shropshire, Telford and Wrekin Clinical Commissioning Group governing body on Wednesday, May 12. Its authors add that the End of Life Care Group is considering its findings while developing a strategy for near-death patients.

Quality and Performance Monitoring Officer Charlotte Dunn and Nursing and Quality Executive Director Zena Young write that Shropshire CCG and Telford and Wrekin CCG – still separate bodies at the time – commissioned Niche to review deaths and serious incidents in 2019.

Ms Dunn and Ms Young note that the review looked at a random sample of 167 individuals who were inpatients at the Royal Shrewsbury Hospital or Princess Royal Hospital or received pre- or post-admission services from another provider before dying between January and June last year.

“Care varied from excellent, when the system provided timely and co-ordinated care, to very poor, with delay and lack of escalation and where patient wishes were not respected,” they write.

“‘Good or excellent’ ratings were given in 52 cases, and ‘poor or very poor care’ ratings were given in 47 cases.”

The review identified cases where “there was a lack of co-ordination of care, even when patients were known to the system” pre-admission and “a lack of ongoing planning for patients with known chronic diseases”, they add. Fifty-eight cases involved patients’ discharge from hospital where “poor documentation, lack of engagement with primary care and apparent lack of documented engagement with community services” caused of concern.

“It is important to note here that this may be due to Covid-19 and the restrictions around access to patients and wards,” the authors add.

End-of-life care formed part of 101 of the cases reviewed, and 35 per cent of these attracted “poor or very poor” ratings.

“Where the care was excellent, it was felt that the staff could not have done more,” Ms Dunn and Ms Young write.

“However, for those falling into the ‘poor or very poor’ rating there was poor recognition that the patient was at end of life, thus delaying end-of-life care plans.

“There was poor documentation in relation to decision-making and family/patient involvement. There was a lack of mental capacity assessments for those who were dying. There was inconsistency in the involvement of the palliative care team.”

The report notes that Niche made a set of recommendations in areas including record-keeping, safeguarding, mental health reviews and admission timing.

“The report will be presented to the system End of Life Care Group to consider relevant findings in the development of an overarching strategy,” Ms Dunn and Ms Young add.