Re: Improving Palliative Care in the UK

Why It Matters

Broadening NACEL will generate nationwide quality metrics, guiding policy and resource allocation to raise standards of palliative care across all settings.

Key Takeaways

• NACEL audited 22,000 deaths in 2025, covering 8% of hospital deaths
• Sweden benchmarks 60% of deaths, underscoring UK's narrower audit scope
• NACEL currently omits emergency, home, care‑home and hospice deaths
• Broadening NACEL would deliver national benchmarks for palliative care quality

Pulse Analysis

The United Kingdom stands at a pivotal moment for end‑of‑life care. Recent commentary by consultants Wee and Paes stresses that coordinated clinical leadership is essential to seize a ‘once‑in‑a‑generation’ chance to overhaul palliative services and address long‑standing inequities among the most vulnerable patients. As the National Health Service (NHS) rolls out its universal and targeted non‑specialist and specialist palliative‑care model, robust measurement of care delivery becomes the linchpin for meaningful improvement.

The National Audit of Care at the End of Life (NACEL), part of the National Clinical Audit and Patient Outcomes Programme, currently provides the only retrospective, population‑level data on dying patients across England, Wales, Northern Ireland and Jersey. In 2025 the audit captured 22,000 cases—roughly 8 % of hospital deaths—far below Sweden’s 60 % coverage of all deaths. Crucially, NACEL does not audit deaths occurring in emergency departments, patients’ homes, care homes or hospices, leaving substantial gaps in the evidence base needed for comprehensive quality assessment.

Expanding NACEL to include these missing settings would create a unified benchmark for palliative‑care performance nationwide, enabling policymakers to identify disparities, allocate resources more efficiently, and drive systematic improvements. Such data could inform NHS England’s service specifications, support targeted interventions, and ultimately raise the standard of care for dying patients and their families. Stakeholders—from clinicians to commissioners—should prioritize the audit’s extension as a cost‑effective lever to fulfill the UK’s commitment to dignified, equitable end‑of‑life care.