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Learning from deaths: new guidance from NHS England

Post date: 21/08/2018 | Time to read article: 3 mins

The information within this article was correct at the time of publishing. Last updated 22/08/2018

In July 2018 NHS England published Learning from deaths: Guidance for NHS trusts on working with bereaved families and carers on behalf of the National Quality Board. This consolidates previous guidance to provide advice on how families should be supported following the death of a loved one, particularly following errors in NHS healthcare.1

It follows a report from the Care Quality Commission published in 2016, which identified that significant improvement was required in the way trusts engaged with families following the death of a patient.2 The guidance recognises that there is no ‘one size fits all’ approach and has been written with input from bereaved families, with a complementary guide produced for families and carers. 

Empathetic communication can make all the difference

A key theme throughout the guidance is the need for compassionate, clear and honest communication, which respects the views and feelings of family members.

If healthcare professionals are uncomfortable talking about death, it can be hard to have the difficult conversations with patients and their families that are necessary at the end of life. Conversations that avoid the topic cause confusion, uncertainty and, ultimately, complaints about care.

A survey of MPS hospital doctor members in 2013 found that, of those who had received complaints related to end of life care, 39% were related to poor communication: 32% of these were in general medicine and 26% in surgery.3

Dr Nicky King, medicolegal  consultant at Medical Protection, and former consultant in palliative medicine, says: “The major issue is always communication. If a patient has their original diagnosis – that first bit of communication – delivered badly, everything else seems to flow from there.

 “If there is good communication between a doctor, patient and their family, whatever the physical outcome, grief is usually handled better. The family have been communicated with and feel involved.”

It is important to discuss end of life care plans in advance, rather than when the patient is acutely unwell. Patients can often feel relieved to have such conversations and can ensure their relatives are aware of their wishes. Avoiding discussing death can mean that families are unsure of how best to support a patient if they lose capacity.

Transparency can avoid complaints

Although three out of four bereaved people rate their relatives’ end of life care as good, 10% rated care as poor. In a national survey of bereaved people in 2015, care in hospitals was rated significantly lower than care in hospices, care homes or at home and one in six bereaved people did not have time to ask questions to health care professionals.5

If, in a hospital setting, the family hasn’t been prepared for their relative’s death, doctors can help allay concerns by taking time to offer a comprehensive debrief to the family soon after the death. Talking through the process, explaining in plain language what has happened and answering any questions shows compassion and can allow families the chance to begin to make sense of the situation and gain some closure.

Relatives may associate a lack of compassion with poor clinical care, which can lead to complaints. Perceptions of brusqueness amongst staff, for example by quickly returning the deceased’s belongings to the family or beginning to clear the room, can make the family feel that their experience is not valued and that the care their relative received was suboptimal.
The new guidance emphasises that bereaved families and carers should be told how to raise any concerns they may have and that their views should inform any necessary review or investigation. The process of any review or investigation should be consistently and clearly communicated to the bereaved family.


A key theme … is the need for compassionate, clear and honest communication, which respects the views and feelings of family members.


It’s understandable to be affected by death

Doctors often feel they should be able to deal with the death of a patient and hide their grief. You may be taken by surprise by how you feel after an unexpected death. However, it is not unusual to be affected by the death of a patient and doctors should not be afraid to seek help in these circumstances.6


A patient’s death can be particularly worrying for a doctor who is already under investigation or has concerns about the possibility of a complaint or legal action. Not openly discussing worries or feelings of grief can have negative consequences for the wellbeing of a doctor. Talking through these feelings with a close friend or colleague can be helpful, and you can seek help through the MPS counselling service if you are also dealing with an issue such as a claim or complaint.  

References

  1. National Quality Board. Learning from deaths: Guidance for NHS trusts on working with bereaved families and carers. July 2018.
  2. Care Quality Commission. Learning, candour and accountability. December 2016.
  3. An MPS survey of 414 hospital doctor members, End of Life Care (February 2013).
  4. S Lowson. Why Families Complain About End-of-Life Care in the NHS. End of Life Care 2007;1(2). 
  5. Office for National Statistics. National Survey of Bereaved People (VOICES): England, 2015. 22 April 2016. 
  6. Marika Davies. Death is part of a doctor’s job BMJ 2016;355:i5597
  7.  

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