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Quality Measurement Framework

End of Life Care

NHS National Services Scotland ISD Scotland & NHS National Services Scotland

End of Life Care

This indicator measures the percentage of time spent by people in the last six months of life at home or in a community setting. It is derived by linking recorded deaths data with hospital bed days data to calculate the percentage of time spent outside hospitals in the 6 months at the end of people’s lives. Accidental deaths are excluded.

Living and Dying Well published in 2008 was successful in raising awareness of the need for high quality palliative and end of life care across a range of groups, bringing together a range of disciplines and networks to develop a consensus position on the requirements for change. In order to build on this work, to provide further focus and to support the continued delivery of high quality palliative and end of life care the Scottish Government agreed in March 2014 to support the development of a Strategic Framework for Action. A new National Advisory Group for Palliative and End of Life Care will meet for the first time in Autumn 2014 and will lead and advise Scottish Government in the development of the Framework for Action.

The quality outcome indicator should ideally represent the wishes and choices for patients and their carers and also demonstrate the effectiveness of having a planned approach to end of life care. For an individual, the preferred place of care can change as their condition and/or family circumstances change over time, making this very difficult to measure and track. Therefore this indicator has been chosen as an alternative. The last six months of life was chosen as this is the period when most hospital admissions occur compared to the last 12 months of life and the period when clinicians would tend to plan end of life care if the patient was not expected to live longer than 6 months.

Indicator Update

The figure has remained at just around 86% for the last few years. Across health board areas, the proportion of the last six months of life spent at home or in a community setting in 2014-15 varied between 83.1% and 92.3%.

In the 2016 publication the methodology as to how this measure is calculated has been revised. Previously only time spent in major acute hospitals was considered however in the 2016 publication any time spent in mental health hospitals or geriatric long stay facilities has also been considered. Trend data from 2010/11 to 2014/15 is available using the revised methodology.

Source: latest results financial year ending March 2015, published August 2016 by ISD

Work that should result in improvement in this indicator

An increase in this measure will reflect both quality and value through more effective, person centred and efficient end of life care with people being better able to be cared for at home or closer to home with a planned approach to end of life care resulting in less time spent in a hospital setting. As more people have anticipatory care plans and as electronic palliative care summaries are rolled out throughout the country, then we should see a gradual increase in this measure in the medium to long term.


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