National Audit of Care at the End of Life (NACEL)

The National Audit of Care at the End of Life will be for NHS-funded care in England, Wales and Jersey (inclusion other devolved nations/Crown dependencies is yet to be determined and will be detailed within the tender documentation).

The initial contract is anticipated to be for a period of 3 years, at a maximum total budget of up to £ 1,085,457.00 excluding VAT and £1,302,548.40 including VAT. Bids exceeding this limit will be rejected. Due to the unknowns in advance of holding the premarket engagement session, it is currently expected that the extension value will be a 2 year pro rata of the core 3 year funding, estimated at £723,638 excluding VAT.

The values stated may be subject to change and the final values will be given when the tender goes live.

There is potential to include other Devolved Nations and/or Crown Dependencies, and aspirational measures (which will be defined in the service specification).

The role of a national clinical audit is to stimulate healthcare quality improvement through the provision of high-quality information on the organisation, delivery and outcomes of healthcare, together with tools and support to enable healthcare providers and other audiences to make best use of this information. Outcomes are benchmarked against available national guidance and standards from established professional and patient sources.

Every year, over 550,000 people die in England and Wales, almost half in hospital, and in most cases death can be anticipated. There is only one chance to get care right for a dying person and those people important to them. It is essential that this is high quality and delivered compassionately by caring and competent staff.

Accordingly, the National Audit of Care at the End of Life is expected to:

Develop a robust, high-quality audit designed around key quality metrics likely to best support local and national healthcare quality improvement

Detect, describe and help reduce unwarranted clinical variation by systematically benchmarking performance, identifying outliers, and supporting services to understand variation in outcomes, processes and experience

Achieve, articulate and maintain close alignment with relevant NICE national guidance and quality standards throughout the audit, as appropriate

Enable healthcare quality improvement through the provision of timely, high-quality data that compares providers of healthcare, and comprises an integrated mixture of named Trust or Health board, Integrated Care System (ICS), commissioner, multidisciplinary team (MDT), possibly consultant or clinical team level and other levels of reporting

Engage patients, carers and the public in a meaningful way, achieving a strong patient voice which informs and contributes to the design, functioning, outputs and direction of the audit

Consider the value and feasibility of linking data at an individual patient level to other relevant national datasets either from the outset or in the future, and plan for these linkages from the inception of the contract

Ensure robust methodological and statistical input at all stages of the audit

Identify from the outset the full range of audiences for the reports and other audit outputs, and plan and tailor them accordingly

Provide audit results in a timely, accessible and meaningful manner to support healthcare quality improvement, minimising the reporting delay and providing continual access to each unit for their own data

Use strong and effective project and programme management to deliver audit outputs on time and within budget

Develop and maintain strong engagement with local clinicians, networks, commissioners, patients and their families and carers and charity and community support groups to drive improvements in services

The delivery of this audit is expected to include information that enables assessment of end-of-life care from multiple perspectives, including those from:

Patients

Bereaved people

Staff

The organisational context in which care is delivered

The anticipated outputs are:

Near real-time dynamic and interactive metric results

Publication of an annual state of the nation report

Quality improvement resources

Resources for patients near the end of life, and those important to them

The identification and notification of outliers