End-of-life care across the NHS in England is “variable and inequitable” and “often falls below expectations”, according to a patient safety watchdog. The Healthcare Safety Investigation Branch (HSIB) found care for patients who are dying is “inconsistent” across England, despite a national strategy for proceedings being in place since 2008. The report highlighted “concerns about the limitations of the delivery of palliative and end-of-life care” which are more noticeable in deprived areas. Services were found to not always be able to deliver individualised care, and varied due to the likes of staff shortages and the availability of charitable donations. The report also found a lack of specific guidance for service providers on the palliative needs of their local populations. Nick Woodier, a national investigator at the HSIB, said: “Conversations about death and end-of-life care are challenging and emotive but it is crucial that health and care professionals can discuss needs and expectations with their patients and families. “They should be supported by a system that provides continuity of care, reassurance and dignity at what is sometimes a very distressing time.” On the back of its inquiry, the HSIB has made three recommendations to NHS England. They are focused on developing datasets to support the understanding of people’s needs in different areas, as well as developing a “minimum expected service level” and adding staff with specialist capacity to the workforce. Woodier said: “The safety recommendations and actions we have set out are directed towards ensuring palliative care patients receive the best level of care wherever they live in England. “Each person, and their loved ones, should have a holistic plan, one that is all-encompassing and meets all their needs – physical, psychological, cultural, social, and spiritual. “We recognise that provision of palliative and end-of-life care is complex, with multiple organisations involved. However, the need for high standards of palliative care will only increase as the population grows and people live longer.” According to Ruth Driscoll, an associate director of policy and public affairs at cancer and terminal illness support provider Marie Curie, “one in four people dies without the care and support they need”. She added: “Marie Curie is concerned that gaps in services for people dying at home, especially in deprived areas, require urgent action to ensure nobody misses out on the end-of-life care they need for pain and other symptoms. “Gaps in overnight services in the community result in unnecessary, expensive and distressing hospital admissions for dying people. The NHS turned 75 this month amid a backdrop of a rapidly ageing population with increasingly complex needs. “The government must act urgently and radically to ensure that dying people are able to access safe and high-quality care on a 24/7 basis. Otherwise, by the time the NHS turns 100, it will be overwhelmed.”