Around half of all deaths in England occur in hospital, but the quality of care people receive at the end of life is cause for deep concern.

That is the key message coming out the National Care of the Dying Audit for Hospitals led by the Royal College of Physicians and Marie Curie which notes "significant variations in care across hospitals in England" and calls for "major improvements". The audit assessed quality of care received directly by 6,580 people who died in 149 hospitals in May 2013 and also included the results from questionnaires completed by 858 bereaved relatives or friends.

Among the findings, for 87% patients, healthcare professionals had recognised that they were in the last days of life, but had only told less than half (46%) of them capable of discussing this. Some 59% were assessed to see if they needed artificial hydration, and only 45% of patients were evaluated for artificial nutrition.

For bereaved relatives, 63% reported that the overall level of emotional support given to them by the healthcare team was good or excellent, while 37% thought it only fair or poor. Based on their experience, 68% were either likely or extremely likely to recommend their Trust to family and friends and 8% were extremely unlikely to do so.

Shockingly, only 21% of sites had access to face-to-face palliative care services, seven  days per week, "despite a longstanding national recommendation that this be provided". Most (73%) provided face-to-face services on weekdays only.

The RCP's Kevin Stewart, who chaired the audit's steering group, said "although some aspects of care are good in hospitals in England, I am deeply concerned that some hospitals are falling short of the excellent care that should be provided to both dying people and those important to them". He added that "communication with patients and their families is generally poor [and] it is disappointing that hospitals don't seem to recognise this as an important issue".

The report makes ten key recommendations aimed at "driving up the quality of care for dying people", such as hospitals should provide a face-to-face specialist palliative care service from at least 9am to 5pm, seven days per week, while education and training should be mandatory for all staff caring for dying patients.