About NACEL
The National Audit of Care at the End of Life (NACEL) is a national comparative audit of the quality and outcomes of care experienced by the dying person and those important to them during the last admission leading to death in acute hospitals, community hospitals and mental health inpatient providers in England and Wales.
NHS Benchmarking Network has been commissioned by Healthcare Quality Improvement Partnership (HQIP) to provide NACEL since 2017. The initial contract ran for four cycles until 2022. NHS Benchmarking Network was then awarded the contract for a further three years, to run the audit from October 2022 to September 2025. As part of the new contract, NACEL is being redesigned and piloted throughout 2023, with the goal of providing more frequent and timely data to organisations and facilitating the use of this data to drive quality improvement.
Aims & objectives
Overall aim: To improve the quality of care of adults (18+) at the end of life in NHS-funded hospital inpatient settings in England and Wales
Overarching NACEL objectives:
Improving quality of care by identifying areas for action in relation to delivery and outcomes, and adapting QI priorities in line with evidence and guidance
Reducing unwarranted variation through benchmarking of outcome measures as well as identifying and managing outliers using the appropriate guidance
Understanding and reducing health inequalities in relation to impact on the specified measures
Sharing and adopting best practice including QI examples, and signposting to resources available in the wider End of Life landscape
Sources of data
NACEL collects data from four sources:
1. Quality survey: This is an online survey completed by relatives, carers and those important to the person who died in hospital, to report their experiences of the care and support received at the end of life.
2. Case Note Review: This is data collected from patient notes about the care they received during their final admission to hospital. It focusses on 10 indicators of care, including recognition of dying, timely review of the dying and deceased patient, etc.
3. Hospital/ Site Overview: questions focus on the specialist palliative care workforce, staff training, anticipatory prescribing and quality and outcomes within the hospital/site.
4. Staff Reported Measure: this survey is completed by staff who are most likely to come into contact with dying patients and their loved ones. The survey asks questions about staff confidence and experience in delivering care at the end of life, the support they receive and the culture of their workplace. This is not a staff satisfaction survey such as the NHS staff survey.
Further information about each audit element can be found on the NACEL guidance page.
Participation
NACEL is featured on NHS England’s Quality Accounts list for 2024/25. For further information about the statutory function of this list please refer to HQIP’s Guidance on Quality Accounts.
Data processing
For the purposes of NACEL, the NHS Benchmarking Network team process patient level data through the Case Note Review, with the following demographic information collected: date of death, gender, ethnicity, date of admission and primary cause of death. The NHS Benchmarking team do not receive the patient’s name. Please find available to download the Network's Fair Processing Notice.
Mental Health Spotlight
Alongside the audit running in acute and community hospitals, NACEL also features a spotlight audit of mental health inpatient providers. This ran in 2021 and will run again in 2025. This spotlight audit is intended to provide a baseline position for mental health inpatient providers regarding end of life care delivery, patient and families’ experience, and compliance with the Five priorities for care and the relevant NICE Standards and Guidelines. Further information can be found on the Mental Health Spotlight page.
For more information about NACEL 2024 processes please browse: Understanding Practice in Clinical Audit and Registries tool: UPCARE-tool