#141 Holding uncertainty: Exploring NACEL and what we can learn from the audit with Dr Mary Miller

In this episode it is my pleasure to talk with Dr Mary Miller, consultant in palliative medicine and Clinical Lead for the National Audit of Care at the End of Life. It’s a super discussion and we hone in on key findings and recommendations. Listen to hear what we must do better.

Key messages

• Dr Mary Miller, consultant in palliative medicine, shares insights as the clinical lead for the National Audit of Care at the End of Life (NACEL).

• NACEL has broadened its audit to include England, Wales, and Jersey, involving over 99% of eligible hospitals.

• The audit gathers data through four streams: case note review, bereavement questionnaires, staff skills and confidence surveys, and hospital mortality metrics.

• Two key recommendations: improve access to specialist palliative care for all who need it, and enhance staff training in end of life care (currently only 62% have trained within 3 years).

• Only 44% of patients participated in Advance Care Planning discussions, many of those discussions occur after hospital admission.

• Advance Care Planning conversations are crucial but often delayed, with average diagnosis-to-death times at just 56 hours.

• Acute hospitals lag behind community and mental health hospitals in engaging patients and families early in planning.

Resource

• Improving End-of-Life Care: Insights from NACEL 

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

• The Waiting Room Revolution

  
  

Bio

Dr Mary Miller:

Consultant in Palliative Medicine, Oxford University Hospitals NHS Foundation Trust. Honorary Senior Clinical Lecturer in Palliative Medicine, University of Oxford. Director OxCERPC (Oxford Centre for education and research in palliative care). National Clinical Lead NACEL (National audit of care at the end of life). 

Mary was appointed as Clinical Lead for the National Audit of Care at the End of Life in January 2023. The audit is a retrospective audit of the care of those dying in hospital (acute, community and mental health) in England, Wales and Jersey. The audit is part of the National Clinical Outcomes and patient outcomes programme.

Mary qualified from University College Cork in 1988. Mary trained and worked in palliative medicine in Ireland, Sweden and the UK, and has been a consultant in palliative medicine in Oxford since 1998. Mary has a strong interest in education; completing a Diploma in Learning and Teaching at Oxford University 2005, was Training Programme Director and Regional Specialty Advisor (2002 – 2008) and has led the Oxford Advanced Courses in Pain and Symptom Management since 2005. Mary is an elected member of the Education Committee of the Association of Palliative Medicine and joint lead of the postgraduate education special interest forum. Since the inception of OxCERPC in 2017, Mary and the team are focusing on building an exciting portfolio of courses, building research readiness and reaching out to practitioners across the globe.