Compassion in Dying – Bridging the Gap

Bridging the Gap: why end-of-life wishes still go unheard

Two ombudsmen, one uncomfortable pattern. In July, the Parliamentary and Health Service Ombudsman’s Conversations that matter most found communication breakdowns to be the single biggest driver of end-of-life complaints.

Three weeks later, the Local Government and Social Care Ombudsman’s No Second Chances described families who weren’t called in time to say goodbye, who learned of a death with no word of condolence, or who found a relative’s grave unmarked a year on.
 

Bridging The Gap – it’s the system that’s the problem

A new report from the charity Compassion in Dying, Bridging the Gap (published 13 July 2026), helps explain why both ombudsmen keep landing on the same territory. Rather than auditing complaints after the fact, it asks clinicians and callers directly why people’s preferences about their own death so often go unmet, and the answer it comes back with is not a lack of compassion, but a system that makes acting on compassion hard.
 

What the report is based on

Compassion in Dying draws on two strands of evidence: a thematic analysis of 421 calls and emails to its in-depth support service between July 2023 and June 2025, and 15 interviews conducted in December 2025 and January 2026 with health professionals across England — district nurses, GPs, hospital consultants, A&E residents and paramedics among them. Demand for that support service rose 59% in 2025 alone, which the charity takes as a sign that end-of-life decisions are becoming more contested, not less.
 

Three reasons wishes don’t get honoured

Clinicians feel exposed when they stop treatment. Interventionist training, fear of being second-guessed later, and thin community capacity all push staff towards “doing something” even when a patient has refused it. “Stopping feels like failing,” one consultant told researchers. “We’re trained to intervene; death doesn’t fit comfortably with that.” One family described their mother’s advance decision being dismissed by care home staff as “murder.”

The conversations happen too late, or not at all. Staff avoid raising treatment refusal because it’s uncomfortable, because there’s no time, or because a patient seems “too young” to plan. A resident doctor put it plainly: “We aren’t trained in how to move from treatment to care — it’s a really hard shift for doctors to grasp.” The report cites YouGov polling showing only 9% of the public have made a lasting power of attorney for health and welfare, and just 5% have made an advance decision to refuse treatment — while 8 in 10 say they’d prioritise quality of life over living longer.

When preferences are recorded, they often don’t travel. GP, hospital, community and ambulance systems rarely talk to each other, so a decision made calmly in advance can be invisible in a crisis. “If I can’t see the plan, I follow the trust’s policy, so the default is to jump on and resuscitate,” one paramedic said. In one case a DNACPR decision was overridden after a stroke at 3:30am because no record was visible to the paramedics on scene; in another, a woman’s advance decision never reached the hospital staff treating her pneumonia, and she received antibiotics she had clearly refused.
 

What the report recommends

Compassion in Dying’s six recommendations point in the same direction as both ombudsmen’s findings:
• normalise the conversation through a public health campaign;
• build more opportunities for planning into NHS contact points such as GP registration and hospital admission;
• prioritise end-of-life preferences in the NHS’s developing single patient record so they’re visible across 111, out-of-hours and ambulance services;
• give front-line staff 24/7 access to senior advice on difficult decisions;
• strengthen training on dying and mental capacity law throughout medical education;
• involve patients and families directly in designing the policies that will govern their own care.
 

Reading the three together

Line the reports up and the story is consistent. The PHSO’s complainants wanted conversations that never happened. The LGSCO’s complainants wanted basic warmth and honesty at the point of death. Compassion in Dying’s callers and clinicians point to the same underlying gap: not unwillingness, but a culture that treats death as failure, training that stops short of teaching the shift from treatment to care, and IT systems that lose a person’s wishes exactly when they’re needed most.

As the LGSCO’s Amerdeep Clarke put it of families’ memories of a loved one’s final days: “those memories do not fade.” Fixing that, on this evidence, doesn’t require more money — it requires the conversation to happen earlier, and the record of it to follow the person wherever they end up.
 

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Further reading and resources

No Second Chances

Improving communication in end of life care

Bridging the Gap (Compassion in Dying) (external link will open in a new browser tab or window)

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