Contractual requirement to participate in NACEL

Under the refreshed NHS Standard Contract, NHS providers are required to:

• 26.1.2.1 Participate in any national programme within the National Clinical Audit and Patient Outcomes Programme (NCAPOP)

• 26.1.3 Make national clinical audit data available to support national publication of consultant-level activity and outcome statistics

• 26.1.4 Engage in national outlier identification and management processes, in line with published outlier guidance

The Welsh Health Circular (WHC) for the National Clinical Audit and Outcome Review Plan outlines that health boards and trusts in Wales are required to fully participate in audits and outcome reviews listed in the annual plan.

What does this mean for NACEL?

All NHS providers delivering adult inpatient care in acute and community hospitals are required to participate in the National Audit of Care at the End of Life (NACEL), as part of NCAPOP.

Non-participation in NACEL will be treated as an alarm-level outlier, with notification shared with audit funders and care regulators.

Partial participation will also be flagged as an outlier. This includes providers who, during 2026:

• Do not submit data to the Case Note Review

• Do not submit data to the Staff-Reported Measure

• Do not provide data to the Key Indicator Metrics

Participation across all NACEL components supports best practice, enables meaningful benchmarking and quality improvement, and is necessary to meet contractual requirements and avoid escalation.

If you have any questions about NACEL participation, please contact the NACEL team.

January Newsletter

Data Collection Updates

Please continue to submit all your Case Note Review data by 16th January 2026. Here is a link to the data collection pages.

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Data and Improvement Tool New Feature!

Now on the Data and Improvement Tool, users are able to compare their local hospital/site data against the results of the NACEL 2024 State of the Nations Report, published in 2025.

Below you can see a screenshot of the page from the tool. Please go into the Dashboard tab, select 'January 2024 - December 2024', and here you will be able to select your local hospital/site and compare your data to the report.

If you seek log-in access, please register here. You will be prompted to verify your email and the request will then arrive into the admin's inbox, which should be the NACEL audit Project Lead for your Trust/Health Board.

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NACEL 2025 Annual Death Data Collection

The Annual Death Data Collection element of the audit will remain open until 28th February 2026.

This change is to ensure there is sufficient time to work with business intelligence teams to collate and submit the data.

Click below to view the data specification for this audit element

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Management of Outliers

Once data collection for NACEL 2025 closes, the NACEL team will begin the Management of Outliers process.

The outlier analysis will flag submissions that fall below the values calculated as the 2.5 percentile and the 0.15 percentile as ‘alerts’ and ‘alarms’ respectively.

This analysis will be run on two metrics:

1. The number of deaths where it was expected that the patient would die during their final admission in hospital as a proportion of the sample ‘all deaths’ included in the audit (Category 1 / Category 1 + 2 deaths)

2. The proportion of people who had an individualised plan of care addressing their needs at the end of life, where it was recognised that the patient may die during the final admission (proportion of Category 1 deaths)

Before data collection closes, we encourage organisations to review these metrics in the Data and Improvement Tool to confirm the accuracy of their submitted responses.

Please ensure the case notes that were reviewed are accessible should your submission flag as an outlier and require further review within the Management of Outlier policy timescales.

Organisations that are eligible to take part in NACEL but did not submit any data will be automatically flagged as an 'alarm' level outlier due to their non-participation.

Submissions that did not complete the Hospital/Site Overview or where an eligible death occurred but no Case Note Reviews were completed will be flagged as an 'alarm' level outlier due to partial non-participation.

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NACEL 2026 Data Collection Launches Next Week!

The NACEL 2026 Audit Guidance document and data specifications can now be accessed via the button below.

Reminder: Please check your organisation's registration details and inform the team if there are any changes required for NACEL 2026

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NACEL 2026 Bereavement Survey

Further Flexibility!

Starting with NACEL 2026, organisations should invite bereaved person(s) to take part in the Bereavement Survey in one of the following manners:

1. Online Survey

2. Paper Survey

3. Alternative Local Collection (new to 2026)

   • Organisations may collect a selection of NACEL Bereavement Survey questions through a local survey and submit the responses in a spreadsheet for upload.

   • Eight core metrics have been identified and must be collected and submitted as a minimum requirement- available here.

   • Additional NACEL metrics may also be included and are strongly encouraged to enhance the dataset.

   • This approach allows organisations to gather additional local questions or qualitative feedback alongside the NACEL metrics.

New to 2026 is an upload functionality! An excel document will be made available to organisations to collate their offline responses. This will become available via the NACEL data collection pages. Only 1 excel document should be used per NACEL submission. The NACEL Support Team will upload responses into the database quarterly.

Links/QR Codes for the online option will be made available on the data collection page once 2026 data collection opens.

Click below to view the data specification for this audit element

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Patient and Carer Data Tool to be Redeveloped

In 2025, a newly developed patient and carer tool was developed alongside a group of bereaved relatives, showcasing some of the NACEL data to the public. This tool can be found here https://www.nacel.nhs.uk/patients-and-carers-data and looked at for regions or countries.

In 2026, this tool will be redeveloped and allow the public to see NACEL data for their local hospital. This means that your patients and their loved ones amongst others will be able to view some of your data via the NACEL website, a publicly available platform. A lot of work has been going on with national, regional, and local stakeholders including members of the public to develop this tool. In the coming months more communications will follow with specific recommendations for action at a hospital level.

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Further Information

For more details about the National Clinical Audit programme, visit the NACEL Portal.

Reach out to the NACEL Support Team at nhsbn.nacelsupport@nhs.net if you have any questions or need assistance.

New podcast: Exploring NACEL and What We Can Learn from the Audit with Dr Mary Miller

We’re delighted to share that our NACEL Clinical Lead, Dr Mary Miller, recently joined Dr Clare Fuller for the Speak For Me podcast to discuss the importance of Advance Care Planning and what can be learnt from the National Audit of Care at the End of Life (NACEL) 2024.

The discussion highlights findings from the latest round of NACEL showing that fewer than half of patient records included evidence of Advance Care Planning. Dr Mary Miller reflects on the importance of open and early planning conversations to ensure that people’s wishes and preferences are understood and respected at the end of life.

🎧 Listen now: Holding Uncertainty – Exploring NACEL and what we can learn from the audit with Dr Mary Miller 

Published 10 November 2025 

🔗 https://speakforme.co.uk/podcast-episode-141  

Now launched: NACEL 2026

The NACEL 2026 Audit Guidance document and data specifications can now be accessed via the link below

Reminder: Please check your organisation's registration details and inform the team if there are any changes required for NACEL 2026

NACEL 2026 Warm Up Event 

The Warm Up Event for NACEL 2026 took place on Thursday 23rd October. During this session, a summary of the updates and changes made to NACEL 2026 were presented.

If you weren't able to attend or would like to recap any of the information shared, the slides and recording are available on the NACEL Portal Events page.

Case Note Review SNOMED Code pilot

Ahead of data collection for NACEL 2026 opening in January, the NACEL Team would like to encourage any organisations who use electronic systems and may be able to contribute to sense-checking SNOMED codes for the Case Note Review to get in touch with the team for further information.

This exercise is intended to verify that the list of SNOMED codes included within the Case Note Review is complete and accurate, to streamline data collection as much as possible in NACEL 2026