New approach to care for the dying published
26 Jun 2014 03:38 PM
New Priorities for Care
launched as the new basis for caring for someone at the end of their
life.
A new approach to caring for
dying people based on the needs and wishes of the person and those close to
them has been launched today and welcomed by Care and Support Minister Norman
Lamb.
It takes the form of five new
Priorities for Care which succeed the Liverpool Care Pathway (LCP) as the new
basis for caring for someone at the end of their life. The new approach
focusses on giving compassionate care and is a move away from previous
processes and protocols. It recognises that in many cases, enabling the
individual to plan for death should start well before a person reaches the end
of their life and should be an integral part of personalised and proactive
care.
The new Priorities for Care mean
that:
-
The possibility that a person
may die within the coming days and hours is recognised and communicated
clearly, decisions about care are made in accordance with the person’s
needs and wishes, and these are reviewed and revised
regularly.
-
Sensitive communication takes
place between staff and the person who is dying and those important to
them.
-
The dying person, and those
identified as important to them, are involved in decisions about treatment and
care.
-
The people important to the
dying person are listened to and their needs are respected.
-
Care is tailored to the
individual and delivered with compassion – with an individual care plan
in place. This priority includes the fact that a person must be supported to
eat and drink as long as they wish to do so, and their comfort and dignity
prioritised.
The aim is to promote a stronger
foundation for good care and a culture of compassion in the NHS and social
care. The priorities put people and their families at the centre of decisions
about treatment.
The new priorities have been
created by a coalition of 21 organisations known as the Leadership Alliance for
the Care of Dying People (LACDP). The priorities form part of the
Alliance’s overall response, called ‘One Chance to Get it
Right’, to an independent review of the Liverpool Care Pathway led by
Baroness Neuberger.
Care and Support Minister Norman
Lamb, said:
The new priorities will mean
that care is focused on dying people’s wishes – rather than
processes. This will make sure that their voices, and those of their families,
are heard at all times.
The poor care given to some
people and their families on the Liverpool Care Pathway must never happen
again. There are many shining examples in the NHS of excellent end of life
care, and I am committed to making sure that care in the last few days and
hours of life is tailored to the needs of each individual.
It’s also important that,
where possible, planning for dying should start well before the last few days
and hours of someone’s life, where they want to have those
discussions.
We need to change the way that
the NHS and society approaches end of life care and I’d like to thank
Alliance members for their commitment to making this happen.
Jane Cummings, Chief Nursing
Officer for England, said:
The priorities for care
announced today promote a culture of compassion that puts people and their
families at the centre of decisions about their treatment and care. This is
something I am passionate about. They also underline the importance of
sensitive and effective communication between staff and the person who is dying
and those close to them.
As Chief Nursing Officer, I call
on individuals who deliver services for people in the last few days and hours
of life and their families to make the Priorities for Care part of their
practice and to support colleagues in doing the same. I will be writing out to
all nurses to inform them and raise awareness of the report of the
LACDP.
The Alliance response also sets
out how compassionate care for all those approaching the end of their lives
should be delivered. Each organisation in the Alliance has set out what it will
do to support this.
Alliance members will now work
to embed the priorities into every aspect of their work on end of life care
from initial training through to inspection. The Alliance has also called on
members of the public to participate in a national conversation about dying, to
raise awareness and understanding of this important part of
life.
The Priorities for Care follow
an independent review of the LCP carried out in 2013 by a panel led by Baroness
Julia Neuberger. The review found that where the LCP was used well, it
delivered good care, but also found examples of poor care. Issues included a
lack of tailored, personalised care and in some cases, the LCP became regarded
as a tick box exercise. In many cases relatives and their carers did not feel
they were involved in discussions about the care plan. There were also cases of
food and liquids unacceptably withheld. As a result, the review panel
recommended that the LCP should be phased out.
The Panel will continue to have
a role in providing independent advice to Ministers about implementation of the
commitments in the Alliance response. The Panel’s views will inform a
Government report to be published in 2015, which will set out progress on
this.
Baroness Neuberger said on
behalf of the review panel:
We welcome this response to our
review recommendations and its wide range of commitments aimed at improving
care of the dying. There is indeed only one chance to get it right, and in view
of the importance of good quality end of life care for everyone, irrespective
of age or setting, we have accepted Norman Lamb’s invitation to continue
as a panel and will monitor progress against the commitments until July
2015.
Our review exposed some
distressing instances of lack of high quality care and we are indebted to those
members of the public, as well as health and care staff, who told us about
their experiences of the Liverpool Care Pathway. There needs to be in the very
near future an explanation, in terms that everyone can understand, of what care
they and those close to them have a right to receive under the new
arrangements. Without this, there will be continued suspicions of malpractice
and lack of care which may not be appropriate.
When the Review was published
last year, the Minister for Care and Support announced that people who have a
complaint – even where a complaint had already been pursued – about
the care given to a dying patient on the Liverpool Care Pathway should have
access to an independent assessment of their case should they want it. That
message is reinforced today.
The Government strongly agrees
with the conclusions of the Clwyd-Hart Review of Complaints in the NHS, which
reported in October 2013, that complaints amounting to a serious or untoward
incident warrant independent local investigation. The Government wants to see
all hospitals using their statutory powers to offer this to
patients
Background
information
The Leadership Alliance for the
Care of Dying People (LACDP/the Alliance), was formed to provide a focus for
responding to the review panel’s report and consists of 21 organisations
including those statutory organisations to which the panel addressed
recommendations, as well as representatives from the voluntary sector, who were
invited to join the Alliance to develop, support and contribute to its work.
The work of the Alliance has now concluded with the publications
today.
The documents published today
are:
-
One Chance to Get it Right:
improving people’s experience of care in the last few days and hours of
life (the system-wide response to the Neuberger Report).
-
Core commitments from the 21
organisations that made up the LACDP.
-
A summary of engagement that the
Alliance carried out on proposed “outcomes and guiding principles”,
which have been developed into the Priorities for Care.
The support materials for health
and care staff are available on the NHS Improving Quality website here
(www.nhsiq.nhs.uk/endoflifecare)
Key commitments from Alliance
members include:
-
The Department of Health will
continue to measure progress on improving end of life care, including through
looking at the outcomes of annual surveys of bereaved carers’ views on
the quality of care given to their relatives in the last three months of life.
It will use its assessments to ensure that those bodies which are accountable
and report to the Department continue to work towards improving care for people
in the last few days and hours of life.
-
The CQC will include inspection
of end of life care in all acute hospital inspections wherever it is delivered
within the hospital, and include consideration of end of life care in its new
inspection approach in the other sectors they regulate.
-
The GMC will deliver a programme
of activities to raise awareness of its ethical guidance on end of life care.
It will write a joint letter with the Medical Schools Council to all UK medical
school Deans to emphasise the importance of ensuring the curricula they set
properly prepare students to deliver care for people who are coming towards the
end of their life.
-
The Nursing and Midwifery
Council will ensure the five Priorities for Care of the Dying Person are
reflected in the NMC Code ‘Standards of conduct, performance and ethics
for nurses and midwives’ and in any relevant underpinning standards and
guidance. The Council is reviewing the Code and will publish a revised version
in December 2014. It will ensure the revised version of the Code will give
enhanced priority to matters such as hydration, nutrition, communication and
decision-making.
-
NHS England will make sure that
the requirements for the implementation of the Priorities for Care are in place
across the services for which NHS England has commissioning responsibility. It
will work with and provide support to clinical commissioning groups as they
commission high quality services for people at the end of their lives,
including the commissioning of specialist palliative care.
-
As one of the voluntary sector
contributors, Marie Curie will share ways to improve the experiences of
terminally ill people and their families, including support for families after
the death, whether in the community, hospice or hospital; and over the next
five years, double their funding of research, including into better symptom
management and improving the experience for Black, Asian, Minority Ethnic
(BAME) groups and other groups who are less likely to be able to access
specialist palliative care; as well as sharing their know-how of what works and
highlighting new ways of delivering care.
Membership of the
LACDP
Chair: Dr Bee Wee, National
Clinical Director for End of Life Care at NHS England
Members: Care Quality Commission
(CQC) College of Health Care Chaplains (CHCC)
Department of Health (DH)
General Medical Council (GMC)
General Pharmaceutical Council
Health and Care Professions Council (HCPC)
Health Education England (HEE) Macmillan Cancer Support (Macmillan Cancer
Support is also representing the Richmond Group of charities.)
Marie Curie Cancer Care. (Marie Curie is also representing Help the Hospices
and the National Council for Palliative Care) Monitor
NHS England NHS Improving Quality (NHS IQ) NHS Trust Development Authority
(NTDA) NICE (National Institute for Health and Care Excellence) National
Institute for Health Research (NIHR)
Nursing and Midwifery Council (NMC) Public Health England (PHE) Royal College
of GPs (RCGP) Royal College of Nursing (RCN) Royal College of Physicians (RCP)
Sue Ryder (Sue Ryder is also representing the National Care Forum (NCF) and the
Voluntary Organisations Disability Group)